A cross-sectional study examining the equitability of invitation, uptake and coverage for NHS Health Check.

BACKGROUND: The evidence for access to NHS Health Check (NHSHC) varies considerably across the country. This study examined the equity in invitation, uptake and coverage of NHSHC and impact of different invitation methods. METHODS: This patient-level cross-sectional study from 52 general practices in Walsall used adjusted logistic regressions to examine the association between patient characteristics (age, sex, ethnicity and deprivation) and NHSHC access. RESULTS: Over the 5-year study period, 61 464 people were eligible for NHSHC, 66% were invited, uptake was 74% and coverage was 55%. Males had lower odds of: invitation (AOR: 0.78, 95% CI: 0.75-0.81), uptake (0.73, 95% CI: 0.70-0.77) and coverage (0.69, 95% CI: 0.66-0.71). Compared with White, the 'Other' ethnicity group (mixed backgrounds, other Asians that are not South Asians and other ethnic groups) had lower odds of: invitation (0.74, 95% CI: 0.67-0.81), uptake (0.86, 95% CI: 0.75-0.98) and coverage (0.74, 95% CI: 0.68-0.81). The most deprived areas had lower odds of invitation, uptake and coverage. Opportunistic invitation had a 25-fold increase in odds of uptake. CONCLUSIONS: The study has highlighted areas of inequities in access to NHSHC. The group most negatively affected were men, people from particular minority ethnic groups and people from deprived communities. Further actions are needed to reduce these inequities.

An investigation into general practitioners associated with high patient mortality flagged up through the Shipman inquiry: retrospective analysis of routine data.

OBJECTIVE: To identify a credible explanation for the excessively high mortality associated with general practitioners who were flagged up by the Shipman inquiry. DESIGN: Retrospective analysis of routine data. SETTING: Primary care. PARTICIPANTS: Two general practitioners in the West Midlands who were associated with an unacceptably high mortality of patients during 1993-2000. MAIN OUTCOME MEASURES: Observed and expected number of deaths and deaths in nursing homes. RESULTS: Preliminary discussions with the general practitioners highlighted deaths in nursing homes as a possible explanatory factor. No relation was found between the expected number of deaths and deaths in nursing homes in each year during 1993-2000 for either general practitioner. In contrast, the magnitude and shape of the curves of a cumulative sum plot for excess number of deaths (observed minus expected) in each year were closely mirrored by the magnitude and shape of the curves of the number of patients dying in nursing homes; and this was reflected in the high correlations (R2 = 0.87 and 0.89) between excess mortality and the number of deaths in nursing homes in each year for the general practitioners. These findings were supported by administrative data. CONCLUSIONS: The excessively high mortality associated with two general practitioners was credibly explained by a nursing home effect. General practitioners associated with high patient mortality, albeit after sophisticated statistical analysis, should not be labelled as having poor performance but instead should be considered as a signal meriting scientific investigation.