SERVICE SPECIFICATION FOR THE PROVISION OF NHS HEALTH CHECKS IN BOURNEMOUTH, DORSET AND POOLE

Revised for: 1 April 2014 Appendix 2.3 SERVICE SPECIFICATION FOR THE PROVISION OF NHS HEALTH CHECKS IN BOURNEMOUTH, DORSET AND POOLE

DORSET COUNTY COUNCIL Page 2 of 14 1. INTRODUCTION 1.1. This Service Specification relates to the contract, which requires GP Practices to provide NHS Health Checks (vascular risk assessment and management services) 1.2. The Service Specification comprises of two main components 1.2.1. Activity required to identify Service Users, set up call and recall systems, send invitations and record outcome data from all checks carried out in a timely and accurate way on the GP clinical system. 1.2.2. The process of undertaking NHS Health Check assessments, as well as carrying out appropriate follow-up and the use of agreed referral pathways as necessary. 2. BACKGROUND 2.1. Cardiovascular disease is a major cause of morbidity and mortality and is a significant contributory factor towards the current level of health inequalities in Bournemouth, Dorset and Poole. Approximately 21% of deaths under 75 years of age (2010 2012) were attributed to circulatory disease, the highest cause of premature death in the local population. The NHS Health Check programme provides a structured approach to cardiovascular risk management for all people aged 40-74 years old, who are not already on any patient risk register. 2.2. Everyone is at some risk of developing heart disease, stroke, diabetes, kidney disease and some forms of dementia. The NHS Health Check aims to help individuals to reduce their risk of developing these common but often preventable diseases. Those eligible are invited for a NHS Health Check once every five years. Through the check, their risk of heart disease, stroke, kidney disease and diabetes is assessed through some straightforward tests and standard questions about their lifestyle and family medical history. Personalised advice and support is then offered to help lower the risk of developing cardiovascular disease. Those with low or moderate risk are likely to receive advice about changes to their lifestyle, whilst individuals with a higher risk may also be offered medical support through primary care and onward referral to other specialist support services e.g. smoking cessation and/or weight management. 2.3. It is calculated that NHS Health Checks and appropriate management of risk could prevent 1,600 heart attacks and strokes a year nationally, and provide a real opportunity to tackle the gap in life expectancy between deprived and less deprived populations. The total population in Bournemouth, Dorset and Poole eligible for a Health Check is 258,000 (equating to 51,600 per year). 3. AIMS AND OBJECTIVES OF THE SERVICE / SERVICE OUTCOMES 3.1. The Service aims to: 3.1.1. Improve population health outcomes and quality of life by reducing the risk of vascular disease in adults attending for a risk assessment and lifestyle advice (NHS Health Check). 3.1.2. Identify at an earlier stage, adults with previously undetected vascular conditions who are not currently being managed in primary care specifically type 2 diabetes, coronary heart disease, stroke and TIA, chronic kidney disease and vascular dementia and to signpost/refer to appropriate primary care and lifestyle services.

DORSET COUNTY COUNCIL Page 3 of 14 3.2. The Service objectives are to: 3.2.1. offer 20 per cent of all eligible adults within Bournemouth, Dorset and Poole aged 40-74 years an NHS Health Check in accordance with the national Best Practice Guidance (October, 2013); 3.2.2. set up call and recall systems, send invitations and record outcome data from all checks carried out in a timely and accurate way on the GP clinical system; 3.2.3. offer support and signposting to Service Users identified at increased risk of cardiovascular disease to enable them to make changes to lifestyles to reduce their overall risk; 3.2.4. offer convenience and accessibility of one-stop testing facilities by providing a choice of location and extended hours of availability. 4. DESCRIPTION OF SERVICE 4.1. The Provider shall provide NHS Health Checks in accordance with the process outlined below. 4.2. The Provider shall use their GP Clinical Systems to identify the Service cohort for the Service. Eligible Service Users will be those who: 4.2.1. are aged between 40 and 74 years and have not previously received an NHS Health Check; and 4.2.2. are NOT on one of the following disease registers: Diabetes; CHD; Heart Failure; Atrial Fibrillation; Hypertension; Stroke/TIA; Renal disease (stages 3 to 5) / CKD; Familial Hypercholesterolaemia; Peripheral Arterial Disease (PAD); Palliative Care (practices will manually identify and exclude those Service Users that are on the palliative care register); Those taking statins; Those taking blood pressure medication. 4.3. The Service is to be provided in accordance with NHS Health Check Best Practice Guidance (Oct 2013) at all times. This, together with other key documents, can be found at the NHS Health Checks website 1. 4.4. The National Screening Committee has published updated information/guidance on the key components of the health check assessment (including an explanation of the QRISK II risk equation used locally) and this can be found at the NHS Health Checks website 2. 4.5. The Provider shall undertake the alcohol risk assessment (using the AUDIT-C questionnaire) and raise awareness of dementia as part of the full NHS Health Check assessment in line with this guidance, regardless of any local agreements that may have been agreed with the Purchaser and any commissioners previously. [THIS IS A NEW SERVICE REQUIREMENT] 1 www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance 2 www.healthcheck.nhs.uk/document.php?o=310

DORSET COUNTY COUNCIL Page 4 of 14 4.6. In addition, it is expected that Employees conducting health checks will have attended the introductory training course organised by Dorset. Details of forthcoming dates for training will be on the Dorset website 3. 4.7. The Provider shall ensure an appropriate record of activity is developed and maintained for audit and payment purposes, and which meets the requirements of this Service Specification. Summary data must be provided to Dorset, thereby enabling the Purchaser to fulfil its legal duty to upload summary data as required by the Department of Communities and Local Government Single Data List 4. 4.8. It is a requirement that every assessment shall be recorded by the Provider in the lifelong patient record, including the full data set (measurements, values, follow-up, referral and outcome) collected as a result of Health Checks carried out at any venue by any other approved provider. Establishment of call and recall process 4.9. The Provider shall set up and effectively manage a call and recall process for eligible Service Users. The expectation is that one-fifth of the total number of eligible Service Users will be called each year. Those completing an NHS Health Check will not be required to be called again for a further 5 years. Any Service User identified as at risk (CVD risk greater than 20 per cent) will be subject to annual review in accordance with the Providers usual procedures for managing high risk primary prevention patients. Annual review is not part of the NHS Health Check programme. 4.10. Although the NHS Health Checks programme is a universal service, the Provider is encouraged to target checks preferentially to populations most at risk of CVD events. Guidance found in NICE PH15 may assist with search strategies to identify people most at risk. 4.11. The Provider can decide on the optimal call and recall strategy. An invite constitutes any one of the following: a letter, a phone call, a text, or an email. The invite shall be recorded on the clinical system to enable an accurate call/recall system to be maintained. All invitations shall be followed up with written confirmation, including details of the venue, and a copy of the DoH Health Check leaflet. 4.12. Community Pharmacies across Bournemouth, Dorset and Poole also offer NHS Healthchecks and all GP invites shall give people the choice of attending for the assessment in either the GP Practice or a local community pharmacy. [THIS IS A NEW SERVICE REQUIREMENT] 4.13. The Provider is required to record two attempts at contacting the Service Users in order to record that a Health Check has been offered. It is recommended that the time between contact attempts is approximately one month. 4.14. The Provider shall order and maintain supplies of the DoH leaflets to send out with the letters of invitation and appointment confirmations. Orders are made directly from the DoH by following the link: http://www.orderline.dh.gov.uk/ecom_dh/public/home.jsf 4.15. The Service shall be available to patients registered at the practice participating in the Service. 3 www.publichealthdorset.org.uk 4 www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance

DORSET COUNTY COUNCIL Page 5 of 14 4.16. The Provider shall ensure an appropriate record of activity is developed and maintained for audit and payment purposes, and which meets the requirements of this Service Specification. Summary data must be provided to Dorset on a quarterly basis utilising the template in Appendix D, thereby enabling the Purchaser to fulfil its legal duty to upload summary data as required by the Department of Communities and Local Government Single Data List: NHS Health Check Single Data List Returns Guide - Oct 13 Refresh 4.17. Each episode shall be recorded in the Lifelong Patient Record to include the full data set (measurements, values, follow-up, referral and outcome) collected as a result of Health Checks carried out at any venue by any approved provider. 5. QUALITY STANDARDS 5.1. The Provider shall have adequate mechanisms and facilities, including premises and equipment, in place as are necessary to enable the proper provision of the Service. 5.2. The following equipment will be required: 5.2.1. scales; 5.2.2. height measurers; 5.2.3. electronic blood pressure monitoring machine or sphygmomanometer; 5.2.4. point of care testing devices for measuring cholesterol (see paragraph 5.4) 5.3. The Provider shall be required to sign up and pay for the Internal Quality Control (IQC) scheme for their point of care testing equipment (LDX machine or equivalent). All equipment used as part of the Service must be cleaned, calibrated and serviced as advised by the manufacturer with appropriate protocols in place. The results of internal quality assurance tests for point of care testing equipment should fall within the acceptable range. The Provider is required to supply and fund appropriate equipment, supplies and training of their use as needed to deliver the NHS Health Checks programme. 5.4. The Provider can contact Alere, who have supplied all LDX machines and co-ordinate the existing IQC scheme, through their customer care team on 0161 483 5884. Where the Provider chooses to acquire their equipment and supplies from an alternative supplier, the quality and functionality of any equipment must be of an equivalent standard and certified by the Cholesterol Reference Method Laboratory Network. The two certified point of care testing devices available in the UK are the Cholestech LDX (Alere) and the Cardiochek PA (available from several suppliers). 5.5. The health care professional carrying out the procedures listed in Appendix A must demonstrate the relevant competencies to do so and have completed the training and accreditation programme as specified by Dorset. This includes: 5.5.1. Specific training as required for Point of Care testing equipment; 5.5.2. CPD relevant to the Service on at least an annual basis. 5.5.3. The Provider shall work with Dorset to review progress and identify any further training needs. 5.6. The Provider shall: 5.6.1. ensure that there is a suitable amount of trained Employees with the relevant knowledge to adequately meet the potential levels of demand,

DORSET COUNTY COUNCIL Page 6 of 14 5.6.2. ensure that the Service is available during the normal opening hours of the Practice for at least 48 weeks of the year. 5.6.3. ensure that there are suitable contingency plans in place to cover leave (both anticipated and unanticipated) of any Employees leaving the Provider. 5.6.4. notify the Purchaser immediately if the Service is not available due to workforce issues. 5.7. Participate in any organised audit of service provision. 5.8. Co-operate with any national or led assessment of Service User experience. 5.9. Acknowledge that the Service is funded by Dorset, Dorset County Council. 5.10. Fully comply with the Pan-Dorset s Multi agency Safeguarding Adults Policy and the Pan Dorset LSCB Inter-Agency Procedures for Children and Young People. 5.11. Ensure that thorough recruitment and selection processes are in place, which includes full tracking of previous employment history, checking of qualifications, two written references and the appropriate Disclosure and Barring Service (DBS) checks. 5.12. The Purchaser shall undertake visits to the Provider s practice as appropriate as part of quality monitoring, verification of claims and payments and to ensure that the Provider is meeting the Service Specification. 6. CONTRACT MONITORING. 6.1. Summary data must be provided to Dorset on a quarterly basis by the 20 th of the following month, thereby enabling the Purchaser to fulfil its legal duty to upload summary data as required by the Department of Communities and Local Government Single Data List. 6.2. Monitoring data is required promptly and fully and the information sent to the Public Health Team,. 6.3. The Provider will be given a specified target number of health checks to complete during the course of the year. Notification of individual targets shall be sent to Providers prior to 1 April 2014. 6.4. The Provider shall be given a financial limit to the number of invitations to Health Checks they are able to send during the course of the year. Once the Provider has passed this limit any additional invites are at the Providers expense. Notification of individual targets will be sent to Providers prior to 1 April 2014. 6.5. Submissions will be subject to periodical audit by the Purchaser. MIQUEST queries have been written for audit purposes for all relevant clinical systems, and the Provider shall comply with s MIQUEST data requests when required as part of this audit 7. SERVICE SPECIFICATION REVIEW 7.1. It is recognised within this Service Specification that the Service may be subject to change due to a range of national and local policy initiatives. For example, government guidance and legislation, industry professional standards, NICE Guidance or Policy.

DORSET COUNTY COUNCIL Page 7 of 14 7.2. This Service Specification shall be reviewed annually taking into consideration a financial review of the Service, any service developments and/or changes in legislation. Three months notice will be given to the Provider of any significant changes which may impact on the service provided and will ensure sufficient transition arrangements are secured to ensure service continuity. Less significant changes may be made following an appropriate period of consultation with the Provider. 8. FINANCIAL INFORMATION Payment structure 8.1. A fee of 28.00 will be paid to the Provider for each completed Health Check that can be validated in the electronic patient record. This price is fully inclusive of equipment, consumables, attendance at training, administration costs and a professional fee relating to the carrying out of the Health Check. 8.2. The fee for the initial Service User invitation (that can be validated in the electronic patient record) will be 1. Whilst, expected that invitations shall be followed up with reminders and prompts to those who have not responded, there is no additional fee for undertaking these actions. 8.3. A one-off bonus payment is offered, based on the Provider completing a specified target number of Health Checks during the course of the year. Notification of individual practice targets will be sent to the Provider prior to 1 April, 2014. The oneoff bonus fee for achieving the set target during 2014/15 will be 500. 8.3.1. will not pay for additional health checks undertaken following the achievement of the practice target, unless the Provider has gained prior written authorisation from the Purchaser. Before the Provider reaches its target, it should make contact with the team to discuss its plans for any further activity in-year. 8.4. In line with Clause 4.12, where a Service User elects to have their NHS Health Check at a pharmacy rather than the GP Practice, this shall still count towards the individual practice target set in clause 8.3 and therefore assists the Provider towards attracting the one-off bonus fee. However the Provider shall: 8.4.1. not make any claims for this activity in line with clause 8.1 in respect of any NHS Health Checks undertaken by Pharmacies or any other provider. 8.4.2. only account for NHS Health Checks in relation to the Provider s individual target where the Service User first received an invitation letter. For the avoidance of doubt the Provider shall not be able to make a claim for opportunistic activity performed by a Pharmacy or another Provider and this activity shall not count towards the Provider s target. Claims for payment 8.5. will make payments for claims submitted on a quarterly basis if the claim is received by the Team by 20 th of the month following the said quarter. A separate claim shall be made for the one-off bonus payment, following achievement of the practice health check target.

DORSET COUNTY COUNCIL Page 8 of 14 8.6. will make payments in line with the payment for other Public Health services provided by the Provider. Providers must submit a quarterly claim using the electronic Local Authority Claims provided by Dorset, Dorset County Council. 8.7. No claims will be considered if they are submitted more than 1 quarter in arrears. 8.8. No claim should be submitted more than one month after the end of this agreement. 8.9. In order to receive payment the Provider shall: 8.9.1. make available to Dorset any additional information/evidence that the public health team requires, in order to establish whether the provider has fulfilled its obligation under the Contract arrangements; 8.9.2. make the returns required of it promptly and fully as set out in paragraph 8.4; 8.9.3. ensure that all information recorded and supplied is accurate. 8.10. No payments will be made for: 8.10.1. checks carried out on patients who do not fall into any of the groups specified in the Patient Identification section of this document; 8.10.2. Service Users who do not attend (DNAs); 8.10.3. those who have already had a NHS Health Check in the past five years; 8.10.4. services that are outside this Service Specification and for which prior approval has not been sought and granted. 8.11. The Purchaser reserves the right to undertake post payment verification of any claim, utilising MIQUEST. MIQUEST queries have been written for audit purposes for all relevant clinical systems, and the Provider shall comply with s MIQUEST data requests when required as part of this audit. 8.12. Claims for activity more than 6 months old will not be paid. Any late claims shall be paid on the next quarter s payment. Reason for Rejected claims 8.13. No payments will be made for: 8.13.1. checks carried out on Service Users who do not fall into any of the groups specified in the Patient Identification section of this document; 8.13.2. Service Users who do not attend (DNAs); 8.13.3. those who have already had a NHS Health Check in the past five years; 8.13.4. services that are outwith this specification and for which prior approval has not been sought and granted. 8.14. The Purchaser reserves the right to undertake post payment verification of any claim. 8.15. Where the Provider breaches any of the conditions specified in this Service Specification, including the timescales for claiming and audit, The Provider may, in appropriate circumstances, withhold payment of any or part of, any payment that is otherwise payable. 8.16. It is the Provider s responsibility to ensure that payment claims are accurate and on time. The Purchaser will not normally make any backdated payments in relation to inaccurate claims except at its discretion where the Provider can demonstrate exceptional circumstances.

DORSET COUNTY COUNCIL Page 9 of 14 Appendix A THE NHS HEALTH CHECK 1.1 The provider will ensure that people offered an NHS Health Check are informed about the process and are given the opportunity to ask questions. 1.2 The following information and measurements will be collected in order to establish the CVD risk over 10 years as well as the appropriate referrals or interventions required: Age Gender Ethnicity Smoking status Physical activity Alcohol consumption level Family history of vascular disease Body Mass Index Random Cholesterol measurement (TC:HDL ratio) Blood pressure measurement 1.3 The provider will calculate the estimated individual 10 year CVD risk using the Q- Risk2 score tools (as per best practice guidance page 14). Providers can access the Q-risk2 calculator at http://www.qrisk.org 1.4 The risk assessment pathway is presented in detail in NHS Health Check Best Practice Guidance (October 2013). 1.5 All data collected from NHS Health Checks carried out will be recorded in a robust, accurate and timely manner on the electronic patient record. 1.6 All persons undergoing an NHS Health Check shall be given a copy of their results. 1.7 The service provider will communicate the level of risk (high, moderate, low) to the person, and an individually tailored management programme, with appropriate advice, support and interventions depending on the level of risk identified, will be agreed as follows: Brief healthy lifestyle advice and support will be given to all people receiving the service to assist them with managing and / or reducing their risk. People who are found to be at moderate risk will be offered, where appropriate, interventions such as stop smoking or weight management. Where these services are not available in house, appropriate referrals should be made. In addition to the above, people who are found to be at high risk or where a preexisting disease is suspected or identified (e.g. Diabetes), will be further investigated and managed. (see Appendix B) 1.8 The person will be actively involved in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person and with their informed consent. 1.9 If the person is aged 65 year or older, the provider shall talk to them about dementia and referring to the leaflet: www.healthcheck.nhs.uk/document.php?o=327 1.10 The provider will be expected to demonstrate a clear understanding of the services available locally to individuals to support healthier lifestyles and communicate this information to the appropriate individuals. 1.11 The provider shall supply the individual with information appropriate to their needs, as identified by the Health Check. Links to appropriate information are available in Appendix C.

DORSET COUNTY COUNCIL Page 10 of 14 Appendix B REFERRAL AND FOLLOW UP Factor Threshold Action Referral or GP follow up Cardiovascular risk assessment CV risk is assessed as >20% over 10 years Offer intensive lifestyle advice and refer to GP for follow up after 3 months Management of risk and consideration of statin prescribing (if lifestyle advice has been attempted for 3 months) Inclusion on annual high risk register Total Cholesterol TC is 7.5 Refer to GP To assess for possibility of familial hypercholesterolaemia Hypertension risk assessment BP is 140/90 BP is 180/110 Refer to GP for assessment Refer to GP the same day Management for hypertension, (NICE Clinical Guidelines CG127 August 2011) Diabetes risk assessment BMI is 27.5 in individuals from Indian, Pakistani, Bangladeshi, Other Asian and Chinese ethnicity categories BMI is 30 in other ethnicity categories Refer to GP for Fasting Plasma Glucose Test or HbA1C People with symptoms of diabetes must be referred immediately Follow up at GP practice with oral glucose tolerance test or repeat HbA1c as per diabetes filter to establish possible diagnosis of diabetes Chronic kidney disease risk assessment (as for hypertension risk above) BP is 140/90 (either measurement) BP is 140/90 BP is 180/110 Refer to GP for assessment Refer to GP the same day Person requires assessment for CKD by GP

DORSET COUNTY COUNCIL Page 11 of 14 Factor Threshold Action Referral or GP follow up Smoking status Smoker Ask and record smoking status. Advise person of health benefits. Act on person`s response Offer 1:1 SmokeStop support if available or referral to SmokeStop services (see Appendix C) if deemed more appropriate for the service user Weight management BMI is 30 Consider: Overall readiness to commit to making changes Barriers to change Self-esteem Life stage Cultural preferences Offer advice and referral to Healthy Choices Programme (see Appendix C) Physical activity Activity levels are below the recommended levels of 150 minutes weekly or 30 minutes at least 5 times per week/less than active on GPPAQ** Brief intervention in physical activity Goal setting Information The Active Choices programme may be appropriate if person is at highest CVD risk (>20 per cent in 10 years). (For more info see Appendix C) Alcohol Person scores 5 or more on AUDIT-C** measure Ask person to complete remaining AUDIT questions Offer general advice and resources on safer drinking (see Appendix C) Refer to GP if AUDIT score is more than 20. ** GP Physical activity questionnaire can be accessed at http://www.nice.org.uk/nicemedia/live/11927/40195/40195.pdf AUDIT-C** is the short form of the full AUDIT questionnaire and can be accessed at http://www.alcohollearningcentre.org.uk/_library/audit-c.doc

DORSET COUNTY COUNCIL Page 12 of 14 Appendix C RISK MANAGEMENT LIFESTYLE INTERVENTIONS SMOKESTOP SERVICES REFERRAL: Offer one to one Smokestop support or make a referral to the local Smokestop team on: 0300 30 38 038 (Bournemouth and Poole), 0800 00 76653 (Dorset). There are a number of free resources to support people interested in quitting available from http://smokefree.nhs.uk/resources/. As a general leaflet we recommend It`s so much easier since I quit. Order No. 9000a Smokefree Guide. January 2011. DoH 302496. Produced by the Department of Health. Information is also available at http://www.dorsetsmokestop.co.uk/ PHYSICAL ACTIVITY: Active Choices is a twelve week physical activity programme which may be appropriate for those people identified as inactive and at higher risk (>20 per cent in 10 years) of CVD. The programme is run through Healthy Living Wessex Tel: 01305 765200 Alternatively, there are a number of local exercise referral schemes run by leisure services in Bournemouth, Dorset and Poole. Consider referral of people identified at high of CVD risk. DoH s validated tool GPPAQ identifies individuals less than active: http://www.nice.org.uk/nicemedia/live/11927/40195/40195.pdf Get Active, Stay Active Booklet: http://www.bhf.org.uk/publications/view_publication.aspx?ps=1001248 Alternatives for over 50 s: Be Active, Stay Active: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1001242 Let s get moving is a set of resources to support getting people more physically active see http://www.bhfactive.org.uk/sites/exercise-referral-toolkit/downloads/resources/lets-getmoving-guide.pdf for a pack and activity diary Walking For Health link to local health walks: http://www.walkingforhealth.org.uk ALCOHOL Please ensure that the Service User fills out the short AUDIT-C form provided from: http://www.alcohollearningcentre.org.uk/_library/audit-c.doc. Anyone scoring over 5 should complete the full AUDIT on the reverse of the form. If the person s AUDIT score is 20 or more, this may indicate alcohol dependence and consideration can be given to referring the person to more structured alcohol treatment services for a full assessment and any necessary treatment. Those wanting to stop drinking who are experiencing difficulty should be considered for referral to specialist services using locally agreed referral methods. This referral can be made from the person s GP. General advice on safer drinking and a range of resources including drinks diaries can be accessed from: http://www.nhs.uk/livewell/alcohol/pages/alcohol-units.aspx

DORSET COUNTY COUNCIL Page 13 of 14 WEIGHT MANAGEMENT: Referral to the Healthy Choices (weight management) Programme is run through Healthy Living Wessex Tel: 01305 765200 http://www.healthylivingwessex.co.uk/healthy_choices.html The referral criteria for service users accessing the service is as follows Aged 18 years and above BMI of 30 and above Not Pregnant Have not previously been engaged with the Healthy Choices programme. Raising the issue of weight with adults information leaflet order from: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidan ce/dh_4134408 The NHS Change4Life website also provides useful resources to support making changes to support a healthy weight. See http://www.nhs.uk/change4life/pages/change-for-life-adults.aspx RAISED CHOLESTEROL Moderately raised cholesterol in the absence of a high CVD risk score does not require referral to primary care. In the first instance people should try making simple dietary changes. A general leaflet to support this can be down loaded from http://www.bhf.org.uk/publications/view-publication.aspx?ps=1000139

DORSET COUNTY COUNCIL Page 14 of 14 Appendix D NHS Health Checks Service (Vascular) Audit - To be submitted quarterly. Day of Check Month of Check Year of Check GP letter (L) or opportunisti c (O) Service User Gender Service User Age Full Service User Post code (can be submitted separately from age and gender. Diabetic Testing required BP Follow up required Follow up for Total Cholestero l >7.5 CVD risk score