Purpose

Proposed
decision:
 
APPROVE the proposed NHS Health Check
programme model and agree to the commissioning of:
1.   
NHS Health Check primary care delivery – 1 April 2026 –
31 March 2033, (up to five years with two additional one-year
extensions)
2.   
NHS Health Check Outreach Service - 1 April 2026 to 31 March 2033
(five years with two additional one-year extension options)
3.   
NHS Health Check Training Provider - 1 April 2026 to 31 March 2033
(five years with two additional one-year extension options)
4.   
NHS Health Check Quality Provider - 1 April 2026 to 31 March 2033
(five years with two additional one-year extension options)
 
 

Background

 
The
statutory NHS Health Check programme was established in 2009 to
improve cardiovascular health in the population by assessing risk
factors, communicating opportunities for health gain and supporting
people to make positive lifestyle changes that reduce risk of
cardiovascular disease (CVD). The programme offers a free health
check once every five years to eligible people aged between 40-74
years who do not have certain pre-existing conditions. Through a
combination of blood pressure check, cholesterol test and lifestyle
questions, the health check calculates a person’s risk of
heart, kidney, stroke and diabetes problems. The health check
advisor will then support them to consider positive lifestyle
changes which could reduce this risk and make onward referrals for
further support as needed.
 
The NHS
Health Checks programme has been a national priority since
responsibility for providing it passed from the NHS to Local
Government in 2013. It offers the English health and social care
system a proven opportunity to reduce the growing burden of
non-communicable disease related to behavioural and physiological
risk factors and therefore remains a priority area for both the
Local Government and the NHS. It also reduces cost to the NHS and
adult social care services by preventing people requiring treatment
or ongoing support for CVD through prevention and early
identification of those at risk.
 
The NHS
Health Check programme is currently provided by Kent Community
Health NHS Foundation Trust (KCHFT) under a partnership
co-operation agreement and delivered via three main
routes:
 

1.   
contracts with GPs to deliver NHS Health Checks
which accounts for approximately 84% (28,125) of all health checks
provided in Kent.

2.   
contracts with pharmacies to provide NHS Health
Checks, however post COVID-19, recovery in this area has not been
strong and pharmacies now deliver approximately 2% (570) of health
checks compared to 11% pre-COVID.

3.   
provision of NHS Health Checks for GP practices who
do not engage in the programme and provide an outreach service
delivering opportunistic checks in community settings. This
provision accounts for approximately 14%
(4,802) of all health checks.

 
In 2024/2025, the Kent NHS Health Check programme
invited 95,308 of the eligible population, slightly exceeding our
20% target for the year, and supported 33,487 (35%) individuals to
access an NHS Health Check.
 

Reason for the decision

 
Kent
County Council (KCC) has a duty to provide the statutory NHS Health
Check programme as per the Local Authorities (Public Health
Functions and Entry to Premises by Local Health Watch
Representatives) Regulations 2013. This legislation provides key
regulations that must be adhered to by each Local Authority in the
delivery of this programme including:
 

Offering
a check to each eligible person once every five
years. 

·       
Excluding those with a pre-defined medical condition
from receiving a check. 

·       
Recording a pre-defined list of medical information
during each check. 

·       
Providing people with a cardiovascular risk score
and a range of information related to their health check
results. 

Reporting
on invites sent and checks conducted. 

 
The NHS
Health Check programme is currently commissioned under a
partnership co-operation agreement between KCC and Kent Community
Health NHS Foundation Trust (KCHFT). This partnership agreement is
due to end on 31 March 2026, and such agreements are no longer
permitted under the Provider Selection Regime legislation which
came into force in January 2024. As a result, a decision needs to
be taken regarding the future procurement routes for these
services.
 
In
addition, Public Health has undertaken a comprehensive review of
services funded by the ringfenced Public Health Grant as part of
the transformation programme, with the aim of improving future
services and ensuring best value for money and service
sustainability. The work completed as part of this programme has
included stakeholder engagement; service user insights and options
appraisals, as well as a robust peer review process of the
preferred option. Other options considered but rejected during the
options appraisal process included:

 

 
Option
1: Keep current service the same –
the current service provides a universal offer, meets all statutory
requirements and has been performing well against Key Performance
Indicators. However, the service is not reaching those who really
need it i.e. groups at highest risk of CVD, and invite costs are
high and do not make best use of digital solutions. This represents
a large proportion of the budget and leaving less available for
actual delivery of checks. 

 
Option
2: Discontinue the service – this
option was dismissed as a non-viable option as it would place KCC
in breach of its statutory responsibilities.

 

Option 3: Revised model and specification –
preferred option
The
preferred option is to implement learning from the current service,
into a revised model and specification that will better target
those at higher risk of CVD. The proposal includes simplifying the
oversight and management of the programme by directly contracting
with the GP providers rather than through an intermediary provider
(KCHFT). This will give greater oversight over delivery of the
service, improved efficiencies and tighter budgetary control. All
commissioning activity will adhere to ‘Spending the
Council’s Money’ and relevant procurement legislation.
Details of the preferred option are as follows:
 

§ 
Prioritise individuals at higher risk of CVD through
targeted invitation.

 

§ 
Implement findings from engagement work (taking
place in 2025/26) to employ the most effective method of inviting
those at high risk of CVD, to increase their likelihood of
attendance at their Health Check.

 

§ 
Continue to work with primary care as the main
providers of NHS Health Checks, insourcing the contract management
of the service so that KCC are contracting directly with primary
care providers via a Direct Award B (as per Procurement Act 2023)
The benefits of this approach include:

·          
  Fostering
continuous competition throughout the lifecycle of the contract
period, lending itself to better value for money.

 

·          
  An environment of
continuous innovation and cost efficiency to be implemented
throughout the lifecycle of the contract period, without the costs
associated with recommissioning.

 

·          
  Contracting
directly with primary care rather than via a third party brings us
closer to communities so that we are better able to respond to
local need and address health inequalities at pace.

 

·          
  Greater level of
control and access to data and improved ability to audit
performance.

 

·          
  Stronger local
authority relationships with primary care to make the programme
more efficient and streamline with other primary care
contracts.

 

§ 
Work with the Local Medical Committee and individual
GP practices to encourage full roll out of the programme, with
flexibility for GP practices to contract on behalf of other
practices within the Primary Care Network

 

§ 
Commission a NHS Health Check outreach service and a
digital training offer for all Health Check advisors in line with
current procurement regulations.

 

 

How the proposed decision supports the

Framing Kent's Future - Our
Council Strategy 2022-2026
 
The NHS
Health Checks (NHSHC) programme aligns with the Council’s
‘Framing Kent’s Future 2022-2026' strategy,
supporting the following priority
commitments: 

 

Priority 1: Levelling up
Kent 

 

To work with our partners to hardwire a preventative
approach into improving the health of Kent’s population and
narrowing health inequalities.  

 

To see significant improvements in the economy,
connectivity, educational attainment, skills and employment rates
and public health outcomes in deprived communities in coastal areas
so that they improve faster than the rest of Kent to reduce the
gaps.  

 

Priority 4: New models of care and
support 

 

To reshape our commissioning practice to ensure we
build strategic partnerships with our providers, through earlier
engagement, more consistent and proactive commissioning practice,
and a stronger focus on co-designing
services.  

 
The model
enhancements in this proposed decision further supports these
priorities with a greater focus on narrowing health inequalities,
through the prioritisation of key groups at higher risk of CVD and
targeting of the outreach service.
 
How the proposed decision supports Securing
Kent’s Future 2022 -2026:
Securing Kents Future - Budget
Recovery Strategy.pdf

 
This
approach aligns with Securing Kent’s Future and the
council’s Best Value Statutory responsibility, most notably
point 4.6 of the strategy documents as this decision will
prioritise best value considerations .

Public
Health services are preventative services with evidence of good
Return on Investment and can help reduce demand into other KCC
services and across the health and social care system.
 

How the proposed decision supports the Kent and
Medway Integrated Care Strategy :
Kent and Medway Integrated Care Strategy

 
The NHS
Heath Checks programme aligns to with the Kent and Medway
Integrated Care Strategy, supporting the following priority
commitments:
 

Shared Outcome 3: Supporting Happy and Healthy
Living

 

·  
Support people to adopt positive mental and physical
health behaviours
 

·  
Support people to live and age well, be resilient
and independent

 

 

 

Shared Outcome 4: Empower People to Best Manage
their Health Conditions

 

·  
Provide High Quality Primary Care

 
 

Shared Outcome 5: Improve Health and Care
Services

 

·  
Improve equity of access to health and care
services

 

·  
Provide high-quality care
 

Financial Implications

 
These contracts would be funded
entirely from the ring-fenced
Public Health Grant with an
estimated financial commitment for a seven -year contract of
£15,210,647.
 
The
tables below outline the estimated costs to KCC Public Health over
the maximum contract term. Final costs will be subject to
negotiations and procurement outcomes.
 

Table 1: Estimated Costs to KCC Public Health
(NHSHC)

 

Cost to KCCPublic Health

(NHSHC)

Primary Care Delivery and Support

£14,013,037

 

Outreach, Quality and Training services

 

£1,197,610

Total Cost (5 years plus two, 1 year
extensions)

£15,210,647

 
The
Public Health Grant allocated to the County Council has increased
each year since the Covid-19 pandemic. In the unlikely event that
the grant in future years is insufficient to cover the contract
value, further savings will be negotiated with contract holders
across the transformation programme. 
 

Decision

As Cabinet Member for Adult Social Care and
Public Health, I agree to:
 
I.        APPROVE
the proposed NHS Health Check programme model and agree to the
commissioning of:
 
1.       NHS Health Check
primary care delivery – 1 April 2026 – 31 March 2033
(five years with two additional one-year extensions) 
2.       NHS Health Check
Outreach Service - 1 April 2026 to 31 March 2033 (five years with
two additional one-year extension options)
3.       NHS Health Check
Training Provider - 1 April 2026 to 31 March 2033 (five years with
two additional one-year extension options)
4.       NHS Health Check
Quality Provider - 1 April 2026 to 31 March 2033 (five years with
two additional one-year extension options)
 
II.       DELEGATE
authority to the Director of Public Health?to take necessary
actions, including but not limited to entering into required
contracts or other legal agreements, as required to implement the
decision.
 
III.      DELEGATE authority
to the Director of Public Health, in consultation with the Cabinet
Member for Adult Social Care and Public Health, the exercise of any
extensions permitted in accordance with the extension clauses
within the contracts.