# data[].attributes.body
Varies across different staff members. Particularly the clarity around what is involved in health checks, what is good practice and how to deliver them effectively

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Time for training can be a barrier when working with busy GP practices who have multiple focuses to contend with 

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Time for training can be a barrier when working with busy GP practices who have multiple focuses to contend with 

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Varying levels of enthusiasm/support from practices for the programme - I wonder if this is partly driven by them not necessarily being informed of what happens to patients after the check e.g. if they were referred on, what was the outome 

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Varying levels of enthusiasm/support from practices for the programme - I wonder if this is partly driven by them not necessarily being informed of what happens to patients after the check e.g. if they were referred on, what was the outome 

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areas who have aligned to MECC and behavioural risk factors have improved quality and uptake 

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areas who have aligned to MECC and behavioural risk factors have improved quality and uptake 

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Knowledge of where to refer to following Health Checks

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Knowledge of where to refer to following Health Checks

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Massive impact and there is significant variation

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What period does the training last and how often do you have to renew it? It would be good for all practices to refresh due to reduced delivery throughout Covid and you updating the material

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Practice priority - financial viability compared to other services 

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Practice priority - financial viability compared to other services 

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Lack of time which impacts on interaction between HCP and patient

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Lack of time which impacts on interaction between HCP and patient

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Not so much of an issue and has better scope for improvement

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Time taken to complete follow up referrals or not knowing where to refer on to

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Time taken to complete follow up referrals or not knowing where to refer on to

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Having regular training with HCP's delivering HC's is an issue. We circulate the BPG and any changes to practices but co-ordinating training for staff has been a challenge. I think over time, without update training staff revert to the quickest and easiet way of getting the check done, which may mean PA and Alcohol Q's are skipped?

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Skills and knowledge of the geographical area can be both a positive and a barrier. 'no one will ever change in this area, its  its always been' . This can be the attitude of either deliver or client or both

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Skills and knowledge of the geographical area can be both a positive and a barrier. 'no one will ever change in this area, its  its always been' . This can be the attitude of either deliver or client or both

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I'm particularly keen to understand this element more for some C&M insight work on how to best support increased uptake of NHS HCs in target populations (e.g areas of high levels of deprivation, BAME communities, working age men). There could be some valuable learning from the vaccine hesitancy work undertaken in C&M HCP.

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I'm particularly keen to understand this element more for some C&M insight work on how to best support increased uptake of NHS HCs in target populations (e.g areas of high levels of deprivation, BAME communities, working age men). There could be some valuable learning from the vaccine hesitancy work undertaken in C&M HCP.

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Changes to the local "offer" for patients i an issue - some services decomissioned, some new services in place. Will be a level of awareness raising among staff of these changes at restart for H/C to gain buy in and be effective

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May have referred before into other services, and / or given advice with no change for patient

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May have referred before into other services, and / or given advice with no change for patient

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i wonder if there are some challenges regarding referral services and follow up appointments

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i wonder if there are some challenges regarding referral services and follow up appointments

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Discussing alcohol use may be considered difficult by some staff? potentially a lack of services or signposting options for those on the lower end of problematic use can mean its not considered a priority?

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Does impact to a greater extent and staff need support to minimise this

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Low uptake following onward referral to lifestyle support - could be down to the quality of the referral conversation? interested to hear how Gateshead getting on with this since they have integrated their lifestyle support as part of the offer - has this improved uptake?

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Low uptake following onward referral to lifestyle support - could be down to the quality of the referral conversation? interested to hear how Gateshead getting on with this since they have integrated their lifestyle support as part of the offer - has this improved uptake?

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good training around behaviour change that is accessible, cost effective and available to GP practices would be invaluable 

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good training around behaviour change that is accessible, cost effective and available to GP practices would be invaluable 

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There is a tendency to attract the worried well. If the programme doesn't incentivise  a concerted effort to attract population groups who are known to be at higher risk due to genetic predispositions & socio-economic factors - You can end up with a large disparity between the attendance to the checks and the benefit in terms of outcomes for those who have attended between practices.

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Knowledge is an issue in terms of correctly communicating risk to patients. The check list is relatively easy to complete for a full health check but the follow on conversation is where we see barriers i.e. the quality and content of it. In Knowsley we commission Inspira Health to support practices delivering HC's, they have recently delivered training to some new staff and Health diagnostics also provide 2 half day training days for staff .

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May see too many other compounding factors / social economic status of patient or engrained health behaviours

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May see too many other compounding factors / social economic status of patient or engrained health behaviours

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We need better understanding about concerns around consequences.

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Own understanding of areas covered by the health check - not confident in giving advice

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Own understanding of areas covered by the health check - not confident in giving advice

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Staff can get anxious about correctly delivering a health check especially HCA's

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This comes back to training and confidence. Finding time for primary care staff to attend training is challenging.
Perhaps we could look at some attendance at training by staff to be part of local contracts.

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confidence to have difficult conversations about weight, alcohol, smoking status etc and how to address in such a short time scale

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confidence to have difficult conversations about weight, alcohol, smoking status etc and how to address in such a short time scale

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Clarity on referral pathways for wellness service NDPP etc sometimes isn't there

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Ability of patient to retain information could be a barrier

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Ability of patient to retain information could be a barrier

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Has a huge impact as there is lack of belief around health checks motivating people to change their behaviour. Upskilling of staff around behaviour changes approaches will add value

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Annual training (with local offer information) for staff delivering Health Checks.  Practice templates with referrals embedded to support staff.

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Annual training (with local offer information) for staff delivering Health Checks.  Practice templates with referrals embedded to support staff.

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How to unpick the impact of wider determinants - fear of opening a can of worms 

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How to unpick the impact of wider determinants - fear of opening a can of worms 

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Maybe assumptions on patient ability to change and sustain changes

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Maybe assumptions on patient ability to change and sustain changes

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if you don't think you have the right capabilities, or no one is checking and supporting you in your delivery, this can be a huge barrier to the effectiveness of your work. More time and resources can overcome this. buy in from GP practices is essential. Maybe add more into the locality requirments.  

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if you don't think you have the right capabilities, or no one is checking and supporting you in your delivery, this can be a huge barrier to the effectiveness of your work. More time and resources can overcome this. buy in from GP practices is essential. Maybe add more into the locality requirments.  

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I do think staff are aware of the benefits of the check and the reasons why the service exists.
There may be a prioritisation made by staff for the more regular measures eg BP, BMI

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Staff are not always confident that they have enough understanding of behaviour change, supporting this and why this is important in prevention .

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I'm not sure how much of a barrier this is. HCP's may do lots of work that they may consider the patient not to be fully buying into, they still complete the assessments etc

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Reason for not changing behaviour could be deep rooted and complex eg. linked to long term lack of employment. The need to include wider support within referral pathways for providers of HCs

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Reason for not changing behaviour could be deep rooted and complex eg. linked to long term lack of employment. The need to include wider support within referral pathways for providers of HCs

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Orcha report highlights that BAME communities less likely to be offered digital health interventions but more likely to take them up when available.. a real opportunity to embrace digital NHS HCs and reduce inequalities?

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Orcha report highlights that BAME communities less likely to be offered digital health interventions but more likely to take them up when available.. a real opportunity to embrace digital NHS HCs and reduce inequalities?