Over-40 health check: what should it include?

Forty tends to bring a little more attention to your health. Friends start mentioning cholesterol, a letter about the NHS Health Check may arrive, and you start wondering what a good check at this age should actually cover.

The NHS Health Check is a sensible start, and it answers a narrower question than a private assessment does. It looks at your risk of heart disease and stroke. A doctor-led MOT adds a GP examination, an ECG and a much broader blood panel, read together by the doctor who examined you.

If you already know you want that, compare the tiers of our full body MOT, or book the Essential MOT at 117a Harley Street for £495.

Who can have the NHS Health Check?

The NHS Health Check is for adults in England aged 40 to 74, and you should be invited by your GP or local council every 5 years. It is designed for people who don't already have a diagnosed condition, so you won't be invited if you have any of these:

• heart disease, heart failure or atrial fibrillation
• high blood pressure
• diabetes
• chronic kidney disease
• a stroke or transient ischaemic attack (TIA)
• inherited high cholesterol (familial hypercholesterolaemia)
• peripheral arterial disease
• a current statin prescription, or a previous check that put your 10-year cardiovascular risk at 20% or more

If one of those applies, your GP should already be monitoring it, and a private MOT can still sit alongside that care.

What does the NHS Health Check measure?

The check usually includes your height, weight and waist measurement, a blood pressure reading, a cholesterol test and, where appropriate, a blood sugar test. You are also asked about smoking, alcohol, physical activity and family history, and your age, sex and ethnicity are recorded.

The results come together as a cardiovascular risk score, described as low, moderate or high. You also get separate feedback on BMI, blood pressure, cholesterol, alcohol, activity and diabetes risk. It is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and dementia. If you are eligible, have it: it is free and it looks at the risks that matter most at this age. Our sister clinic, Health Screening Clinic, explains how a health MOT over 40 differs from one taken earlier.

Which NHS screening invitations come after 40?

The Health Check is only one of several NHS invitations in midlife. This is the timetable for England:

NHS screening in England for adults (NHS screening programmes)

The gaps in that table are where people most often ask us for help. If you are in your forties and would like a mammogram before your first NHS invitation, a private mammogram is £245. If breast or ovarian cancer runs in your family, our guide to BRCA testing explains who qualifies for genetic testing and what it costs.

What does a private over-40 health check add?

A private check adds a GP consultation and physical examination, a 12-lead ECG and a much wider blood panel. A doctor reads them together, rather than a questionnaire doing the screening. Our Essential MOT is a doctor-led baseline for adults from 18, and at 40 it covers the NHS Health Check measurements plus a broader set of blood tests and an examination.

What each check includes

Essential includes a GP consultation, a structured physical examination, a 12-lead ECG, body composition analysis and urinalysis. Its 60+ markers include full blood count, iron and inflammation, cholesterol and triglycerides, glucose and HbA1c, liver function, kidney function including eGFR, uric acid, calcium and bone markers, and basic thyroid function.

Advanced adds a chest X-ray reported by a radiologist, spirometry and a VO2 Max fitness assessment. The blood work gains a full male or female hormone profile (LH, FSH, prolactin, testosterone, oestradiol, SHBG and FAI), an advanced thyroid panel with antibodies, and vitamin B12 and D. It also includes four GP consultations, unlimited in duration, over the following 12 months, for you or your immediate family. Our Essential or Advanced MOT guide compares the two in more depth.

How common is an abnormal result at this age?

More common than most people expect. In a snapshot of Medical Express Clinic MOT results completed between April and August 2026, 47% of screenings that included cholesterol markers had at least one high cholesterol-related finding. That is what we see in our own patients, not a national statistic.

A single high result isn't a diagnosis of cardiovascular disease. Results outside the range can be temporary, need no treatment, or be affected by medicines and supplements. What the figure does show is that the included results consultation does real clinical work. Where a treatment plan is clinically appropriate, it is agreed at that same appointment at no extra consultation cost. Prescriptions, medication and any repeat testing are charged separately, and an MOT is not insurance.

Dr Mohammad Bakhtiar, the clinic's screening clinical lead, puts it this way: "the right MOT is not automatically the one with the longest list. We look at age, symptoms, family history and what the patient wants answered, then choose the level of investigation that is likely to be useful."

Does an over-40 check include a PSA test for men?

PSA sits in the Elite MOT rather than Essential or Advanced. There is no national PSA screening programme in the UK. On the NHS, men aged 50 or over can ask their GP for a PSA test after talking through the pros and cons. The age drops to 45 for men at higher risk, for example Black men, or men whose father or brother had prostate cancer. A raised PSA is not always cancer, and a normal PSA does not rule it out; our guide to understanding a PSA result explains the numbers.

At Medical Express Clinic, PSA is included in the Elite MOT for men over 40. Separate doctor-led prostate screening starts from £349, with a GP examination and an in-person review of the result. If prostate health is your main reason for booking, say so, and your GP can have that conversation with you first.

Do I need the examination and ECG, or would a blood profile do?

A blood profile alone is a reasonable choice if you specifically want laboratory markers, for example as a faster or lower-cost top-up between full checks. Our blood test profiles range from general health packages to 18 clinical profiles for specific concerns, and many single blood results are ready within 24 hours. The trade-off is that nobody examines you, listens to your heart and lungs or records an ECG.

How do I choose between Essential and Advanced at 40?

• If you want a doctor-led baseline (blood pressure, ECG, cholesterol, glucose, liver, kidney, thyroid and a physical examination) without imaging or hormone testing, choose Essential.
• If a chest X-ray, lung function test, hormone profile or a year of GP access would answer a real question, choose Advanced. It suits smokers and ex-smokers, anyone with breathing symptoms, women with perimenopause or PCOS questions, and men with symptoms of low testosterone.
• If you want imaging such as a full-body MRI, read what a full-body MRI can show and what each MOT costs.
• If you have new or worsening symptoms, book a GP appointment first. Chest pain or signs of a stroke need 999.

Appointments run Monday to Friday at 117a Harley Street. Essential takes 45 to 60 minutes; Advanced takes roughly 60 to 90 minutes because of the added chest X-ray, spirometry and VO2 Max testing. Keep taking your regular medicines unless told otherwise and arrive hydrated. Fast only if the clinic gives you a specific instruction for your tests. Once results are back, you attend an included in-person review where your GP goes through the findings and agrees next steps. Further GP appointments beyond that review are booked separately, apart from the four that come with Advanced.