Open Access Highly Accessed Research article

Postcode Lotteries in Public Health - The NHS Health Checks Programme in North West London

Clare EM Graley, Katherine F May and David C McCoy*

Author Affiliations

Public Health Directorate, NHS Inner North West London, 15 Marylebone Road, Westminster, NW1 5JD, UK

For all author emails, please log on.

BMC Public Health 2011, 11:738  doi:10.1186/1471-2458-11-738

Published: 28 September 2011



Postcode lotteries in health refer to differences in health care between different geographic areas. These have been previously associated with clinical services. However there has been little documentation of postcode lotteries relating to preventative health care services. This paper describes a postcode lottery effect in relation to the NHS Health Checks Programme (a national cardiovascular screening programme in England) in eight PCTs in the North West sector of London.


A descriptive cross-sectional analysis of the Health Checks Programme was carried out in eight PCTs in North West London using a structured data-collecting instrument.


The analysis found variation in the implementation of the national Health Checks Programme in terms of: the screening approach taken; the allocated budget (which varied from £69,000 to £1.4 million per 100,000 eligible population); payment rates made to providers of Health Checks; tools used to identify and measure risk of cardiovascular disease and diabetes; monitoring and evaluation; and preventative services available following the health check.


This study identifies a postcode lottery effect related to a national public health programme. Although it is important to allow enough flexibility in the design of the Health Checks Programme so that it fits in with local factors, aspects of the programme may benefit from greater standardisation or stronger national guidance.