Shropshire Public Health Standard Operating Procedure NHS Health Check
April 2016
This document provides a framework for the delivery of the NHS Health Check programme in Shropshire County. Guidance relating to referrals and treatment are based on NICE guidance. Any changes will need to be agreed with Help2Change . All providers engaged in the delivery of the NHS Health Check programme in Shropshire County will require staff to operate to this procedure. Any changes to this procedure must be agreed with Help2Change. For all queries relating to this operating procedure please contact Help2Change on 01743 454910.
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Table of Contents Shropshire Public Health NHS Health Check Operating Framework ..................................... 2
NHS Health Checks: .......................................................................................................... 2
Step 1:- INVITATION AND OFFER: identifying the eligible population and offering an NHS
Health Check ........................................................................................................................ 5
Step 2:-INVITATION AND OFFER: consistent approach to non-responders and those who
do not attend their risk assessment ....................................................................................... 5
Step 3:-THE RISK ASSESSMENT: ensuring a complete health check for those who accept
the offer is undertaken and recorded. .................................................................................... 6
Step 4:- THE RISK ASSESSMENT: Equipment use ............................................................. 6
Step 5:-THE RISK ASSESSMENT: quality control for point of care testing ........................... 6
IQC and EQA scheme ....................................................................................................... 7
Step 6:-COMMUNICATION OF RESULTS: ensuring results are communicated effectively
and recorded ..................................................................................................................... 8
Step 7:-RISK MANAGEMENT: high quality and timely lifestyle advice given to all ................ 8
Step 8:-RISK MANAGEMENT: additional testing and clinical follow up ................................. 9
Step 9:-RISK MANAGEMENT: appropriate follow up for all . .............................................. 10
Step 10:-THROUGHOUT THE PATHWAY: confidential and timely transfer of patient
identifiable data Read code audit, or if not possible, notes audit ......................................... 11
Appendix 1 Alere Equipment and systems. ......................................................................... 12
Briefing Document for the Afinion™ AS100 Analyzer ...................................................... 12
Quality Standards - The International Quality Reference Standards for Cholesterol &
HbA1c. ............................................................................................................................ 13
Alere Image – Information Management and Governance Engine ................................... 13
References ...................................................................................................................... 13
Afinion Lipid and HbA1c Controls .................................................................................... 13
Appendix 2:-Order Form ..................................................................................................... 14
Appendix 3:-Health Check Leaflets ..................................................................................... 15
Appendix 4:-Service User Satisfaction Questionnaire ......................................................... 16
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Shropshire Public Health NHS Health Check Operating Framework
This framework is intended to provide guidance and consistency in the delivery of the NHS Health Check programme in Shropshire County. NHS Health Checks is a national programme, delivered locally in a way that best suits the needs of local populations. It is important, that the tests and measurements are consistent to help ensure the quality and effectiveness of the programme. Ensuring those offered a NHS Health Check receive a complete and accurate Health Check is key to optimising the clinical and cost effectiveness of the programme. This is especially important for populations with the greatest health needs and will impact on the programme’s abilities to narrow health inequalities. The aim is that every person eligible for an NHS Health Check is offered a good quality, complete risk assessment, guidance and follow-up, irrespective of where they live, or the provider commissioned to deliver the service.
NHS Health Checks: In delivering the programme providers will:
work to achieve a high standard of care, review and risk assess local pathways against national guidance and standards
ensure that all staff delivering Health Checks are competent, comply with the NHS Health
Check Competence Standards and staff should have completed the online NHS Health
Checks Training module and use the learner handbook. The link to the module and manual
respectively: (http://www.e-lfh.org.uk/programmes/wm-nhs-health-check/how-to-access/ ) and
http://www.healthcheck.nhs.uk/commissioners_and_providers/delivery/training_and_develop
ment_tools/. A copy of certification should be stored and if possible logged within the IMAGE
software. Note the training module link will be updated during 2016
utilise the NHS Health Check competence learner and assessor workbooks to support,
assess and evidence staff competence against the national occupational standards (NOS) as
set out in the NHS Health Check competence framework
work with commissioners to develop, implement and maintain appropriate risk reduction measures
enable provision of agreed performance data and evidence of quality to the commissioner at agreed intervals
review implementation routinely through audit and ensure appropriately trained staff and supervisor for delivery of the programme. To audit the service, the practice should seek the views of patients who attend for an NHS Health Check; asking their experience of and satisfaction with the NHS Health Check, together with suggestions for service improvement. Service user satisfaction questionnaires are available in Appendix 4, and are available for patients to complete at http://www.healthyshropshire.co.uk/feedback
ensure appropriate links are made with internal governance arrangements, such as risk registers, and
ensure the Equality Act 2010 requirements are adhered to by ensuring reasonable
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adjustments are made for disabled people, those with a sight or hearing impairment, learning disability and whose first language is not English. Community venues need to be fit for purpose and have the equipment needed to conduct an NHS Health Check.
Two measures are stated indicators for health improvement within the public health outcomes framework for England 2013-16.
100% of the eligible population invited every five years
>50% take up, aspiring to >75% take up
There should be year on year improvement in the take up of the health check. Please see attached Public Health mandated functions.
PH mandated functions_2013 regulations.pdf
This framework is intended to provide guidance and consistency in the following elements of the NHS Health Check Stages of the NHS Health Check 1 Identifying the eligible population
and offering an NHS Health Check
Invitation and offer
2 Consistent approach to non-responders and those who do not attend their risk assessment appointment
Invitation and offer
3 Ensuring a complete health check for those who accept the offer is undertaken and recorded
The risk assessment
4 Equipment use The risk assessment 5 Quality control for point of care
testing The risk assessment
6 Ensuring results are communicated effectively and recorded
Communication of results
7 High quality and timely lifestyle advice given to all
Risk management
8 Additional testing and clinical follow up
Risk management
9 Appropriate follow up for all if CVD risk assessed as 20% and greater
Risk management
10 Confidential and timely transfer of patient identifiable data
Throughout the pathway
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The diagram below highlights the key elements of the NHS Health Check
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Step 1: INVITATION AND OFFER: identifying the eligible population and
offering an NHS Health Check
As outlined in the 2013 regulations, each local authority is to ensure systems are in place to consistently and accurately identify the population, establish eligibility and offer NHS Health Checks to all eligible persons in its area in a five-year period. The Informatica Health Check software is designed to ensure patients eligible for their Health Check are invited at appropriate timescales within the stated timeframe. The software enables eligible populations to be categorised by current degrees of risk and invite due dates, ensuring patients are:
Aged 40 to 74
Have not have been offered a health check within the previous five years
Are eligible to invite and have not been previously diagnosed with the following:
o Coronary heart disease o Chronic kidney disease (CKD) (classified as stage 3, 4 or 5 within NICE CG 73) o Diabetes o Hypertension o Atrial fibrillation o Transient ischaemic attack o Familial hypercholesterolemia o Heart failure o Peripheral arterial disease o Stroke
In addition, the software identifies patients who:
Have been prescribed statins for the purpose of lowering cholesterol
Have previously had an NHS Health Check, or any other check undertaken through the health service in England, and have been found to have a 20% or higher risk of developing cardiovascular disease over the next ten years
Practices should ensure the Informatica Health Check software is used to deliver NHS Health
Checks. Software updates are required throughout the year and should be undertaken as advised,
however, go to http://healthanalytics.bmj.com/files/7114/3919/6588/BMJ_V4_User_Guide.pdf
to check and upgrade your system routinely. NHS Health Check activity will be monitored and
reported for payment through Informatica pseudonymised data.
Step 2:-INVITATION AND OFFER: consistent approach to non-responders and
those who do not attend their risk assessment An agreed process should be in place for those eligible for the NHS Health Check who either do not respond to the offer or do not attend (DNA) their appointment. At least two contacts should be made: a written invitation letter should be followed up by a reminder if there is no response. Practices can decide on the most appropriate reminder method for their population (e.g., phone, text, letter, email, in person). Individuals who opt out should be identified and read coded. An auditable process should be in place to recall them in five years, if they remain eligible. The Informatica software can assist with these processes.
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Step 3: THE RISK ASSESSMENT: ensuring a complete NHS Health Check
for those who accept the offer is undertaken and recorded. A complete NHS Health Check must include all the elements outlined below, all taken at the time of the check, unless specified:
age
gender
ethnicity
smoking status
family history of coronary heart disease
blood pressure (systolic and diastolic)
General Practice Physical Activity Questionnaire (GPPAQ)
alcohol use score (AUDIT-C)
Cholesterol level: total cholesterol and HDL (TC/HDL ratio) Practices are supplied with Point of Care equipment. See appendix for tests and ordering details
Cardiovascular risk score- QRISK2 is currently used as the preferred algorithm for Health checks within Shropshire. This is calculated using the templates provided within Informatica software.
Dementia awareness for those aged 65 -74
Diabetes filter questions, running HbA1c for those required as outlined within the Informatica workflow during assesments
All data needs to be recorded and be auditable. The Informatica Health Check Software provided ensures Health Check recordings incorporate the above elements, are accurately read coded and are reported data back into clinical practice systems automatically. Alternative service providers: should record the read codes as set out in the information standard and transfer them to the GP in a timely manner as outlined in Step 10.
Step 4: THE RISK ASSESSMENT: Equipment use All equipment used for the NHS Health Check should be: fully functional, used regularly, CE marked, validated, maintained and is recalibrated according to the manufacturer’s instructions. This includes height and weight measuring devices, blood pressure monitors and point of care testing equipment. All staff should be trained. For the Afinion point of care blood testing equipment this will be through Alere UK Ltd. Please contact Shropdoc Help2Change Co-ordinator on 01743 454900 for this to be arranged. All training, equipment checks and maintenance should be documented and auditable. All Afinions should be upgraded to version 6.06 or above. Contact Alere support (0161 483 5884) if you require the USB Upgrade device to be re-sent. Any adverse incidents involving medical equipment should be reported to both the manufacturer as well as the Medicines and Healthcare products Regulatory Agency (MHRA) and managed according to providers’ governance arrangements.
Step 5: THE RISK ASSESSMENT: quality control for point of care testing Point of care test (POCT) is a device has intended to be used for examining specimens derived from the human body including blood and urine. The following Point of Care (POC) equipment, the Afinion AS100 Analyser has been provided by and remains the property of Help2Change for use within the NHS Health Check Programme in Shropshire. All Cholestech LDX machines should be returned to Help2Change.
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The equipment provided should only be used by Healthcare professionals and staff trained by a competent trainer. There should be routine quality control checks:
An appropriate internal quality control (IQC) process will be run a minimum of monthly in respect of the NHS Health Check assessment.
Each POCT location will be registered and will participate in an appropriate EQA through an accredited (CPA or ISO 17043) provider that reports poor performance to the National Quality Assurance Advisory Panel (NQAAP) for Chemical Pathology.
All details will be managed using the Alere IMAGE software that will be used to monitor the compliance of operators.
All staff providing the NHS Health Check who are responsible for running Quality Controls are required to create an account with https://alereimage.co.uk/forms/view.php?id=29143 and routinely log monthly controls within the IMAGE system.
IQC Scheme
IQC material - o Afinion lipids & Afinion HbA1c controls
Frequency of testing – o Monthly (for NHS Health Check programme)
Distribution/storage - o Automated distribution from Alere bi-monthly to each provider, fridge storage, open-
vial stability 60 days
For Lipids and HbA1c – o Same schedule for both lipids and HbA1c
Testing regime e.g. Health Check, Diabetes Management, ACR CRP o If using for diagnosis or onwards management, there will be more frequent QC
regimes required. As these additional services fall outside of the NHS Health Check protocols quality control processes will need to be agreed in conjunction with the Royal Shrewsbury Hospital and CCG Pathology group.
The minimum standard approach
o This will be the manufacturer’s minimum standards and recommendations that are in
the product information (i.e. change of lot number, new user, erroneous result).
EQA scheme The scheme is provided jointly through Alere and UK WEQAS, and managed by Alere Ltd reporting to Help2Change.
EQA material - o Afinion lipids & Afinion HbA1c controls (whole blood patient samples and human
plasma)
Frequency of testing – o Bi Monthly
Distribution/storage - o Automated distribution bi-monthly to each provider, fridge storage
For Lipids and HbA1c - o Same schedule for both lipids and HbA1c
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WEQAS HbA1C EQA Scheme.pdf
WEQAS Lipid EQA Scheme.pdf
The following data will be recorded and audited on Alere IMAGE, initially using WEQAS samples for Hba1c EQA. Upon registration within the scheme practices will be provided with Alere IMAGE Logins and active prompts to run and record Controls within Alere IMAGE.
Step 6: COMMUNICATION OF RESULTS: ensuring results are
communicated effectively and recorded
All individuals who undergo an NHS Health Check must have their cardiovascular risk score
calculated and explained in such a way that they can understand it. This communication
should be face to face.
Staff delivering the NHS Health Check should be trained in communicating, capturing and recording the risk score and results, and understand the variables the risk calculators use to equate the risk. The Informatica patient printout provides all service users with information relevant to their results and should be provided to all.
When communicating individual risks, staff should be trained to:
use behaviour change techniques (such as motivational interviewing) to deliver appropriate
lifestyle advice and how it can reduce their risk
ensure that individuals receiving a NHS Health Check should be given adequate time to ask questions and obtain further information about their risk and results
ensure that Individualised patient handouts provided through the Informatica software are given to patients. It includes their results, bespoke advice on the risks identified, and self-referral information for lifestyle interventions.
The advice given should include and provide an explanation of their:
Risk score and what this means
BMI
Blood pressure
Audit –C alcohol use
Cholesterol TC/HDL
HBA1c as part of the diabetes filter A personalised patient plan explaining results gathered and how to positively affect risk can be obtained via the Informatica Health Check software. A separate leaflet has also been produced by Help2Change and is available on request from Shropdoc Help2Change Co-ordinator on 01743 454900 to support this process.
Step 7 RISK MANAGEMENT: high quality and timely lifestyle advice
given to all Provision and timely access to appropriate risk management services should be provided. This will include access to commissioned services for:
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Stop Smoking services
Physical Activity interventions
Weight management interventions
Alcohol use interventions Details and access to a range of services can be found through accessing the Healthy Shropshire website
www.healthyshropshire.co.uk Or through the Single Point of Access on 0345 6789 025 NHS Health Checks is a preventative programme to help people stay healthy for longer. To maximise these benefits, all individuals who have an NHS Health Check, regardless of their risk score, should be given lifestyle advice, where clinically appropriate, to help them manage and reduce their risk. That means that, unless it is deemed clinically unsafe to do so, everyone having the check should be provided with individually tailored advice that will help motivate them and support the necessary lifestyle changes to manage their risk. This includes supporting and encouraging individuals to maintain a healthy lifestyle where no change is required. A record should be kept of interventions offered and outcomes. In order to improve services and uptake, a Service User Satisfaction Questionnaire should be offered to all patients having an NHS Health Check Appendix 4.
Step 8: RISK MANAGEMENT: additional testing and clinical follow up Individuals should not exit the programme until all abnormal parameters have been followed up and a diagnosis has either been made or ruled out. Timely access to further diagnostic testing should take place as outlined in the NHS Health Check best practice guidance at the following thresholds or as per individual practice protocol: 1. Following the diabetes filter, undertaken as part of the risk assessment, blood glucose test; either fasting plasma glucose or HbA1c (glycated haemoglobin) for all identified as high risk. Indicated by either:
a. BP >140/90 mmHg or where the SBP or DBP exceeds 140mmHg or 90mmHg respectively b. BMI >30, or 27.5 if individual is from an Indian, Pakistani, Bangladeshi, other Asian or Chinese ethnicity category
Individuals identified with pre-diabetes need to be reviewed at least annually NICE guidance https://www.nice.org.uk/guidance/ph38/chapter/1-Recommendations#flowchart-identifying-and-managing-risk-of-type-2-diabetes 2. Assessment for hypertension by GP practice team when indicated by:
a. BP >140/90 mmHg b. Or where the SBP or DBP exceeds 140mmHg or 90mmHg respectively
Individuals diagnosed with hypertension to be added to the hypertension register and treated through existing care pathways. They should be reviewed in line with NICE guidance, including provision of lifestyle advice. 3. Assessment for chronic kidney disease by GP practice team when indicated by:
a. BP >140/90 mmHg b. Or where SBP or DBP exceeds 140mmHg or 90mmHg respectively
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All who meet these criteria to receive serum creatinine test to estimate glomerular filtration rate (eGFR). 4. Assessment for familial hypercholesterolemia by GP practice team when indicated by:
a. Total cholesterol >7.5 mmol/L 5. Alcohol risk assessment, use of full AUDIT when indicated by:
a. AUDIT C Score >5 b. Or FAST >3
If the individual meets or exceeds the AUDIT C or FAST thresholds above the remaining questions of AUDIT should be administered to obtain a dull AUDIT score. If the individual meets or exceeds a threshold of 8 on AUDIT, brief advice is given. For individuals scoring 20 or more on AUDIT, referral to alcohol services should be considered. 6. Where the individual’s BMI is in the obese range as indicated by:
a. BMI >27.5 in individuals from the Indian, Pakistani, Bangladeshi, other Asian and Chinese ethnicity categories, or b. BMI > 30 individuals in other ethnicity categories
Then a blood glucose test is required. For all, systems and process should be in place to ensure follow up test(s) undertaken and results received. The Informatica Health Check systems provide a workflow for each patient dependent upon their results. This ensures the above risk thresholds and coding are followed and recorded into practice records.
Step 9: RISK MANAGEMENT: appropriate follow up for all Prioritise people for a full formal risk assessment if their estimated 10-year risk of CVD is 10% or more. All individuals should be managed according to NICE guidance including provision of lifestyle advice and intervention, assessment for Lipid modification therapy according to: (guidance.nice.org.uk/CG67) Updated: NICE guidelines [CG181]
People found to be at or above 20% risk should exit the NHS Health Check programme, irrespective of whether they have signs of disease and entered on to a High Risk register and followed up accordingly e.g. NICE guidelines [PH15] Published date: September 2008.
Where the NHS Health Check is delivered by an alternative service provider, a timely referral back to the GP practice should be made to ensure appropriate follow up undertaken (see below).
Those diagnosed with diabetes, hypertension or chronic kidney disease should be managed
according to NICE guidance, including brief advice and follow-on lifestyle interventions, recorded on
the relevant disease register and exit the programme.
The practice should:
Have in place protocol/clinical pathway to outline process for follow up. Updated
annually
Documentation of individuals’ transfer to the high-risk register recorded as a result
of the NHS Health Check
Record of statin offered, accepted and declined
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Step 10: THROUGHOUT THE PATHWAY: confidential and timely transfer of
patient identifiable data Read code audit, or if not possible, notes
audit
Legal duties exist for local authorities to make arrangements for specific information and data to
be recorded and where the risk assessment is conducted outside the individual’s GP practice,
for that information to be forwarded to the individual’s GP.
As a minimum the following data needs to be recorded
age
gender
smoking status
family history of coronary heart disease
ethnicity
body mass index (BMI)
cholesterol level
blood pressure
physical activity level - inactive, moderately inactive, moderately active
or active
cardiovascular risk score
alcohol use disorders identification test (AUDIT) score (AUDIT C or
FAST)
Patients having been made aware of Dementia and referral options
A protocol also needs to be in place for timely referral of patients where abnormal parameters
are identified.
All data must be recorded in full using agreed templates to ensure accurate read coding. All
data must be auditable and payment is conditional on receipt of accurate and full data reporting
for all individuals formally entered into the programme. Informatica tools and templates
compatible with clinical systems are available and should be used to record data. This is the
data that will be utilised to calculate activity and associated payments.
Ensuring a high percentage of those offered a NHS Health Check actually receive one is key to optimising the clinical and cost effectiveness of the programme. This is especially important for populations with the greatest health needs and will impact on the programme’s and local area’s abilities to narrow health inequalities. The higher the take up rates for the programme, the greater its reach and potential impact.
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Appendix 1: Alere Equipment and
systems.
Briefing Document for the Afinion™ AS100
Analyzer
The Afinion™ AS100 Analyzer enables CCGs and General Practitioners to look beyond the NHS Health Check programme, extending the use of point of care (POC) into the management of diabetes, lipid disorders, metabolic syndrome and infectious disease. Clinicians can immediately perform four important tests using the Afinion™ AS100 Analyzer in any setting with quantitative determinations of Lipids, HbA1c, ACR and CRP. Afinion™ Lipid Panel Total Cholesterol, High-Density Lipoprotein (HDL) cholesterol, Low-Density Lipoprotein (LDL) cholesterol, Triglycerides (Trig), non-HDL and Chol/HDL ratio in whole blood, serum and plasma - used in the diagnosis and treatment of many lipid and metabolic disorders. Afinion™ HbA1c Glycated haemoglobin (HbA1c) in whole blood to monitor metabolic control in patients with diabetes. Afinion™ ACR Albumin, Creatinine and Albumin/Creatinine ratio (ACR) in urine for early detection of renal disease in patients with diabetes and/or hypertension. Afinion™ CRP C-reactive protein (CRP) in blood which is valuable in the diagnosis and monitoring of infections and non-infectious inflammatory diseases. NB This document only references use of the Afinion for use with the testing required as part of the NHS Health Check ie Total Cholesterol HDL and where indicated HbA1c. All testing outside of the NHS Health Check should be agreed with the CCG.
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Quality Standards - The International Quality Reference Standards for
Cholesterol & HbA1c. Measurements are: CRMLN – Central Reference Method Laboratory Network
Certifies manufacturers of clinical diagnostic products that measure total cholesterol, HDL and LDL ensuring they are rigorously standardised to international reference methods
NCEP – National Cholesterol Education Programme
Specifies requirements for instrument performance goals based on total analytical error. This approach takes into account both accuracy and precision of any test
NGSP - National Glycohaemoglobin Standardisation Programme
Standardised HbA1c test results against The Diabetes Control and Complications Trial (DCCT) & United Kingdom Prospective Diabetes Study (UKPDS) which established direct relationships between HbA1c and outcome risks
Certification process for manufacturers The Quality Standards for Cholesterol measurement are set out in the NHS Buyers’ Guide.1 The
Afinion™ Analyzer exceeds the NCEP criteria and is CRMLN certified.2
The Quality Standards for the measurement of HbA1c and ACR are set out in the NHS Buyers’
Guide.3 The Afinion™ Analyzer is recommended by the Centre for Evidence-Based Purchasing and
exceeds the NGSP criteria. There are also many independent studies outlining the lab-quality of the
Afinion™ HbA1c assay.4
Alere Image – Information Management and Governance Engine The informatics underpin Shropshire PH commitment to quality assurance, training, accreditation, governance and information management, ensuring that data flows seamlessly between health providers, managers and commissioners, wherever they are. Alere Image provides real-time visibility and governance of the NHS Health Check programme and can also be applied to the extended use of POC diagnostics within any setting. It supports the provision of consistent, high quality and fully auditable results, alongside providing competency-based training and assessment, device maintenance and support and asset management.
References
1. CEP 09020: August 2009 “Buyers’ guide: Point-of-care testing for cholesterol measurement”
2. Evaluation of the Precision and Accuracy of the Afinion™ Lipid Panel; Axis-Shield Oslo;
September 2012
3. CEP08057: June 2009 “Buyers’ guide: Point of Care devices for the measurement of HbA1c and
low concentration albumin in urine”
4. Precision of the Afinion™ HbA1c Assay in 11 Independent Studies; Tracy L Brett and Denise
Furtado, Axis-Shield Inc; July 2010
Afinion Lipid and HbA1c Controls
Controls will be sent direct to practices bimonthly and should be refrigerated on receipt.
Sufficient material will be provided to allow for multiple tests and provided on the condition that it is
stored between
2-8º C.
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Appendix 2: Order Form FAO Customer Services Department
Customer Order Number: Mike Parry
Help2change – Sold To 100013726
Alere Pre-paid Call-off contract: **TAKE FROM THIS CONTRACT FIRST 40002216**
THEN 40001752
Date of Order: Delivery Date:
Invoice Name: Help2Change
Invoice Address:
Health Checks Department,
Longbow House,
Longbow Close,
Shrewsbury
Postcode: SY1 3GZ
DELIVERY DETAILS:
Contact Name:
Site Name:
Address
Postcode:
Contact Tel No:
Email Address:
Afinion products
CAT. NO. DESCRIPTION PACK SIZE PRICE QUANTITY
1116062 Afinion Hba1c Test Kit 15 Tests £57.75
1116069 Afinion Lipid Panel 15 Tests £82.50
YYAT1014 Unistik 3 Lancets Pack of 200
£23.27
7364 Haemolance Plus Max Flow blade (Purple)
Pack of 200
£38.00
Please note:
Only the items typed on this form can be taken from the prepaid contracts.
Schedules are set up for the controls therefore no controls are to be taken off the pre-paid contracts.
Practices are responsible for transporting QC to a partner/sister practice. No carriage on pre-paid orders
90% of orders received will be despatched for delivery within 2 working days.
Email for orders: [email protected] or fax 0161 483 5778
If you have any queries please contact the Customer Services Department on 0161 483 5884 option 1
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Appendix 3: Health Check Leaflets
Alcohol Audit – Completed as part of Health Check Dementia Awareness for 65+ Health check background Retained by patient Given at Health Check Include with Invite
1) No. Required: 2) No. Required: 3) No Required:
Information required at H/Check Results explained and agreed Risk Management options Send with Invite Completed as part of the Health Check 4) No. Required: 5) No. Required:
Deliver to:
Name:
Practice:
Address:
Please order from ShropDoc – 01743 454 900 ext 608
Email: [email protected]
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Appendix 4: Service User Satisfaction Questionnaire
Online feedback: http://www.healthyshropshire.co.uk/feedback
