6. Recommendations
This report makes 17 recommendations split across six core themes.
Theme 1: Improve early detection through targeted outreach
1.1. Adopt a more targeted approach to cardiovascular case-finding
Prioritise proactive detection of cardiovascular risk factors amongst groups at greatest risk of poor outcomes and underserved by existing services, including men, younger eligible adults, global ethnic majority communities, inclusion health groups, high risk occupations, and those living in deprived areas in Camden.
1.2. Expand community detection opportunities
Build on the success of existing initiatives like outreach via the Health and Wellbeing Bus, community pharmacy blood pressure checks, workplace health check pilots, health kiosks. These initiatives provide cardiovascular risk assessment in settings that residents already use and trust, including workplaces, community centres, faith venues, and other neighbourhood locations.
Theme 2: Embed community-based approaches in partnership
2.1. Strengthen collaboration on community-based initiatives at a local level, including how data flows between partners
Strengthen connection and collaboration on community-based initiatives at a local level, for example via developing Neighbourhood networks. This collaboration could facilitate integration of community-based interventions into existing routine clinical and system pathways to ensure adequate follow-up, management and referral.
2.2. Develop a Camden Heart Health Ambassador Programme
Through standardised training, establish a network of community ambassadors to promote heart health and blood pressure detection, support and empower residents to access services, and provide culturally competent peer support within local communities.
2.3. Develop culturally competent materials and approaches to reach high-risk communities
Work with trusted community organisations to reach at-risk populations in Camden, ensuring interventions and materials are culturally appropriate, locally relevant and informed by community insight.
Theme 3: Improve the quality, reach and impact of NHS Health Checks
3.1. Enhance awareness and uptake of NHS Health Checks
Implement targeted communications and invitation approaches to improve awareness of NHS Health Checks, particularly among groups with lower uptake, including men, younger eligible residents, global ethnic majority communities, and the digital pilot where available.
3.2. Ensure health check risk assessments are fully complete, with appropriate follow-up and referral pathways
Ensure that every health check adheres to the best practice guidance encompassing risk assessment, clinical assessment and risk management. This should be accompanied with clear communication of test findings, informed and personalised advice, and referral to appropriate clinical, behavioural and community support services where required.
3.3. Develop NHS Health Check delivery models outside of primary care settings
Continue developing community and workplace-based outreach models, using consistent protocols, quality standards and referral pathways, for example delivery via the Health and Wellbeing Bus.
3.4. Improve data quality, monitoring and evaluation
Strengthen recording and sharing of health check data across the pathway to enable routine monitoring of completeness, equity of access, referral activity and service impact.
Theme 4: Harness technology and innovation
4.1. Promote innovative technologies for early detection, such as health kiosks
Promote the use of blood pressure kiosks and community health pods across Camden, particularly in high-footfall and deprived areas, ensuring strong links to primary care systems so that abnormal results trigger appropriate follow-up.
4.2. Continue to evaluate digital approaches to NHS Health Checks
Continue to monitor and learn from the NHS Health Check Online pilot, while ensuring that digital approaches complement rather than replace face-to-face services.
4.3. Leverage population health management and case-finding tools to enhance early detection
Continue to develop and promote data-driven case-finding tools that can be used by primary care to identify residents with potentially undiagnosed or poorly controlled cardiovascular risk factors.
4.4. Explore the role of digital self-monitoring
Explore opportunities to use remote monitoring and digital technologies to empower patients to monitor and manage their own health, using integrated platforms to share data directly with their GP, for example, home blood pressure monitoring.
Theme 5: Raise awareness through a local heart health campaign
5.1. Deliver a borough-wide blood pressure awareness campaign
Develop a Camden heart health campaign aligned with London Million Hearts and Minds and national campaigns such as Know Your Numbers, using consistent and evidence-based messaging.
5.2. Tailor communications to communities experiencing the greatest cardiovascular risk
Work with residents and community partners to develop culturally relevant and accessible communications by using formats and channels that people trust and regularly use, including social media, community networks, local radio, WhatsApp and faith settings.
5.3. Translate awareness into action
Ensure health checks and blood pressure checks are linked to wider behaviour change campaigns and support pathways, across a range of risk factors (such as smoking, nutrition, physical activity) so people know how they can take action to reduce their risk of a cardiac event.
Theme 6: Working together in partnership
6.1. Establish a Camden Heart Health Partnership
Bring together public health, primary care, pharmacies, community providers, VCS organisations, residents and other system partners to oversee implementation of this report’s recommendations, share learning, coordinate activity and drive progress towards reducing cardiovascular inequalities and improving heart health outcomes across Camden.