POCT Healthchecks

Purpose:
The NHS Health Check is a prevention programme which aims to reduce the chance of a heart attack, stroke or developing some forms of dementia in people aged 40-74. It achieves this by assessing the top seven risk factors driving the burden of noncommunicable disease in England, and by providing individuals with behavioural support and, where appropriate, pharmacological treatment.

PHE NHS Health Check – Best practice guidance, 2019, For commissioners and providers
Responsibility for delivering this programme including the testing process has been devolved to Local Authorities in the first instance. These diagnostic tests include Cholesterol as part of an initial assessment of cardiovascular risk in all individuals, with either an additional fasting plasma glucose test or HbA1c offered for those at high risk of type 2 diabetes.

The WHO did not provide specific guidance on HbA1c criteria for people at increased risk of type 2 diabetes.
However, a UK expert group on the implementation of the WHO guidance recommends using HbA1c values between 42 and 47mmol/mol to indicate that the individual is at high risk of type 2 diabetes.

NICE public health guidance 38: Preventing type 2 diabetes: risk identification and interventions for individuals at high risk, supports this recommendation and requires that HbA1c tests, including point-of-care tests, conform to expert consensus reports on appropriate use and national quality specifications The tests should only be carried out by trained staff.

Scope:
Weqas provides 3 different Programmes for HbA1c based on the clinical utility of the HbA1c test. This programme aims to assess the performance of organisations undertaking population health check screening, the NHS England Health Check Programme and independent pharmacies providing private services. It is designed to assess the performance of POCT applications using capillary whole blood samples for Lipid and HbA1c testing.

Separate programmes are available for Laboratories or organisations using HbA1c for diagnosis and monitoring diabetic patients.

Fresh EDTA whole blood from healthy volunteers and individual diabetic patients are distributed monthly / bimonthly. These samples reflect the wide range of HbA1c and Lipids seen in healthy individuals, at risk individuals and in diabetic patients.

The HbA1c reference target values in the Weqas programme are assigned using IFCC secondary reference methods in an IFCC network laboratory. The programme allows for the assessment of the organisation’s and method’s performance, including linearity, trueness, bias, and imprecision. The acceptable performance specification used in this programme reflects the requirement for screening within the population and is less stringent than the Weqas Programme for HbA1c Diagnosis.

Key Features:

Whole blood samples are collected from healthy volunteers and patients with Type II Diabetes.
Samples cover non-diabetic, at risk, diagnostic, pathological and analytical ranges.
Scoring based on Milan Model 3 performance specification.
Programme assesses both laboratory and method performance, including trueness, bias, within and between batch imprecision.
Trueness is assessed using the IFCC secondary reference methods.

Frequency:
Monthly / Bimonthly

Samples:
2 x 0.2mL (monthly)
2 x 0.2mL (bimonthly)
1 x 0.2mL (monthly)
1 x 0.2mL (bimonthly)

Material:
Fresh EDTA whole blood

POCT Healthchecks Programme
Analyte	Approx. Range Covered
*HbA1c	32 - 85	mmol/mol Hb
Cholesterol	2.5 - 7.0	mmol/L
HDL cholesterol	0.4 - 2.0	mmol/L
Triglycerides	0.5 - 7.0	mmol/L
Non-HDL Cholesterol (calculated)	1.5 - 6.5	mmol/L
LDL Cholesterol (calculated)	1.0 - 5.0	mmol/L