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Now, please put your um microphone on mute. Um And obviously, obviously not if you are speaking or saying something. So that is, that is quite important as we have a quite a long agenda. We will have a really very short and very brief comfort break. After the video, there will be two or three minutes really comfort break. And I would really ask you then to come back um really promptly because um otherwise we won't be able to finish on time. So, ok, that's it, Michaela. Can you move on to the next slide, please? Right. So I think most of you know what this is all about, but really this is a um it's a showcase really for, oh, I um London and it uh health checks resource back because what we really all want to do is to gain feedback from colleagues from providers and from commissioners. Um And that is really the aim of this afternoon. Um Next one, please. Yes. Now, um again, why do we need this? Why do we need this training pack? And just to say immediately, this is obviously not to replace anything that uh that we have already our colleagues have. This is really um a complement to all the training and existing training programs that colleagues you have. But as with all these training programs, there are really 22 key aims. Uh one is to improve the quality because we all know we've been doing these health checks for many years. And um unfortunately, we we we are never perfect. So improving quality is important. Um Another really important factor in all this particularly, I suppose for, I would say commissioners problem, but also for providers is to reduce the variation between providers. We continuously see a real difference between providers. You know, if you look only at GPS, there is a huge variation between certain certain practices or certain providers and of course, that has detrimental effect on quality itself and on patients now. Um why have smart health solutions you may ask as well? Uh Well, I suppose, uh again, I I'm sure that most of you um know smart uh health solutions we, you know, not for quite some time. And of course, um the, the Royal Society for Public Health Training Center. But also I think uh uh some of you, uh a lot of you will, will have had training uh already provided um by, by um smart Health solutions, at least in London. I know that this is, this is really commonplace and of course the lead trainer. So previous positions in the Public Health England or, or um ok, please. Thank you. So what we are going to do now, we will be moving down the agenda and I shall pass uh now the b to uh Monica who will give you a little bit of a background and then we'll continue on with, with Michaela and so on. And I would just like to say, have a really good afternoon, enjoy. Uh the D I'm looking forward to sort of looking as well. It is a really good opportunity whilst you're watching it. Please think about your comments because this is I said at the very beginning, a key aim is really to get your comments. So think about what you think about it and provide comments afterwards, right? Uh Monica, you thank you very much Nada. And it's great to see so many people attend this webinar and I hope you all take part in the discussion as well. So I following on from what Nader said, we know informally that there's a lot of variation in the quality of the NHS health checks across London. And we know there are so many challenging issues as to why that is. And we thought with a very, you know, with a very small budget to look at how we could improve the quality of the NHS health check. And so we, we decided to, to, you know, produce these two videos which will help give you an insight into what really happens during the check, which is normally in a, in a room with just two people in. So it's to give everybody that inside view of what really happens and the conversations that people have. And so really, it's to equip staff with information and skills and confidence to deliver the N HSC check and, and, and also to offer re reassurance on the consistency of practice in line with National guidance. Um We also wanted to have this um quality assurance in terms of the London region to ensure that we're supporting all the healthcare professionals in London to deliver the best health check they can deliver. And so we come to the resource pack itself. So the resource pack um includes two videos of different scenarios. So which Mia will be talking us through shortly and also um AQ and a document with some initial questions that we have thought about that. We will welcome more questions from you to add to the document. Um We will also be adding links to other online training resources available such as the fairly new NHS health check training hub um and all the information will be hosted online. So be available any time you want to, to watch or read the document. There's also going to be a very short evaluation form. I think it's about 5 to 6 questions and it will cover your confidence in delivering an NHS health check before and after watching the videos and also what what you would use the information you've gained, what, how would you use to make a difference? And there will also be an opportunity for you to request a certificate of learning after watching the videos. Um Michael and I are also looking to publish a blog and we will also welcome some suggestions from you as to where we can publish them. So it's accessible locally to the actual people on the front line delivering the check because that is really, really important. We don't want it to get lost and we will, we, we do promise to continuously um promote this resource back because we do know there's quite a lot of change and trend in terms of the professionals delivering the check so that people find a way to these videos and, and it supports them to improve the quality of the check. Um So I will now hand over to Michaela to talk us through the videos. Thank you. Lovely. Thank you Monica and thank you for the opportunity to um to do this. And when Monica contacted me, it was um it was a bit of a, it was one of those things where I thought, oh, do you know this sounds like it could be some really good fun. And then once you delve into it, you realize what a challenge it's going to be. So, and now I can't see anybody here cos I'm sharing my screen but uh but I wanted to show you that we didn't just randomly come up with a couple of people. And in fact, when, when we first started talking about this, we were thinking about just one video and one potential patient. And actually, as we started to evolve of what we thought the type of patient we would want, then actually, it very quickly became two people. And we also wanted to make sure it reflected the the diversity that we have within London and some of the challenges that we have as well as some of the output. So we wanted to make sure that we had people whose BP might be a bit high or whose cholesterol might be high or who doesn't want to stop smoking or who is feeling really mod a bit motivated. So we kind of drew out two profiles. Then we went off to fine two people. So we've got Dak on the call today who is a pharmacist and he played Sanjeev and Sanjeev was a very sort of um oh, how you'll only see part of Sanjeev? You'll see an excerpt from Sanjeev. And Sanjeev was a very busy working man whose mum's got dementia. Oh, it's all going on for poor old Sanjeev. And really, it was just really good for to turn up for a health check. Whereas uh Lola who's playing Gloria was, is a very motivated, really keen, wants to get on and problems with her joints and stuff. And that's gonna be Lola's video that we see first. So we recorded these in. Um we rented some properties we rented, did you know, you can rent rooms? Ideally, we would have used existing clinical rooms, which we kind of did, but we couldn't sort of um use one that it was full of everything that you would normally have, which takes away some of the, the sounds and everything. Um some of the echo type stuff, but we were able to rent some rooms through a system so we could at least make it look and feel like we were somewhere clinical. We had the discussions around should one be in a GP practice and one be in a pharmacy. But then we thought it's gonna get even harder to rent a pharmacy room. And actually, it was really about the interaction that we have with the two patients. So we didn't do a full script because we wanted it to sort of flow naturally because that's kind of what happens in a health check is there is a bit of flow to be had. So this is as much what you can see now as what our potential patients got to see and they had to get into character and, and do this. Now we know that uh health checks are good and usually somewhere between 20 to 30 minutes for uh for the check, depending if you've got point of care devices and stuff. When we run the videos, when we make the videos we were going to edit it down a bit and then we thought actually we've covered sometimes more than, you know, we, we, we emphasize more maybe about physical activity and alcohol and smoking, but actually each element of it. Um we just thought we, we want, particularly with Monica, we wanted to keep it all in. So one video. So both videos are just slightly longer than 30 minutes. But we thought that would be ok because people can take from the videos what they want to, but we wanted them to see the videos in totality. So I'm gonna share with you now. Well, I'm not, but Siobhan is gonna share with you. Now as soon as I stop sharing, you'll see that. Actually the picture is here. We've taken the NHS pictures, the NHS health check pictures, but that's not gonna be who you see now for Gloria. So Gloria's video is gonna run for about 37 minutes. What I will say is I've topped and tailed the videos with a couple of minutes, either side with a minute for me at the beginning saying this is what the video is about. We're not gonna show you that and there's a bit at the end that says, and this is, you know, do evaluation type thing. So if I can get Siobhan now to share the video. Now, before, before you press play, Siobhan, I will let people know that they are what you're gonna be watching it whilst it's actually projecting on Siobhan s computer. So there might be a little bit of a lag. Um But when you're watching it directly yourself, it will run differently. Yeah. Cos now you're, now we're projecting a video of a projector. Yeah. So hopefully you get that. So I'm gonna go quiet. I'm gonna put my camera off and we're gonna sit here for about 35 minutes. It is weird watching myself. Ok. What we really wanna get from you is not. Oh, did you, why did you say this word or why did you know? But really your overall feeling of how could this is this gonna be useful? How could this be used? We can't go back and repeat any of the videos that, that job's done, but we can still do a little bit of editing if needed. But um, I'm gonna just sit here and get really embarrassed now of all the things being videoed whilst I'm trying to deliver a health check. So Siobhan over to you to press play, please. Gloria. Brilliant. You've come in NHS health check. Have you been? It's been a long time. Thank you. Yeah. Very good. Brilliant. And I'm gonna tell you before I do this, I'm gonna tell you a little bit about it. Have you heard about them before? No, no. Ok. Well, you've come to the right place then. So great that you responded to the invitation. Um Not everybody does and this check is gonna take somewhere between 20 to 30 minutes. Is that all right? Brilliant. So, um now I am gonna do a variety of questions. So I'm gonna ask you things about your alcohol intake, smoking, family history. I'm also going to do things like that and your weight. I'm going to check your BP. That's fine. Yeah. And uh I'm also going to check your cholesterol today. That's good. Yeah. Yeah. So we'll get an instant result. It's gonna be a finger prick and we'll get an instant result and then we're going to have a bit of time to think about you and what you want. Um, and any changes we want to make to your lifestyle or Yeah. So we'll see how it goes now, depending on some of the results we get today. You might need to go on and have a blood test today because we, we look for people who might have say diabetes or kidney disease and you might go off and have, I don't know different tests. So we'll, what we'll see, it's about asking you a lot of different questions. So, are you happy for me to proceed? Yes, I'm happy because we can't even get a GP appointment now with these. So, so, so it's good to go to, to have a check. Exactly. So, that's brilliant. That's brilliant. Yeah, it is a, it is a bit of a challenge, isn't it? It is a bit of a challenge. Lovely. I'm happy that you're happy. That's really good. And, uh, the first thing I'm gonna do now is I'll do have some weight. Yeah. Cool. So, follow me. Ok. Yeah. Brilliant. Right. Gloria. So, um, was I get that a surprise to you? Well, I've been trying to lose weight. I've done a lot. I've cut down on what I eat. But exercise I can't do, I can't go to the gym apart from the fact that there is no money because everything is expensive nowadays. But even with my walking, I can't do a lot because I've got arthritis in my knee. Yeah. Yeah. You been bad a while? Yes, I've got this. Yeah. So, well, today we've got you down because what we do is we take your height which is 160 we've got your weight, which was 84.5 kg, which compared to when you were here last time, I know you said like it looks like you've been trying, but actually it's gone up a little bit. Um, but that's just on our scales, you know, are always a little bit different where we're at and that calls in something. So what we do is we try to look at people's BMI S and BMI S stands for body mass index and that's where we can start to compare and say what should be about right for somebody our height as it were and yours is coming in at 33.2. Now, do you, have you heard of BMI? Yes, I have. But I've been told that being a black woman is your, your bones are heavier and that contributes to the BMI. Is that right? And it's, it's, it's not quite right. I'm afraid it's not quite right. So, um, our BMI as it, where it just a, it's a, it's a calculation and it's where we try to look at. But unfortunately, um it doesn't, it's not really like a one size fits all for everybody. So the way we was classifying you now, from the result of your BMI is that you would be in the obese C. So that's not a judgment. That's a clinical term. OK. That's not saying. So this is a clinical term, but we know once our bi gets greater than 30 at all, 27.5 depending on people's ethnicity, then um then we start to improve health risks. So that's things like BP problems, diabetes, heart attacks and things. So it's not that we're trying to be judgmental to people. It's more that we use these as a marker to look for other things as well as trying to help people and lose weight. Now you mentioned about, about being black and, and we know that actually uh muscle density, muscle proportion is different in different ethnic, across different ethnicities, but it still creates a problem, you know, it's still a problem and it's still the, the, the, the, the results that we use um is, is to see that's there. So II have got you on phrase in our, in our obese category. OK? But it's not about being a judgment. Ok? It's about how our services are geared and disorder because my B BMI is high and it's improved to any through diabetes, through high BP and we're going to be checking your BP today actually. Ok. Have you ever been worried about your BP at all? No, I haven't but I've got really history of BP. Yeah. Yeah. Yeah. And it's, and we know that high, what we call that the, the clinical term, that high BP is hypertension and we know that actually, um, people who are black up are going to be more likely to have high BP. Unfortunately, that's why I keep watching my words so that I can get it so that I was having any history. So, um, next, what I'm gonna do is have to check your BP if that's all right. That's what I need you to do though is, uh, take your jumper off but you just, just sleeve one. But let's see what's going on with that sleeve because normally I'm, oh, oh, you've got a lot going on under bed. You've got a lot going on under bed and so can I can I do this bit? Can I just say what you've actually got on because ideally, ideally we don't push this up but because it's so loose, I don't mind pushing it up now as well. This, I'm not going to push up because when we do push it up here actually creates um extra pressure, which makes a difference. And um rather than getting you all undressed, I am going to do your BP through this because um, yeah, but that might make a slight difference to the results, but I'm just gonna take that risk. Ok? And then at worst, what I'm gonna have to do is get you all undressed. Ok? But we're not gonna, so, but we'll see where that's at. Ok? Now, before we take your BP, we need to make sure we've got the right size cup. So I'm just gonna measure at the top of your arm. Ok? And the top of your arm here is coming in at 37 centimeters. Now, do I have you off that much at the top of your arm or what? I'm surprised. Get that. Well, it's not many people do that but we shouldn't do it because the whole size cup can make a difference to your blood. So, uh my, my cuff has got a set of sizes in here that lets me know to put these glasses on that. This goes between 422 and 48 centimeters. So we're absolutely fine to use this one. I'm gonna pop that cuff on now. The chances are and do this BP three times today, a chance that I'm gonna do it before I do your BP, I'm gonna take your pulse and to take your pulse here. What I'm not gonna do is looking for the number. Although that is important, I'm going to look to see if it's beating regularly. Yeah. And that's because we're starting to look for other conditions. That's part of the health check is to find other conditions. Um, so why don't we take it for a whole minute? So it can feel like a long time and we feel around here and we'll just sit quiet for a whole minute. I'll, I'll put my timer on. So we've got it and uh see you over to the side of a minute. That's fine. All right, we're gonna have a little clock that twirls around for a minute because I'm not gonna say that that often. Perfect. Your pulse is really good. It's nice and regular and not a problem. Um, so that's good and your pulse rate is 76 at a nice regular rate here. Now to do your BP, it's also really important. I'm gonna get you to sit, sit up right in the back of that chair. Lovely. And I need to flat on the floor and be relaxed. Now, just double checking, just double checking. You didn't have a cigarette in the last 30 minutes. No, or have any tea or coffee and do you need a win? No. Good, good because all of those things can make a difference to your BP. We wanna get the best number that we can here. Now, when I do take your BP, I need to just be nice and relax those tummy muscles, just relax down. Um, and I'm not gonna talk to you, I'm not gonna do anything and I'm gonna tap right on the computer. All I'm going to do is, um, sit here quietly whilst the BP goes on. Ok. Ok. And then I'm gonna tell you what the numbers are going to be. Ok. So the numbers at the moment, the wheezing at the moment is coming in a bit high, which does mean I am gonna have to repeat it again, but in a, in a, in a couple of minutes here, we, we expect them to be a bit high today. I've been worried that they might be a bit high. No. So the top number, the top number is, um, is what we call your systolic. And that's coming in at 100 and 58/96. That is high, that is high. So that is high. And then once you get over 100 and 20 then we start to have increased heart problems and once we get over 100 and 40 then we need to start trying to assess if somebody's got high BP, but I'm going to repeat it because it might just be that you're a bit stressed. A little bit, little bit anxious. Yeah. Yeah. And so, um, yeah, so I'm just gonna pop up in the computer. So it is a good job. I've got a spare moment here now. And can I just check any family history of, um, heart attacks at all? Yes. Grandfather had a stroke, a stroke. Ok. Yes. Yes. A stroke. And how old were they when he had a stroke? They had a stroke at, uh, 75? 75. Ok. Ok. Yes. Then father had a high BP as well. Ok. Yeah. Yeah. And mother had a high BP. Both your mom and your dad have had high BP. Ok. And, um, and how are they now? Are they, have, they passed? No one has passed but the other one is there and they're still on medication for the high BP. Yeah. Ok. Well, that's good that, you know, everyone is still here. That's good. Um, and it's good that they're on BP medication because that can really help. Um, I'm gonna check this again if that's all right. Is that ok? That's still, I'm afraid that it's gone up a little bit more to 100 and 60. You got more than 92. So, um, and I'll show you the numbers because I think it's really important that everybody knows the numbers. So I will be checking it once more. Um, and then we could take that cuff up. Now, I don't want you to get worried about your BP. I'm getting worried, you know, what, what am I going to do? Well, the, the next step would be to get you assessed for hypertension. Ok. So, so that's the next step before we do anything and, and, um, and we do that, we manage that here ourselves. Yeah. Yeah. So, um, I met the lovely healthcare assistant. You have you met him? He's not, he's amazing. He's amazing. And he runs the BP checking service for us. So, yeah, and, and so what we'll do is I'll book you in at the end of the day and he said we'll get you booked in to see him. And what he'll do is walk you through how to measure your BP at home. We lend out the machines just like this. That's good. You get to measure at home by yourself and then you come back and see him with the machines and the results and then depending on the results, then um then you might go off and see one of the GPS. Yeah. So, so, and actually, whilst it might be morning, uh and the BP is what we can do. Is there anything I can do with that? That's the medication? Well, yes and no. Yes and no. So we know a lot of people do need tablets to manage their BP. And actually one of the best things they can do for BP is weight loss is losing weight. That's the best thing we can do. Um And actually, so, so actually if you were a, we count as a normal body weight, you wouldn't have any weight to lose to help your BP. But the fact that your BMI is over 30 means you do have some weight to lose, which may impact your BP. That will likely to help bring that BP down. But if you do need tablets to help as well, that's ok. Then it's just because I'm going through a lot of stress at the moment, you know, the economy to like me trying to pay the bills, you have to make sure you have enough job to pay all the bills. And so I think that is what's affecting my BP. That may well be and that's why checking it having can be really, really good. So I'm gonna just do it one more time, ok? Because we do it at least three times. So um just sit nice and sit nice and relax, relax, put your feet flat on the floor for me. Lovely. It still raised at 100 and 63/93 ok? But I don't want you to talk about it. We got a lot going on as well, but so the good news is we can do something about high BP. But the first step is to get it checked to see. Do you really have high BP? Let's see if we can get that diagnosed. We also know that actually for people who are black, it's almost even more of a problem than for people who are black and that BP. Um, yeah, causes so many other problems like problems with your kidneys, problems with strokes, problems with say dementia. So it is really important that we try and get those numbers down. But the first step is to get it diagnosed. Ok. So I'll brought you in with, I'll put it on the screen now because it's quite straightforward how I can send in the quick note over and I'll just pop your BP in. Give me a mind. You've got this new Tate. It, yeah, got this new template. So it takes a few seconds. Ok? So that should trigger something off on now. Who will um, we'll follow you up and say when you're going to come in for the BP check? So we've got a quite a good system to text you. Have, you've been getting the text. Yes, I have been getting the test. Yes. Yeah. And how are you finding the text? Actually? It's good. It's good to remind because we your mind having so many things you text messages. Oh, yeah, I have brilliant. So it's ok. Fabulous. Just a couple more questions now for you and I'm gonna just go back to the family history bit. So you said it was a stroke and high BP when your mom and dad, is there any heart attacks at all? Um, a couple of my uncles have heart attack? Yeah. Yeah. Ok. All my uncles have a heart attack. Yes. Yeah. So, because the reason why we're looking for family history in this bit is we're actually just looking for first degree blood relatives that, that you actually to do with heart attack. Not necessarily. So we know it's important for BP, but one of the things that we do today is calculate your chance of having a heart attack or stroke in the next 10 years. And I use a computer program for that one and that's where all of the different measurements that were put today, it goes into the computer program and that's how we can explain to you what we think your risks might be. Um, so, so it was your uncle. So, so whilst that's really important, it actually doesn't fit into our computer program for that. It's just for life. Ok. But not just for this bit of a computer program we've got. So next is, um, I'm gonna ask you a bit about alcohol and then I'm gonna ask you about smoking. Ok. So always t ones for these people. So that for people sometimes, you know, but I smoking, that might be, well, that's good because I don't smoke. Oh, brilliant. Ok. Then that's what really good, that's really the news with, with our culture looking at smoking is the, is the on too, right? Have you and upon? Yeah. So I've got you down here that you've never smoked? So that's ok. So, so that's a nice quick set of questions. I'm brilliant because not smoking is so good for our health. Ok. So good for our health. Ok. So that next is alcohol. So um and I've just got a series of questions I'm gonna ask you about alcohol. So do you drink alcohol at all? Well, I do socially, socially when I get invited to a party. Ok, so maybe once or twice a month and there can be a month where there's every weekend there's party, that's a lot of parties, that's a lot of. Ok, so I'm gonna put you down then at 2 to 4 times a month. That's what you're hoping is that about right? Does that feel about right? Ok. Sure. So it 2 to 4 times and when you are there at these parties, how, what do you drink? I drink a, a beer, beer. Ok. Ok. And um in what is it in a bottle or a can? Well, I can but when I do, I don't drink more than two because I've got to drive. So. Ok. Yeah. And so what we know is that regular can of beer that size has got about two units in. So what we're going to say, is that, so that makes it four units, four units when you're there? Ok. So that's four units. And, um, do you have more than that? Well, if I have more than that, I'm, I'm not driving. Somebody gave me a lift with the party. Ok. And, and, and how often would that be? Well, maybe once a quarter, once a quarter. Ok. So that's, and that's, well, that, that what my school here because everything is a school nowadays. It's in the school here is, is actually comes in at less than five, which means that, uh, enjoying the drinking of the. Oh, yeah. Yeah. So that's all, that's all good. That's all good. You're drinking what we call responsibly and within safe limits. So, yeah, so some people worry that we're gonna give you a big lecture on alcohol. But, um, yeah, so, ii think the driving is actually a deterrent that stops me from drinking a lot. So, that's, that's really good. You know, that drinking drive a coming and so you don't want to be a criminal. Exactly. Exactly. And, but we do know sometimes alcohol can influence BP. So it's something to think about it. Not that ok, but that's something we can pick up later, particularly with, um, things because I don't know if you're interested. We have a weight management service. So that's, you'd be interested. Yeah. Yeah, that's good because I've been trying to lose the weight but I don't know. But with weight management, how I'm eating African foods because I love my African food can be eating potatoes every day and eating vegetables every day. So I will eat a bit of African food. Oh, ok. So, well, well, that's, that's not my speciality. I have to say that's fine. But, uh, Ay is one of who's a fabulous African woman who is part of the weight management service. So, yeah, so she was put, especially because we know we have such a fantastically diverse population. We don't just have sort of diets for traditional western diets where that's there. So. Oh, I'm really pleased that you are good. I'm happy to do that. Well, there's a bit of a waiting list, unfortunately. Like, I think there's a bit of a waiting list, but at the end of the day I'll refer you off if you're happy and they should be in contact with you in the next couple of weeks. They probably contact you by phone and then they'll, you know, how long it is before they can get you in. But usually they can give you some good sign posting as well. Ok. That's good. At least before that I can do what I'm doing to just keep my weight down. Yeah. Yeah. And, and the weight sometimes just not getting is a good thing, you know, keeping our weights at because, uh, a lot of us are carrying a little bit of extra pounds and II know I know what it's like. It's not easy, especially when we're all sitting down, the list is about physical activity and exercise and I've got another series of questions to ask you. Um So what, so your job, of course, because social life for a long time when you're at work, do you move around a lot? Or you actually see most of the time I'm in meetings or I'm on telephone, talking to clients or putting my report in which take longer hours. So, really, I sit there most of the time at work. But let's know when I go and get a cup of tea or when I go to. And it's the way of nowadays, isn't it? Two days since the pandemic, a lot of us are spending more time sitting down more than ever. And it's, it's not good for us and when I walk for a, I know some people I know have those standing desks but, um, doesn't work for us. No, it's not gonna work for us. Ok. Now, um, so the next thing is about exercise and, uh, I'm gonna ask you the questions, although I think I know what the answer is because II know about, I know about your knees. And do you ever do any sort of vigorous exercise? Are you able to play badminton dancing or? No? No, I can't. I try and dance when I go to the party, but usually I end up taking paracetamol after the dance because I love to dance. Yeah, I dance but I end up to dancing is not every day. It's the weekend or the weekend. What, how, how, how, when you do, how, how long do you dance for, would you say? Well, maybe 1.5, 2 hours. Oh, no, I have a lot of stress. You know, if you got to take a bit of paracetamol afterwards, that's really good. Dancing is great and it's good for not just a good activity, but it's good for everything. You know, it's good for the soul, I think, isn't it? Yeah. Yeah, I, II believe so. Yes. Yeah. Good. Yeah. Brilliant. So, um, I think this drug is more about you getting old men. Um, so I know. So, what do you do? Exactly. And you, well, are you seeing anybody about the menopause at all? No. Oh, I haven't had an appointment to see so much. Ok. So, well, there is a bit of a, you know, getting the GP appointments is a bit trickier nowadays. However, when you leave here, why do you book in? It might be in four weeks, time or six weeks time. Do you book in? That's a good idea to walk in and say, you know. Yeah. Yeah. Absolutely. And because, you know, the menopause is really important and we do know that actually, but as women, when we go through the menopause, it increases our risk of things like heart attacks and strokes makes our cholesterol go higher, makes our BP go higher. Yeah. So it's really important to and, and the stuff we alongside all of those awful physical symptoms that we feel the joints aching, the sleeping. Yeah. No, exactly. On the way out. Thank you. I think about that. Yeah. No. Well, to the exercise question now. So, dancing is really good and I think you should continue on dancing as much as you can do. Um And if paracetamol is, is, is enough to, to sort your joints out then, then that's good because actually not moving them can make them even worse. Um Do you do any cycling at all? I have to laugh because I have a bicycle at, at home, but I do keep getting it. You had like, no, it's just there. I look at it sometimes I go see when I watch Telly and I do two rounds or just like, ok, after I get that. So, so because we don't know how to learn because, well, you know, that's what happened with the love of us and we have all these bits of kids at home. But would you like to cycle more? Yes, I love to do more as long as my knee is not affected. Yeah, because it's sadly what I'm hearing is that you're, you're quite motivated to want to do something and there's just little bits in the way, obviously, there's your joints in the way. But actually being motivated is really important to on the first step of being able to do more. And as part of our weight management system, they all say we touch on visit activity too. Um Yeah. So it, because it's not just about the food and we know physical activity is really good for BP. So maybe, maybe, maybe I have to do more because of this BP going up. Yeah. So maybe we have to do more. So, so, so before I, I'll finish this bit first and then I'll ask you a bit more about that cycle. If that's all right, that's fine. Ok, so um walking, how, how many hours a week would you say you walk? Oh wow. Sometimes I try to park the car at home, take the bus and walk to the office. Ok. That's good because I thought, ok, I thought the fuck saving money and I can use it for exercise. That's a very good thing. That's a very good way. And so how long if you have to add hours on days while walking from to, to my office? About 10 minutes? Yeah. So if I want to add my exercise for the day, maybe 45 minutes, 45 minutes. That's it. Ok. That's it. So I can take on my leg here that you walk for more than three hours. And because that's the rate that I'm looking for one hour, 1 to 3 hours. So we're definitely gonna say you're more than three hours, which is great because, you know, walking is really good for us. And how fast would you say you walk? Is it quite a steady pace? Is it not very fast? Not, it's ok? Steady pace so much. So, let me touch with you on it. And, um, do you do, uh, how many hours a week would you say you spend on housework and childcare? I'll give you the l it's either less, like zero, less than one hour, 1 to 3 hours or more than three hours, would you say? Well, a week, a week, a day, a week, a week because Saturday is my usual cleaning day. Yeah. So Saturday I can spend about 3, 3.5, 4 hours. Wow. Ok. Ok. So that's keeping you that. So you're busy, you're very busy and, um, and any at all? Well, I put a, but every now and again, I've got a COVID. That's what I love more. I use a little more, but apart from that, not, not really a lot. Ok. So on my, on my scoring system here you're coming out as an moderately inactive. So that's the system there. So, although, although you're being really busy and you're dancing and you're walking, that's all really good. It's just the way the computer phrases things because it only gives us, um, a few bits. But I think, um, to me it feels like you're actually doing a lot of the right stuff. And what we will always want people to do is, is, is, is move more. And, um, and you're like, you're already doing a lot of walking as much walking as you can with your knee and that feels really good, loving the dancing. But what would make you, um, what would, if it's this one, is that, is that bicycle, You know? Ok. Ok. So would you, would you like to use a bi a very long? Well, it's there. So that's why I make you be. Yeah. Yeah. And was it a, a time that you did use it more? Yeah. Sometimes when I've got motivation that I need to lose weight, I jump on it. I can do it continuously for about a week and the motivation just put it down. So, what do you, what do you think you could do? Is there anything you could do to, to keep that motivation going? Well, maybe if I'm accountable to something, accountability to somebody or a group, whatever you said I done this today. If I have to report back, that means that a will be great for that. Yeah. A will be great for that. Absolutely. And actually as, as because the, the Weight Management service does form as part of a group as well, but we do know a lot of people do stay quite well connected. Um, yeah, so, so are you gonna get quite motivated to the? No, I don, I don want that BP medicine. But if you do need to, if let's say you do need to take BP. Ok. That's good. But, but if you get one where you do, then it's really important that you do if that makes sense. Ok. But there's so much we can do with lifestyle BP. That is brilliant. Ok. Wonderful. I'm just going to finish that bit on here. Another part of the health check that we do is actually around dementia um and dementia prevention and early identification we're looking for. Now, um in this practice, what we have to do is for everybody. So you know, the the rule, proper rules, but the guys in the city need to see people who are 65 to 74. But in our practice, we've been everyone that comes for a health check should have the just should be informed about to mention. Now, um it's very simple to have a particular say to you and I'm gonna give you a leaflet, ok? I'm gonna give you a leaflet and inside the leaflet has got lots of information about dementia awareness. Um And if there is anything in that leaflet that you are worried about, so whether that's for yourself or for a member of your family, then it is make an appointment to see the GP I'm afraid um the leaflet is I have to send it to your phone. Um um So we don't have any hard copies anymore to give out those days. I put a lot of things all over. So I'm gonna have to send that through to you, but we've got a system to get those checks through and the loop that will be there. Now. Um So we didn't do any assessment for dementia. You check. Oh, I thought you were gonna do a, an assessment because with menopause, I don't even know sometimes I don't know if you see dementia when I'm, I'm looking for my glasses one time. I had my glasses was in the freezer for a few days. So I was thinking, is it dementia or is it so and that's why it is important. So, so this li it can be good. It will let you know something and actually, and everything that I'm gonna tell you about what's gonna be good for your heart is also good for your brain. So even getting on that pack of yours is gonna be good for your heart and good for your brain because actually exercise is one of the best things we can do to stay off. So, um, so I'll get that leaflet sent over to you. Um I'll put that all through at the end of the day, at the end of the day, at the end of our session. Um, as well as doing any, you know, the referrals and stuff that we need to make sure sorted. Um Yeah, so, so that, yeah, yeah, so I like it in our practice that we do for everybody. That's good, but that's why I want to do it. My foot. Brilliant. Next thing we're gonna do is ac test. OK. It's a big book test. I'm just gonna go wash my hands and, and grab a shot. Give me my book. That's what I check before. Yeah, I have, I used to have a blood test for the GP and that was before COVID since COVID. And do you know what your result was? I mean, I can check it earlier. I think you were five or something. Yeah. Yeah, it was, it was a 1.3 and that's your total cholesterol. We call 0.3. Um and well, what we're gonna do today is check your total cholesterol and I'm gonna look for what level your good cholesterol is as well and it's all gonna happen instantly. It instantly it's gonna take about two minutes to run. Lovely. So I use a bit of kit here and we just literally, I'm gonna wipe your finger and um and then I'm gonna prick your finger and take some blood. OK? The results aren't too bad and it's gone up a little bit your cholesterol. So it's 5.7. Now it's 5.7. But you did say, you know, through the menopause and we know cholesterol can go up a bit also your good cholesterol is 1.2 and we want that to be at least above point, well, probably about 1.1 for women. So overall your risk of your cardiovascular and your ratio is what we look for is just over five. It's coming in that it's coming in under five at 4.75 which is quite good actually. So it's quite good. So I'm quite happy with your cholesterol. Some people worry about that top number shouldn't be down. I mean, I, you have it less than five, but it's about looking at all of the numbers that are there, the GPA, it's over five. Then you start medication. Yeah. No. What the reason why we decide for medication in terms of cholesterol is when we do your, we put it all into that computer program, we come up with your cardiovascular risk. And that is the thing is we use it with the algorithm we use at the moment is called pubis. That's the algorithm we use. And um that a bit I'm gonna do next for you. So we put that in that, that's the last bit of the template. And so we'll pop your cholesterol in here now and your p risk um is coming out coming out at about uh 3.8%. Now, a lot. Is that good? Yeah, that's the question people always ask because that's the question people always ask. And the language that we use in a health check is less than 10% is what we call low risk. So a low risk of having a heart attack and that this one is, which is really good. But we also start to look at other things in this risk. But although it's low actually, and I think, I don't know if you can see here and your chance of having around or so here. Is it, is it 3.8? OK. Good, good, good. But if I show you this next screen here, it should only be about 2.1%. So it's a little bit. So it's still good. OK? And, and a lot of that is being driven by your BP. So by getting the BP down, then it will help the risk to come down a bit. Yeah. OK. And so there's another way and it, and we know that this is often used as a bit of a motivator. So you're 59. OK. And um um but your heart age and that's how another way of being able to compare what your puberty is is coming in at 68. 0 Yeah. So that, that's where getting your BP down will be the heart age that nobody wants a heart age. No, no, we all want a heart age younger than our really get to the Y Exactly. That would be perfect. So if anybody, so if you ever think about what's gonna motivate you to get on that bicycle. Your, do you think? Yes, I want you your heart. Exactly. Exactly. And between that and the d I think that'd be really good. So that's pretty much it done for the health check. Ok, good. Have you any questions before I fill out all the paperwork? Now? Well, now I will, I know that my take home today is, uh, uh, physical exercise and also weight loss and that BP and the blood and that BP because both of them, if I continue with that is gonna be the BP down. Exactly. Exactly. So the plan we've got for you and, and what we, why we give you your results is it's another text message. So we'll, we'll get it all set up, you know, get a nice little, it will be adequate. Actually, we'll send it to your, we'll send it to your phone as well. So we've got your cholesterol coming in at 5.7 and your HDL at 1.2 making your ratio less than five. It's about 4.74 0.8. Your BP is raised. Yeah. So we do, we are gonna get you booked in with our meds to be able to get that BP at home. Now, I do, I do have a leaflet somewhere for BP at home, measuring your BP at home. I'll get that for you before you go out. Um, so yeah, So we've got a lovely set of leaflets and I'm measuring your BP at home and we're gonna send you through the dementia leaflets. Ok, online. And I feel like I'm giving you the right thing to do list, you know, is that ok? I can, I can do that in my spare time because you have so much spare time. And, um, so, yeah, so we've got that and we're gonna see how it I'm going to, you're gonna book in to see the uh to see the GP about your menopause. It's quite, it's quite a long list that's there. Yes. Yeah. Is that all right? That's fine. Lovely. I'm gonna go and get that up for you. We've got it over here and um, yeah, so this is all about measuring your BP at home. Yeah, so it's quite a nice one. so when you see, I tell you don't need one because I'm just giving you one there. I've got some in my room as well and uh, yeah, great to see you and thank you very much. Now, what I would, what I will say the one thing I just remembered, I'm also gonna give you a blood test for because I've got to get you checked for diabetes. I wanna check for kidney disease. So in that form I'll just get it printed off here for you now and I send that to reception. So it puts at the reception. So when you're making an appointment, get that BP, get your blood test form. Ok, and put yourself in with our lovely phlebotomist um, to get your bloods done. That's fine. Is that I'll give you a video of that. Yeah. Oh, that's good. At least I've got an appointment today and I've got so many things which is much more better than waiting for an appointment to see the doctor when you're ill. Yeah, so I'm not sick, but I've got this appointment. That's good. Brilliant. Thank you very much. Brilliant. Thank you. Thank you. We hope you found this video useful and your feedback is really very important to us. It will only take a moment and remember after you've given feedback, you will be able to access your certificate. Thank you. Thanks Yvonne. You can stop sharing now. Well done. If I may say well done, I liked your comments when you said me, I didn't like watching yourself. Horrible, well done, well done. Now, um we did say that we will have a very brief uh comfort break minutes colleagues if I may ask uh during that period, can you please think about the feedback as well? And we will have a very again brief, just sort of, you know, immediate thoughts and then we'll move on to the second video. So two minutes and then back, please. Ok. It yeah, at 11 o'clock, at 11 o'clock, I'll go and have a blood test after I've been taking, oh, somebody's got a, yeah, I need you to have the blood test. I think that's the person who's just joined. I just, we'll just talk loudly. Oh, yeah, they've got that all gone off just because it was the background. Oh, well, I think we, we, we did have two minutes. Well, what can we say? A, a quick, quick two minutes. So, um, Mia, um, I think it is, it is your turn now to um give us a second video. But before that, can I just ask any quick immediate feedback or reflections? One seat? So whilst people might be reflecting, I if I just pick up on some of the stuff that came through the chat, which I thought was quite interesting. So one discussion earlier on was about the template and how actually the template can make a challenge on the timing that you have if it's particularly clunky and some have a better flow than others. So there was definitely something through there a around that side of things. There was another bit about the amount of time that people get for the health check because of course, I showed what we showed it was longer because what we wanted to do was almost expand in different areas to demonstrate all of the different elements that could be in the second video. So for example, Gloria didn't smoke her audit c came out as low. So um so whereas Darshan, when you'll see Darshan who's playing uh Sandy, his audit scene comes out high. He is a smoker, but we've pulled back in other areas. So we, so we've tried to demonstrate now we know that not everybody will have everything but we were trying to just, yeah, demonstrate the different elements. Um Yeah, it's, and it was a shame that we, we, we don't have a template to play with that, you know, in public health, we, we outside of practice, we can't have it but we can point at things and pretend. So I think what we and no one's coming through, Sheila go for it. Are you gonna say something? Sorry, I haven't seen that. No, no, I wasn't. I just came through because I turned my camera on. But I just wanted to say, yeah, I think that managing, taking the measurements, building the report and talking to the computer can be very challenging, can't it for people? And I think you manage that really well. And I suppose what I always say to people is I'm going to be putting data into the computer. So I am listening but please just be mindful that I do need to put data in because data accuracy and completeness is one heavy part of the health check, isn't it? So, yeah, that was my point. Really? Thank you, Michaela. Yeah. Yeah, cool. Thank you. So, shall we go for the next? How about you? No. Well, I have only one Well, what you said, but also I think there was some discussion about other things that we are raising issues like menopause like, you know, and that is firstly obviously adding an extended time, but some people might not. And I think that was it in the chat. I think somebody commented that didn't feel comfortable about it. So that, you know, I, I think we may, that's maybe something that, that we may want to just consider. Sorry. Well, it was more that she asked me about the menopause. So II know, I know. So you obviously, but I, but I could, we can cut it out. I just thought it was a question that was asked and I addressed it and then signposted it towards the doctor. Yeah. So, but that's a reflection we can have from everybody because we can, yes, we can edit that bit out. It was just, I mean, I wasn't expecting Gloria to that. It was, it was, it was important other things, isn't it? There could be other things this time. It was menopause, it could be something else. And the question is if you feel comfortable responding, you know how to manage it or do you, is it best to say, you know, we have specific, this is a specific program, this is what we are doing for everything else you may need to talk to analyze or something. Yeah. Yeah. No, that, that was what I wanted to say. It was like with the script in the beginning, it's about this health check. We're going to be looking at it, this, this, this, this and this and if anything else comes up, we'll, we'll refer you to wherever you can go because people want to get out their wounds. And I think of their dressing and we, we ask about mental health in our health check in Greenwich and we have people crying and also really, it's about how do you feel to that and focus on the health check? Yeah, I've just seen the question come into the chat about um cholesterol. Now it's quite a clinical one and I think that's beyond what we're asking here. I will. Oh, I can be, we wanna know about the video but Julie, I think very briefly if the HDL is high, it's your ratio is total cholesterol divided by your HDL. So it does affect the final number that that goes into the risk, although not all high HDL is good, but we'll leave it there for now. We'll leave it there for the Yeah. So shall I tell you a little bit about so, and D might be back on, he had to dip out because he, he's a clinical pharmacist working in a, in a PCN. So I know he often has a, a list of patients he has to see. We're hoping he'll be back for about quarter past. Um So Donald Trump plays a very different character. So he is much more quiet. You have to listen to him and it was, it was hard, you know, we have to listen to him while he's there and he is very overwhelmed with, um, yeah, very overwhelmed with everything that's going on. Um, we're only gonna show a snippet but um, I'll give you his background, his looking after his mum with dementia. He works beyond full time as a cashier in a, in a, in a petrol station. His kids aren't married yet. They're still living at home. He smokes too much. He's, it's, it's just, it's all going on. There's lots of family history that he's worried about with his heart. His dad had a heart attack, his brothers had it. So he was coming in from a very different perspective and really not ready to face anything. So we're gonna show you a small snippet. Now this one's gonna take, this is a long snippet of seven minutes around the audit seat. And we just wanted to show you the bit about the audit C and again, the whole sane video is longer than the 30 minutes because, well, because of the same reasons why I'm saying because we wanted to explain different elements. Um I think we could have done about 50 videos. Me and Monica to try and cover every bit of the health check. So we've tried to cover it in. So we're gonna have about seven minutes now. Oh, just before we do, I'll let you know when people watch them online later, there will be a little intro uh which is places the video for everybody. So you jump, jump straight in with Gloria or with Sanjie. It is me saying why the video is a little bit longer. So it, it does allow people to um have that wider feeling. So Siobhan, if I could get you to play Sanji for me, please. Next on the list is um thinking about alcohol. And so I've got a few questions about alcohol now for you. And again, this is alcohol is often a tricky one and it's not about judgmental and it's not about, you know, um I just want you to be as honest and as truthful as you can be. Um And we know that often people underestimate how much alcohol they drink. So I've got a lot of questions for you now and we use a, a specific tool for this called audits. So we know that within a health check, if you go wherever you go in the country for it, people are getting asked the same questions. So we have the questions printed out for you because because there are a lot of questions to go through. So I'm going to ask you the questions, but I I'll get you to have a little look as well, particularly at the questions and what the options of the answers could be. How often would you say you have a drink containing alcohol and it can go anywhere from never all the way up to four times a week. What would you say? I'd probably say four times, four times a week. Ok. And when you are drinking, do you do, what, what do you drink? Um, I tend to drink whiskey. 10 and, and is that at home or are you out and about at home? Ok. And how many, how many glasses of whiskey would you say you have on average? Uh, I probably have on a single day on a, on an average day, one or two sort of. So, so you, do you measure it at all or do you just pull you hand pull? Ok. When you hand pull, do you feel it's a generous one? Is it like the same size as one in the pub or is it, um, a bit big? Probably a bit big. And would you say it is like twice as big as the p one or they're about probably twice as big, probably twice as big of a, and you may be having one or two of those, two of those, so that single bit in a pub, that's one unit. Ok. That's one unit. And if you're having twice that, then you're having two units. And if you're having that twice, then that's four units. Ok. And so what we can put down here for that one is we see that actually for four units. Um, you're here? Ok. So we'll pop that in. How often do you then think you have more than those four units? I sometimes drink a little bit more during the weekends, during the weekends. Ok. Ok. And then would that be every week, do you think more or less, more or less? Ok. So what that means is, now, I'm just going to ask you some more questions. Now, these ones can feel a bit weird. But, um, but let's go with it and see where we're at. Ok. So, um, and you get to read them as well. Um, and if you think that the answer is gonna be never, you can let me know before I start to give you the, the rest of the bit. So have you ever found that you were actually couldn't stop doing what you were, couldn't stop drinking once you started? Do you remember in that situation, on occasion, on the weekends, on occasion, on the weekends? And, and is that maybe once a month, once a week, once a year? What would you say? Maybe once or twice a month, once or twice a month? Ok. And how often have you ever sort of not been able to do what you're supposed to be doing because of the alcohol? Usually it's just before in the evening times before bed. Yeah. So I tend to fall asleep and fall asleep. Ok. Ok. Have you ever found in the mornings? That you might have needed a glass of alcohol to get you going. Not usually, not usually. Ok. That's really good. That's really good. Have you ever, has she ever felt really sort of guilty or remorseful after drinking at all? Uh, yes. Um, because I'm looking after my mom and because I'm mindful of the Children, I do feel guilty and I feel quite bad in the mornings that maybe I should be in control of what I'm doing. I'm not drinking as much as I should. And it's sounding that, you know, from, from what I'm hearing actually is you've got, you've got masses going on and it's not unusual for people to use whatever is around when, when there's times of stress. But, uh, I'm already thinking to the end of our session and where I might be able to signpost you to get some support because I think you might benefit from some support. Um, there, have you ever not been able to remember what you did the night before? Only after I've been drinking so much, only after it. And was that every week, every month, every year? How would you describe it? I say maybe once or twice in a month, once or twice in a month. Ok. Has anybody ever been injured or have you been injured at all? Have you ever hurt yourself or hurt anybody else got injured, maybe falling off the couch at that time. But apart from that, and was that during the last year or was that before? Um, I think it happened a couple of months ago, a couple of months ago. Ok. Has anybody, whether it's a friend or a relative or a doctor or another healthcare professional said they've been a bit worried about the drinking at all. I don't really tend to use health care services as much. Yeah, because it's just so busy at the moment and I'm the only bread. Ok. Yeah. Yeah. So at the moment this is coming out to one and a and actually I think it will come as no great surprise that your alcohol intake is quite high. Um, and it's almost what we would say is almost, is in this risky space and whisky space, not just because of, um, because of the quantity of alcohol, it's almost as well about the impact and that's what it's having on your life and that whilst in the week that your alcohol intake is relatively relatively and that, that the units aren't too bad, but the weekend ones are sounding like it could be really high. Have you? Has, has your alcohol intake worried you at all? It has. Yes. Something that's been, that's one way I can take the edge off at the end of stress that I need to have on a regular basis. And so would you, would you like to drink less alcohol? I would like it. Would you like to have you always drunk this level of alcohol in this way, or I think since my, my dad passed away it's, it's increased really since then. Um, it's always been ongoing since a younger age, but it's been increased since there's more pressure. Yeah. And when you were maybe drinking less alcohol, how did that make you feel? I just wanted to forget the day. I just wanted to forget the pressures and forget the issues that I was having when I was using. II, I'm almost pondering now on what, on what, what people find useful. Um, because, because at the moment, uh there, there's a lot going on but some people find it really useful to just because I'm not gonna ask you to change anything yet because you, you've got so much going on, but sometimes people find it really useful just to track their alcohol intake. Um, and you do that with your phone. You got a, do you have a smart phone? Do you do? Ok. So, um, I can show you that one at the end if that's something you like or, or I can, if, if you'd like, I can even show it to you now. We can do if you want. Yeah. Yeah, absolutely. So I'll, I'll show you the app. It's a simple app but I can, I can, um, send you the app on a, on a, on a text message. Ok. Yeah, I can get that sent to you. Um, it's called drink. We, it's, you know, it doesn't come to us. We won't know the information you, everything is stored about you anonymously. But, um, a lot of people find it really useful just to track their alcohol for two weeks. Don't change anything. Just track it. It's really simple. It's really easy here. Let me show you II have it on my phone. Um, and, um, let me just find it here. There we go. And you can look at it like this. It simply just takes you through and let's say you have to make your account up first of all. But it, all it asks you to do is log every day what you drank and it, it's really straightforward and then at the end of the week or the end of the day, it tells you always like how many calories you might have had, how many units you might have had and it can help you maybe think I might wanna drink less one day or something. But don't make any changes. Just maybe track. Yeah. OK. And I'll show you and I'll show you that what, a week later, I'll send you that link through. And uh that's, that's a uh now he, I didn't know what he was going to be like before then and he just broke my heart in the middle of it. All he goes on about his mom. He goes on about everything. But um yeah, so that's looking at at the audits and actually his end up it was getting him towards um and I've forgotten the name of them now. Oh, come on, help me social prescribers. So I my bit was like, can I just get him towards a social prescriber? I wasn't gonna fix everything. I wasn't going there stopping smoking with him cos he really wasn't ready. I thought a bit of tracking alcohol following up on his BP. So, yeah. So that's, that's so that's Sandy. Uh Yeah, heartbreaking. So that's, that's the two videos people, Michaela, especially when you asked him if he would like to drink less. And he said, yes, I mean, and then you explored the benefits of not drinking. That was so skillful. Well, that's very skillful. It's, that's just, that's just motivational interviewing, isn't it? That, that's those little tips though just to pick up and if you don't get it cos you'll see it on when you, when you get him in case you ought to watch the other one. Watch it later when he's not ready for smoking. I stay away. So that's what we're trying to tease out on the videos as well for that bit. Yeah, Monica, I think uh I can see your hand. Yes, I wanted to say it's, it's amazing, you know, having this sort of fly on the wall. You know, you always feel like you are. I don't know what's the right word, but you know, you're seeing something happening in real life and the reaction from yourself, Michaela was wonderful to see the care. I think somebody also put that in the chart. Um And you're right. I think in an NHS L check you don't know what the person is going to present what they're gonna say and whether you write with it or whether you stop them or, or, or samples them, I think it, it really has to be organic but I understand the time pressures as well. But this, I think, you know, and maybe I'm biased. I think that NHS health check is such a wonderful opportunity. It's making every contact count. You know, you, that could be the day somebody's put on a pathway to really improve their life or to get a car in so much needed that have not been able to present at a GP practice, especially to get that help. So it, it's just my chance to say thank you, Michaela and well done. It's been so much fun. Thank you though. It's horrible to watch yourself, isn't it? And all you can see is everything that you've done wrong as opposed to doing right? So I think the next bit is back to Monica. Is it? It is indeed. So Monica, uh we have now panel discussion and Monica will, you, you can take it on and manage all the, the panel if any questions. Yes. So it'll be good. Thank you. Um Na it'd be good to see all our panelists on camera if possible. I'm not sure how many of us are here. Um And I'm gonna ask you to introduce yourself. So I'll just mention your first name and then you can do your full introduction, see which barrier from. I know we also have Dahan, who is the star of that second video. Um If he's able to join us later, so somebody tell me when he's rejoined so he can introduce himself or you? Ok. And um, so we'll start with Carol. Um If Carol is online, if she can introduce herself, please. Thank you, Monica. Thank you everyone. Mia, this is really, really useful. I'm Carol. I'm a public health principal and I work in the London Borough of Barking and Dagum uh leading on NHS health checks as well. Thank you. Thank you. And you go to Gillian. Hello. Hello, everybody. Um Yeah, I'm Gillian Felli. I'm he head of disease disease prevention in uh public health in London Borough, Bromley. And uh leading I have been leading on the NHS health checks for a long time. I'm an a, I'm also a nurse uh by background too. That's fantastic. And then we go to Abraham if he's not. Um, afternoon everyone. Uh Ibrahim Khan public health programs lead and I work in London Borough of Tower Hamlets. Hi, everyone. Hi, Abrahim. Good to see you. And then we go to Jonathan. Hi, everyone. I'm Jonathan Hillbrow. I'm public health commissioning manager in Harrow. So, commission NHS Health Checks and not to 19. Thank you, Jonathan and, and lastly, Sheila, hello, everybody. So nice to see all, all of you. I'm Sheila Taylor. I work in London Borough of Green and I'm a public health principal too, just like Carol. And I've been around health church for a very long time. More a hands distance now. But before I was um I was with all you early birds. Nice to be here. Fantastic. So hopefully we should be able to get a good discussion going and Michaela is going to um let us know whether there are any questions in the chat that we need to cover. So we have some questions to start us all off and I'll start with Carol and Gillian first to answer this first question. So Carol first, how do you see the tr this training result pack improving the quality of the NHS health check locally? And then um Gillian if you could also answer that after um Carol and give you your own perspective on this. Mm mm Thank you. Yes, it's pretty good for my to see the other end because we're, we're sort of receiving the claims and working with the practices. But this is very useful for me and obviously for my team because um we get to actually understand the importance of being trained and um ensuring that the health professional is very competent. Um So for us I think it's gonna be a question of ensuring, you know, we sort of strengthen, you know, the, the, the, the, the staff who actually are conducting the NHS health checks and ensuring that we have some form of monitoring but not at a sort of not big brother monitoring, but ensuring that we do work closely with our practices by supporting them and sort of stressing that, you know, if you are going to be delivering the health check and we are going to be paying you for the health check, we do have requirements and expectations that the staff are going to be trained to ensure quality quality, not just um primarily for the patient themselves and ensuring that the requirements of what is required of carrying out a health check is actually being done. Because for example, we are looking at currently, we are trying to improve our quality uh internal process and we have gone through specific measures that we feel are important and from the checks and the claims we've been receiving. There's an, there's an element of query reporting recording that's not to the level that it should be. So we are just sort of assuming it's reporting recording as opposed to not bring it out properly. So we feel that how we can address the challenge is by ensuring that we do stipulate that every individual who's actually going to carry out this check is is trained and this will, you know, this resource will be able to sort of help us in terms of improving the quality process. Thank you. Thank you, Gillian. Um If you want to chip in and I think I'll open it to the, to the others, Jonathan and Abraham. If you and Sheila, if you want to, if you want to say anything after Gillian, please do. Yeah, I just think the videos are great in demonstrating the complexity of the, of the NHS health check. It's not just a matter of doing some measurements and, and that sort of bit, it's those conversations that you're having with people about what you're finding and what it all means and, and what they can do with that information. And I think that's the thing that I think a lot of people who are delivering the NHS health check maybe struggle with. And so I think these, these videos are going to be really useful resource into how, how can you phrase something? How can you, you know, address what, what words should you use? I mean, it, it obviously doesn't give you every scenario, but I think it can just be really useful to in that sort of thing and will help. Obviously, a quality health check is not just about taking all the measurements. You've got to have those that report that conversation, that motivational interviewing to be able to, you know, encourage and facilitate somebody to, to make those behavior changes that they need to make So, um I think it's a, it's a great tool and yeah, so I think, yes, it's, it's, it's going to help a lot of people, I'm sure. So can I chip in here as well? I think it's really going to add value, I think is what we're saying here to the weight of the health check. I mean, in terms of the competency and confidence of the staff, but also in the eyes of the local authority and in the eyes of the clinicians. So I mean, even within practices because I think health checks are amazing as, as um as has already been said, but they are not, they are not, we don't shout about them enough and these, these videos will enable us to shout about them a bit more, not just within primary care, but outside of primary care. They are just like a catch all for so many things. And yet you can see there are so many different things going on within that interaction in terms of rapport building and making every opportunity count and trying to get that teachable moment plus giving very important stats about someone's health. So I think it's, it's great. It's gonna add value to the weight of the health check in different audiences. Um and actually improve consistency. I would, I would hope in terms of the what we're doing across the boroughs. So if we're all, you know, it can improve consistency. So we're all singing from the same hymn sheet, sort of, I hope. Thank you. Yeah, Abraham II see for your, um, yeah, II make a great job, I think really, really good. Um, you know, I've been involved in NHS Health Check since it, it began back in 2009, 2010. Um, and it's very weird being a commissioner and then two weeks ago when, for the first time, because I turned 40 I was invited to my first ever NHS Health check. So I was all that build up, you know, for 15 years, working 13 years, working in one on one program. And finally, you know, getting, getting invited. Um my experience and I think I'm going to relate this to be the, the, the training as well. So my experience of when I just health check wall and I tried to keep my mouth shut because I just wanted to just be there as a patient, not as a commissioner in total, it was eight minutes that my NHS health checked lasted. Um I was not told what NHS health check is. I was just told we're just going to do some measurements, BP, weight and some blood. I said, ok, fine. They took my BP, they did my weight BMI was not explained. Um, took my cholesterol test, family history of diabetes CVD was not taken, no smoking history, no physical activity. Um, nothing really and even cure risk was not explained. And then I was told, ok, well, if you don't hear from us, it means that your tests are fine, but if there is any problem, then we will let you know. And that was it. I was on my way back. So I, so I felt it was a bit of a, um, um, I don't know, a very different kind of experience for me because it was such a long build up and then finally, you know, just being seen for like seven or eight minutes. And I just believe that although as commissioners we offer trainings that can be very descriptive, very theoretical. I think something like a practical video where they can actually see as you know, J and J the complexities of NHS health checks, you know what it actually involves how it all relates to the overall long term conditions, prevention. I think that is really important for even our health care professionals to understand that. So when they are seeing patients, they can actually have all that information and then present it in that way. So I think mine was a long winded one, but I had to say it. Well, happy birthday in the first I should say. And I'm really, really sad to hear of your experience. It's, it's awful for you to just have an eight check. You might as well have just, you know, completed a questionnaire at home so that I think we need to speak to the bar lead. For that area and get that sorted immediately. So let, let's catch up after this if it's in London, where was it? Where was it? When was it? It's not about maybe complaining. I mean, I think that's a question that will actually come a bit later about the barriers. I think the biggest barrier as a commissioner that we have seen is the time because it's only 10 minutes appointment. Although we do say in the service medications, no, it has to be two appointments, 20 minutes at least, but it doesn't really happen in practice. And most of these health checks are provided by a health care assistant. Although they are, they are trained, they can provide an NHS health check, but very rarely, they will have that input maybe from a nurse or a GP that sometimes you would require if like a bit more clinical management is required, which I think in some, a lot of cases it does happen, but maybe in some cases it doesn't happen. So, and I think that's an issue. I think that we are seeing across nationally. It's not just specific to maybe one particular GP surgeon or, or, or, or one particular bi think it's a widespread barrier that we have seen. Thanks, thanks Abrahim. Um And um, before we come to you, Jonathan, do you mind if we, um I see Dahan has joined us if he can briefly introduce himself and then we'll come to you, Jonathan. To answer that question. Oh, thank you so much. Oh, can you hear me? Ok and see me? Ok. Fabulous. Thank you. Um, ladies and gents. Thank you for having me on. My name is DSH and I'm actually a, a PCN pharmacist working in Southwest London. And I was very kindly invited by Mika to play the role of Sanjeev as an individual who has got struggles, who's got pressures with family, who's got a cardiovascular risk and a person who generally doesn't take care of himself as a result of the cost of living, the cost of food prices, you know, fruits and veg. Sometimes it's easier to get a fried fried chicken in our outlet. You know, on the way home from work from a sedentary works style and concerns that people like myself who I've seen working in, coming into my own practice in Morden do sometimes face because they are working hard. Alcoholism is a big issue, especially with maybe the stresses and difficulties in having that escapism. And because of the lack of escapism, the lack of people to talk to because it's a taboo and a lot of ethnic minorities, mental health is like, oh, we mustn't talk about that. Don't talk about that. You know, someone's going to think you're like, you know, a looney and I find a lot of that happening with my patients. So the as kind of patient I was trying to depict. Um but I also like like Ibraham have undertaken a health check as well and it difficult to separate when I'm doing like, you know, Q risk to what another person might be doing it because they know I'm a pharmacist as they kind of like assume, ok, you know, this anyway, so, you know, your Q risk is like, you know, 11%. And, but I guess the narrative behind that needs to be a bit more robust and take time to explain what this risk is in terms of what they need to do and what they need to know about. Because ultimately, it can affect their life going forward and they can go in that sort of detrimental effect if they don't change anything. And we've got to be the mechanisms of change for our patients going forward. But yeah, really interesting. And I hope Michaela, I did you guys justice. We've seen you, we've seen you and actually you're great because you're seeing so different than Sandy who was and we saw you with the, when we did the audits and the alcohol bit there. So, thank you a huge, thank you Darshan for playing a, a heartbreaking Sandy. I'll have back to Monica and then Monica, once you do the, I'll um I'll pick up the questions in the chat, but back to you Monica. Yeah. So I'm going back, I'm going to Jonathan. You, you, your, your, your thoughts, please. Yes. And thank you for this Michaela and it sort of really makes your training effectively available on video to everyone, which I've always over the years found so helpful. I, you know, echoing what others have said, it's such a deceptively complicated program. Everyone always thinks, oh, it's dead easy. It really, really isn't. This is about doing the basics well. And having just brought since, since April the health checks program back in house before it was a top tier provider who used to manage it. So we didn't have the direct contact with practices and I've started to go into practices which in itself is obviously very difficult but getting in there talking to practice managers observing health checks and it's really shocking, you know, having been on Michaela's training and seeing, you know, it's on the video as well. Nurses don't know how to do BP, taking all the different things into account that you go through Michaela in the video or practice managers who their processes, they do the bloods and if there's nothing wrong with them, then the health check is done. They don't even follow it up. They see it as a screening program, they don't see it as a whole package, which is about creating teachable moments. Well, before anyone hits any thresholds for real proper clinical interventions. So hopefully, this can only help having the video to make that kind of learning accessible much more widely. Can I can I just add in? It wasn't just about my training though this is the video separate, it's to complement whatever training is going on out there. I mean, I do some training but not all of it. So it is about complementing. Yeah, because there's lots of different training providers. I think we, we have to make that absolutely clear. Watching the video does not train you to deliver an NHS health check. There is I, I've, I've actually joined one of Michaela's wonderful online training sessions and I tell you what, it's very clinical. There's, you know how you take your BP, how you, you, you um calculate the cure rate. It goes into so many different components which we don't touch here in any shape or form. So having that 1 to 1 training is really important. I think this video is just to give all of us an insight of what an end to end conversation looks like. What can, what can come up, how you react and also give commissioners a window because commissioners, most of, I think a lot of them, not all of them have just commissioned it on paper. They haven't actually sat through one yet. And so this will give them an insight of something they are commissioning but haven't actually seen in practice. So I think this is really powerful stuff. Um And I want us to take a question from the audience. We do you have any questions from the audience before we go into an uh another question that we have. I do, I've got a few here. So one is around the timing which we've already started to touch on with Abraham. So we've got somebody asking about how long should a health check take, how long? And I think there's something different between take and, um, and should be commissioned. Um, there's another one asking about all the numbers of health checks being cut next year. So I don't know that's from Kim and Jack. So I don't know if they're from a specific area and they're the two main ones I would say for now is timing and, and, and, and all the numbers being cut. All right. Um I don't know which commissioner would like to take it first, would like to comment. Should I pick one? Should I go for it? I, I'll pick Carol. What, what do you think about timing? Thank you. Well, I think um Michaela is very experienced. So obviously depends with your background because she's a nurse. Someone said healthcare professionals will be doing it. But I think at least, um we're looking at 20 minutes 15 to 20 minutes, depending on the pressures and also depending on the practice, depending on the number of people that need to see. But I think it's just ensuring that um the key elements are actually being covered. And for me looking at the second patient, what presented to me was mental health, you know, and I think it's, it's, it's just obviously, it's specifically for your physical health, but it depends on what you pick up. And the way um Michaela was now addressing the alcohol and going a bit deeper. And that, so that is all subjective, but there has to be a minimum sort of requirement of just ensuring the whole template, the whole process has gone through if there's additional time and you've got this further skill to then dwell the areas that are presenting to you highlighting to you, then that, that can be the case. But at least, I think at least 20 minutes, 1520 minutes minimum. I would say Carol, I'm going to jump in. If you write down 15 to 20 minutes, your practices will only ever give people at the max 15. You'll find it really hard to get 20. Um, and I know because I go around everywhere. So if people say 20 minutes, sometimes they'll squeeze them down to 15, we've got quite a few here that give 30 minutes. And I always say to people, well, if you commissioners, that's what you're paying for. So we've got 30 minutes in Bromley, 30 minutes in Bexley. If you're using point of care, you're gonna need that extra time because you're, you're doing those extra bits, Emma from, she's near, um, she's in Southwest London is 20 minutes. So 30 minutes in Greenwich. And I, so I think, and particularly for those areas that have gone, um, who have gone and added a mental health. There is longer that is needed to be able to do it because there is something about that. Can Sheila? I can see it coming in. Yeah. Uh before Sheila can I just jump in? Because I think I want to be devil's a advocate to Carol's point about 15 to 20 minutes. Because I think as we were watching the video, somebody said something about the time it takes to complete the template. So that is just typing to the system. So if you're giving a healthcare assistant or healthcare professional, 15 minutes, at least five minutes is going to be on typing. Unless you know, they, they can type very, very fast. And also what time would they have to explain the results to the patient? So basically, all they're probably going to do is just take measurements, won't give advice and probably will not complete a template very well. Anyway. Um So, II, you know, I would say this, this, watching this video gives us the opportunity to go and think and we look at how we commission the service as well and, and, and you know, and, and try to make the most of this opportunity when we've got somebody in front of us that we, we use in that time to the optimum. Um I'll go to Sheila that yes, thank you very much. Um I was going to say if you don't have at least 20 minutes, then I would suggest 30. I think we are missing a trick because it's the quality of the intervention as well as the intervention. So being able to take the measurements, put a complete and accurate data set into ami to actually do a complete health check for practices to get their funds. If you don't actually give the relaying the communicating the message of risk and the behavior change aspect is skillful. You know, it's not just about an information dump on someone about their results, it's about negotiating. What are the next steps? How might people then go forward from here making those referrals? So if you want to refer to a social prescriber, a care coordinator in house GP whatever, but then you have the structures that you can refer out of the health check to as well and all these things take time and need consent in a way. And if you haven't built that rapport and you're just doing a health check to somebody that's a very different feel to doing a health check with someone, isn't it? You know. So I think the 20 minutes, I mean, we had people in Greenwich when it used to be in practices that would get the women on the couch to do a smear if a person was due a smear within the health check. So, you know, trying to make that make, make the 20 to 30 minutes count a bit more. We there is so much pressure on the health check time as we are looking at the CVD priorities and how we might change our health check. And so in Greenwich, we've already got cancer. So looking at cancer screening in Greenwich about, are you up to date with your cancer and the mental health stuff? So there's a big pull on what we might do with health checks going forward. So we're not going to reduce it. We're trying to keep hold of that time, but also don't forget digital is flying down the pipe. So just to put that in there, II want I know we, we, we, we don't have a lot of time, but there's one particular question I wanted us to cover what and it's what do um um commissioners have to actively do to improve the quality of the NHS health check, noting the different providers because at the moment, we have so many people and, and Jonathan has alluded to it. Now, you know, we have GPS who, who are doing it directly. Some people are using their primary care network. Some people are using the GP Feds. Um I are using pharmacies and people of now using um com community providers. And how can we receive feedback on the quality of the NHS health check is my concern. So we've got two people in the room. Um Abrahim is actually tested the system. He had eight minutes check. Now who see tell that I had just checked eight minutes, I felt rushed. I didn't even get a chance to say anything about my background that my mom has had a stroke or my father's had something else, you know, to get my history. Who, who did they speak to? So how do we, how do we, how do we get this feedback? I want to, I don't want to tell people, I want people to tell me what they think would be the best way to do that. And um nada, please start us off. Well, um I think what is really interesting at all this debate is getting patients feedback. And the reason I'm saying that because um we had, we Bromley had, I think for the first time ever, we've been Gillian and I have been doing this for donkeys years. I'm not going to say how many we had for the first time, complaints from patients, two patients, not 12. Um So I think there is something about engaging uh people and Julian and I were discussing why suddenly this. And we think we think that this is because Julian has put um the council sent some kind of leaflet about council tax or whatever. And we, we have been asked if you wanted to add something about uh help and Julian has put um think about, you know, health checks, this is what you should expect and that what maybe we think might have prompted people. So maybe isn't there something to try and communicate with people. Firstly uh about invitations, I think like we had with this particular patient. Uh people are not invited. II must admit. Now, in so many people here, I am 63 years old and I have been invited only once, three years, four years ago. No, it was. You don't look it, nada. You don't look it. Well, that's very kind, but that's the honest truth. I'm not going to tell you that I was told to lose weight and I'm only my BMI is 22. But you know, that's beyond the, but I was invited first time when I was 60. I think so, you know, there is something about that a lot of people don't know about health checks, but maybe if we manage to communicate and I think communication somehow I'm not saying that this is the, the only way, but let's try and think about communicating somehow with patients. Thank you, Nada and Abraham, please. Yeah. II totally agree. Uh Nada. Um We ent Hamlets, we sometimes would receive complaints and then we would obviously respond to those. Uh sometimes patients can um directly make complaints to their, to their GP practices or practice managers as well, they have their own platform. Um But I totally agree. Now, in so in my case, or in similar situations where I mean, I knew what an NHS health check is what the expectations are, but a regular patient does not know what an NHS health check is what the, how it is conducted, what information you know, is, is given us. So you, you have absolutely made it in, in this head that if we promote it properly, if we give out proper information, then patients know. So when they are coming in, they are already prepared for it. And then the other bit is around the feedback, then they can give us the honest feedback. In other cases, if somebody's BP is taken and blood tests are done, they just leave happy. They are like, well, that's fine in my, I'm, I'm happy just with this because they don't know what, what more, what more uh sh should be there. Yeah, Gillian. Yeah, a few years ago we did a sort of satisfaction survey and it actually asked specific things, you know, was this, you know, how was this explained to you about, you know, physical activity about the, all the different elements? And so people could actually see, well, actually this should have, this should have been included. So, um I mean, you know, on the whole that people were very satisfied, but it is maybe a way of getting the feedback from people, but also highlighting to them what they should have received. Um So that if they didn't receive it, you know, what was the, what was the issue? And that's, you know, potentially something that we could implement on a, on a London wide level, you know, we could all use a similar, similar satisfaction. I mean, some people might be doing it anyway. But it's, um, it was, it was, you know, valuable, I think. Yeah, that, that, that is what I was hoping. Um, it was going to come out of this conversation, um, having some kind of satisfaction survey done and I was even thinking something really short, maybe three, you know, five questions maybe. And, um, you know, now you could send links to people's phones and they could complete them or as you come out into the main reception area in my GP practice a little um ipad and you quickly put in your information before you walk out of the door. So there some, you know, we've got a tech now to, to streamline this informa you know, this feedback process. Um Jonathan, did you want to say anything? And then Carol? No, you have nothing, Carol. Do you want to say anything about this question? Yeah, I think, yeah, feedback is, is, is very important and it's something we need to cause I was actually thinking with a different hat that if we manage to do like a pilot of the whole journey, someone gets the whole check. Um We follow them through in terms of the follow up. So in terms of, did they actually get any information, did they actually go to the services that were referred to? And what was the outcome sort of sort of like doing a study, you know, from the beginning you came and you presented like ABC and D the interventions, the advice you were given and what you actually did and then the results I was just thinking of that, you know, that would be ideal to just follow up because it's like at the moment, for example, we just know they're being done. But again, what's happening afterwards, you know, what's happening, what's the patient's experience after? Were they given all the information they needed? Did they actually attend the, you know, the places that they were signposted? Did they get the assistance that, you know, they needed? So, for me, I think it's an area that we do need to, to look at incorporating um as we continue to improve the service. Yeah, I II was gonna ask Michaela, how are we doing for time? And can we ask one more question or are you going to move us on to the next item? I, no, no, no, we can, I just, I just put my hand up briefly because there was one question before we go to that, I just would like to go back to if that's all right before then we, yeah, so it was from Bexley and wanted to know what training should people attend? Because that really is also part of the quality. Um And is it that we just do the e learning for health module which hasn't been updated for ages? That's not really fit for purpose. And this, these videos are intended to complement whatever whatever training that is commissioned in your area for providers. Now. Um And there was, there was different training providers out there. So I would suggest to you look at the competency framework, work out what your area needs, what your area wants be. Um They're usually quite good at turning up at training, I will say. But um, yeah, so you need to as a commissioner think about what you're there and I can see Sheila, you're nodding a lot. Do you want to add, add something to, to it's Jackie from Bexley. Oh, no, no, I was just going to say, I suppose when we commissioned our health checks out to our federation in our specification, we said what they needed to have and the basis was the RSPH understanding how to deliver a health check is what we did and we did it. We became a training site ourselves in Greenwich and we provided that to our healthcare assistants and to the federation. But as time goes on, things change, people move. So it is about keeping on top of this and actually going out and quality, assuring the checks yourself, the commissioners. So getting really involved in the program, shouting about it too. Local councilors at management meetings at just getting the word out there, but almost co producing stuff that's going out with the Federation. So it's not just, it's, it's working with not working too, if you, it's a way of working, I suppose that you're going, you're getting involved in what's being delivered. And I can see Sarah's put on here. So this is what we do in Greenwich about our friends and families. Thanks, Sarah. Yeah, I think that is great and I love the, the, what, um, Bromley have done and put in a little note in the council tax, um, letter which goes through, you know, almost every household or every household. And I think that is a win, win. Uh, you know, if you could, if people could look into that, I think that would generate a lot. It's a soft invite. It's, you know, and a soft promotion, but I think very, very effective. So I think that is fabulous. Absolutely. Can I, can I come in there? Sorry. Can I just check that is, is the council tax, is it to everybody? Because my, my worry about this thing is just about how to manage expectations when we do this blanket invite and then you get people coming back and you have to say no, you're not eligible. No, you're not eligible. So I suppose that's always been my issue, but great to know that it works. Thank you. I think, yeah, I mean, I it was a newsletter, I think on a range of council stuff that had the health page in there. So various little public health messaging in there, whatever. We wanted to get out to people. But NHS health checks was one of those. And II did, I think II had to think about the words carefully but did put in the link to our council website as well to so people could check if they were eligible or not because obviously you don't, you know, you don't want people saying, oh, I have no other health check but actually they're not eligible at all. So, um yeah, so, so I have to think of the words carefully, happy, really, really helpful. Thank you. I, I'll just go probably to our last uh last questions. Um So I had a question about what would the barriers be to try to improve the quality and how can we mitigate them? Anybody wants to go first on this, I'll go, I'll choose Jonathan because he's been so quiet. I mean, I II think the, the linchpin of any GP practice is the practice manager and that if you've got them on board, that's the key battle and it's hard work and it's individual work. I find it's no good turning up to the practice manager forum and doing another presentation on health checks. You have to develop individual relationships with practice managers um to walk and talk them through it and you know, that just helps and somehow you can get messages across more easily. Like for example, the number of coughs that they'll hit in addition to the payments, they get for the health check and all those other things and iron out all the queries, you know, that they bring up about. Well, we've got problems with resources and then you can, there's usually solutions you can find, but you have to know what they are. That's fantastic. Thank you. Um Gillian. Did you want to say anything about barriers? Um Yeah, I suppose, I mean, because obviously we talked about the time commitment, didn't we? For, for, for staff getting staff trained? Because it was always a challenge. But I do think, yeah, I mean, what Jonathan said is quite right is, is like making sure that that practice and actually appreciate that if you get somebody properly trained for an NHS health check, they're not just changed for an NHS health check. Those, those benefits of being able to have those conversations with people, being able to do all the measurements correctly go all the way across long term condition management, all all and, and all sorts of other things. So I think it's, it's actually, I think in Bromley they really appreciate it, you know, the, the um the, the quality of the training they get uh because it, it, it clearly has knock on effects and, you know, adds to their c et cetera. So I think, you know, it's hopefully you can commission for it, you know, that they, they have, you know, training to meet the competences and the um and that you know those e emphasizing those benefits as well so that they can, yeah, hopefully get on board with it. Abraham, you've got your hands up. Um I would answer this question from um uptake point of view. So currently we are conducting just a review of our NHS health Checks program, just the uptake and, and the outcomes and the initial findings are that the lowest uptake we are seeing is among the younger white male population, 40 to 50 in comparison, same age, we are actually seeing a lot better uptake in the South Asians, the BME a lot better uptake than white. And I think that's something as providers were also on this call. And commissioners, I think we just need to understand a little bit more. Of course, the barriers are that maybe younger white population, they don't see CVD or diabetes as a risk to them at that age, but still we need to engage with them and it could be a different way of working, how, how we normally do just to engage, engage that group. Yeah, thank you, Abraham. Um Anybody else want to chip in? Got a hand up again or? Yeah, Gillian, I have. Yeah. So ju just thought of another barrier really that um that we wrestle with in Bromley because the using the national competency document, it is very long and, and not terribly user friendly and uh but we are, you know, really keen that people do get signed off as competent. But, um, uh, we're sort of reviewing our support practices at the moment and I'm worried that if we don't, if we don't hand, hold them through they, they won't do it. So I'm just not sure of the mitigation for that. Um, I'm not sure. I've got a, a mitigation for the, the national competency document, whether anybody else has come, you know, got any good ideas about that. Yeah. Sheila. sorry, mine's not about the mitigation. II don't know Gillian. I was going to say about funding and commissioning arrangements and the big big um a big thing about money, you know, about cuts and all the rest of it going forwards. Um I think there are big squeezes on, on funding in local authorities. We have to lose 30% of our public health budget going forward um for the local authority, not just public health and public health has to support that within the local authority. So there are knock on effects to what we're going to be spending our money on. And I know that we have to, it's ring fenced for the health checks, but we our commission of providers will now want to the amount of people that we need to get for that money will increase as time because we're going to want them to do other things too. So I think money is a big deal. Lack of funding is a big deal. So that's all I wanted to add there. Thank you. Thank you very much. Um, Panelist, you've been fantastic and very honest um with your comments and given us lots of food for thought. Um We will pick some of these issues up at our own Bespoke London network meetings to carry on this conversation. Um But I'm now gonna hand you back to Michaela. So we, we finish in good time. Thank you very much and it will thank you. It'll just be, I'll be very brief now because there are some other elements Monica mentioned, there will be a questions and answers document that supports the resource packs as part of the resource pack. Um And just, I've got some sample questions that we started to think about. I'll share it with you now. Um And I split them into three sections and these are the ones that we started to think about was and, and we've got to think it's around this quality and training because that was the scope of the commission for this piece of work. So we thought about training for the check during the check and around quality and improving the check and then also signposting to other training. What I'm mindful to do, Monica is to share this afterwards um out to people and let people give feedback if you think if you could pop anything in the chat now where you think this looks like a good question, add in another question. So I'll just very briefly read them out for you before I go to the last bit. So, I mean, that's, it almost picks up what, um what, what some of the questions have been on, who can do the check how much training is needed does watching the videos mean that you don't need to a training, attend training? When could the videos be watched? How might you build training at these videos into your training plan? And I will be looking for um, we know that we can't. So we want to do the question and then we'll do the answers, but actually the answers might be slightly different in each area. So we've kind of got to come up with a Pan London response to this. Then during the check, things like which templates should be used. And for this one example, I'd be saying, find out with your commissioner, which is the one you should be used. So I know for example, one area says you've got to use E version three, but actually practices will say, oh, just use Ardens, we use Ardens for everything, then you get the wrong data back. Um There's a really big issue about is the health check in two parts. Do we do bloods? The dementia leaflets? That's a huge issue that we haven't got anything and we've got to send it out as a link. I know it's a bugbear of mine, the handouts booklets and, but I think it, it should be, there's so many bloody leaflets out there, we should be able to have these ones and about improving the quality of the check. So, for the, so are we getting, I, we'll send these out for you and I'd really love you to add value. If we get the questions right, then we can start to get the answers, right. So, I, I'm really keen to get the questions right first. And so the final bit is about how can you access this? So it will be on the A DPH London website. We were hoping to get the link to it on ready for the launch today. But unfortunately, Monica's had an out of office from them. So from the person that would be doing it. So we're hoping it should be available within the next few days. What that will do is take you the link that you direct to a dedicated web page, which will give a bit about the health check. Why you use these resources. What it's about to be able to click on the films, both of the films and watch it as well as see that there is AQ and a pack coming to be able to access these though. Um People have to because they're intended for healthcare professionals, not the general public. We wanted to make sure that it's it's accessed in a safe way. So we use a platform called Medal for this stands for Medical education for all and people need to register and we have at the bottom of this web page, it will have how to register for that. If you've got an HS email address, it's really easy. If you've got a.org email address, it's really easy. So, and, and even if you haven't, it's still, you can still access it. So it's a safe place where people, we know that people can go in and people are using this all the time. I use this all the time for my training. And also we are able to uh for people to watch this, they can watch it and they need to watch 80% of the video before they can get close to doing an evaluation and gaining the certificate. Now, their certificate will say that you have watched, you know, one video for X amount of minutes of X amount of stuff. It will, it will be really clear. It's not that you're able to do a health check, but we know that people want to collect certificates. So we will be able to collect evaluations. Now, the evaluations we've agreed with Monica that um we will report back to Monica Monthly on how many people are accessing it and which boroughs that they are from? We will be able to ask that. And also has it changed people's confidence in, in one, you know, in ability to have these conversations. After the end of six months, we will, it will still be available, but we'll stop counting in quite the same way in that every month way just because it goes beyond the, the contracts as it were. And so that's, we'll let you know as soon as that's ready and that is me done, Monica. I think it's over to um not, not, not a thing. Summary. Thank you. Thank you all very much. I don't know to come to a thing first. Obviously, Monica and Michaela, both of you have done a splendid job for bringing us all together, bringing the Panelist on, bringing all this, organizing it all, making it of the sort of, you know, gender flowing smoothly. So I'm, I'm, I'm really, really thankful for, for all this. It was really interesting uh session. Uh I've, I've been, as I said in this, this just health check for donkey's years, but I've learned a lot today, which I didn't know which I think is great. So, um and we are really on time in 15 minutes past three. So great. What else can I say? I think for just a certificate, Michael? I did just say that people can put um in a chat if they want to have a certificate. So please do I tell you what? Yeah, so you will get pop in the chat and what we can do yet. We'll leave the chat open, pop in the chat and then we'll follow up with a certificate as well for you as well. If attendance. Thank you. And I want to say thank you as well to everybody for joining us and if you are delivering the health checks, go on delivering it to the highest quality. Yes. Thank you. Thank you brilliant much, everyone and I I'll see you for some of you very soon actually. Exactly. See you later. Thanks a lot. Thank you. Thanks. Bye.