The Annual Health MOT: Which Blood Tests Should You Get Every Year?

Most of us only think about blood tests when something feels wrong. But by the time symptoms show up, the underlying change has often been building for months or years. An annual blood screen gives you a baseline, a way of spotting gradual shifts before they become clinical problems.

This isn't about replacing your GP or second-guessing the NHS. It's about filling a specific gap: routine monitoring for people who feel well but want to stay that way.

What the NHS Health Check Covers

The NHS Health Check is a free screening programme offered every five years to adults aged 40 to 74 in England. It's designed to assess your cardiovascular risk, and it does that job well [NHS England/OHID, 2022].

During the check, you'll typically have your blood pressure measured, your BMI calculated, your total cholesterol and blood glucose tested, and a QRISK3 score calculated. QRISK3 estimates your percentage risk of having a heart attack or stroke over the next ten years [NICE, 2023]. If you're over 65, you may also be asked about memory and signposted to dementia services.

There are some important eligibility points. The NHS Health Check is specifically for people who don't already have a diagnosed cardiovascular condition, diabetes, chronic kidney disease, or hypertension. If you're already being monitored for any of these, you won't be invited because you're already in the system [NHS England/OHID, 2022].

The programme is valuable. But it's designed for one thing: cardiovascular risk stratification. It doesn't routinely check your thyroid function, iron stores, vitamin D status, liver enzymes, or a range of other markers that can shift gradually without causing obvious symptoms.

Why Consider Going Beyond Cardiovascular Screening?

A cardiovascular risk check is a snapshot of one system. Your body has several others worth keeping an eye on.

In clinic, I regularly see patients whose thyroid function has been drifting for two or three years before anyone checks it. Their TSH (thyroid stimulating hormone) is creeping up, they're gaining weight, feeling sluggish, and putting it down to age or stress. A simple blood test would have flagged the trend much earlier.

The same applies to iron stores. A patient's ferritin (the protein that stores iron in your body) can drop steadily over months. By the time they're symptomatic with fatigue and breathlessness, their haemoglobin may have fallen significantly. Catching that ferritin decline early, while haemoglobin is still normal, gives you a much better window to intervene [Snook et al., 2021].

And HbA1c (glycated haemoglobin, a marker of your average blood sugar over the past 2 to 3 months) can show pre-diabetic patterns years before a fasting glucose test picks up a problem [NICE, 2024].

None of this means the NHS is doing something wrong. It means population-level screening programmes are designed to catch specific conditions in specific groups. An individual health screen can look more broadly.

What Should a Comprehensive Annual Blood Screen Include?

A sensible annual panel for a generally healthy adult might include the following markers. Your GP or the doctor reviewing your results can advise on whether additional tests are appropriate for your individual situation.

• Full blood count (FBC) checks your red cells, white cells, and platelets. It can flag anaemia, infection, and some blood disorders.

• Ferritin measures your body's iron stores. It's the single most useful marker of iron deficiency, more reliable than serum iron alone, which fluctuates with diet and time of day [Snook et al., 2021].

• HbA1c shows your average blood sugar control over the past 2 to 3 months. A result between 42 and 47 mmol/mol may suggest pre-diabetes. A result of 48 mmol/mol or above may indicate diabetes [NICE, 2024].

• Lipid profile measures total cholesterol, HDL, LDL, and triglycerides. What matters most isn't your total cholesterol number. Current NICE guidelines focus on non-HDL cholesterol as the primary target for assessing and reducing cardiovascular risk [NICE, 2023]. Your GP will look at the full profile, including LDL, HDL, triglycerides, and non-HDL cholesterol together.

• Thyroid function (TSH) is the first-line screening test for thyroid disorders. An elevated TSH may suggest an underactive thyroid (hypothyroidism), while a suppressed TSH may suggest an overactive thyroid (hyperthyroidism). Your GP will interpret this alongside your symptoms and clinical picture [NICE, 2019].

• Liver function tests (LFTs) include ALT, AST, ALP, GGT, and bilirubin. These can flag liver inflammation, fatty liver disease, or bile duct problems, often before symptoms develop.

• Kidney function (eGFR and creatinine) estimates how well your kidneys are filtering waste. Early kidney disease rarely causes symptoms [NICE, 2021].

• Vitamin D is worth checking at least once a year, particularly if you live in the UK and spend most of your day indoors. Deficiency is common. The SACN links severe deficiency to bone pain and muscle weakness [SACN, 2016], and in clinical practice low vitamin D is frequently associated with fatigue, though the evidence for that specific link is less definitive.

A result outside the reference range doesn't automatically mean something is wrong. Lab reference ranges are based on population statistics, and a slightly out-of-range result in someone who feels well may simply be their normal. Your GP or reporting doctor will always interpret results in the context of your symptoms, medical history, and the overall clinical picture.

Why Tracking Trends Matters More Than Single Results

A one-off blood test gives you a snapshot. Regular testing gives you a trend.

This is where annual screening really shows its value. If your ferritin was 60 µg/L last year and it's 25 µg/L this year, both results might technically fall within the reference range. But that trajectory tells a story. Something is causing your iron stores to fall, and it's worth finding out what before you become anaemic.

The same logic applies to HbA1c. A result of 40 mmol/mol one year and 44 mmol/mol the next is still "normal" by lab standards. But it suggests your blood sugar regulation is shifting, and that's the point where dietary changes can make the biggest difference.

Trends are more clinically useful than isolated numbers. That's why I review every Brooksby report with the patient's previous results in mind where they're available.

A Note on Iron Deficiency and When It Needs Urgent Investigation

Iron deficiency is the most common nutritional deficiency worldwide and a frequent cause of fatigue [WHO, 2023]. In premenopausal women, heavy menstrual bleeding is the most common cause. But in men and postmenopausal women, unexplained iron deficiency anaemia requires careful investigation.

The British Society of Gastroenterology guidelines are clear on this. In men and postmenopausal women with confirmed iron deficiency anaemia, the standard approach is to investigate both ends of the gut: a camera examination of the stomach and upper bowel (called a gastroscopy) and a camera examination of the lower bowel (a colonoscopy) [Snook et al., 2021]. The reason is that blood loss can come from the upper GI tract (stomach, duodenum) as well as the lower (colon). Focusing on only one misses the other.

Coeliac disease also needs to be screened for. The BSG notes that coeliac disease is found in 3 to 5% of people investigated for unexplained iron deficiency anaemia, and recommends a specific blood test for coeliac antibodies (called tTG) as a routine part of the workup [Snook et al., 2021].

This isn't something to manage on your own. If a blood test shows you have iron deficiency anaemia and you're male or postmenopausal, see your GP. They'll arrange the appropriate investigations through the NHS.

When to See Your GP

An annual blood screen is a useful health monitoring tool, but it doesn't replace medical care. You should see your GP if:

• Your results show a significant abnormality, particularly a haemoglobin below 120 g/L (women) or 130 g/L (men) [WHO, 2024]

• You have symptoms that concern you, regardless of what your blood tests show

• Your ferritin is low and you're male or postmenopausal, as this may need further investigation

• Your HbA1c is 42 mmol/mol or above, which may indicate pre-diabetes or diabetes

• Your TSH is significantly outside the reference range

Blood test results should always be interpreted by a qualified healthcare professional. A private blood screen complements NHS care. It doesn't replace it.

How Brooksby Medical Can Help

Brooksby Medical offers a range of blood tests designed for annual health monitoring, with every result reviewed and reported on by a GP.

The Wellness Profile covers the core markers most adults would want in an annual screen, including FBC, ferritin, HbA1c, lipid profile, thyroid function, liver function, kidney function, and vitamin D.

For men over 40, the Over 40s Men's Health Blood Test adds PSA and testosterone alongside the standard panel. For women, the Advanced Well Woman Blood Profile includes hormone markers relevant to perimenopause and general wellbeing.

If you're specifically concerned about heart health, the Advanced Lipid Profile includes apolipoprotein B (ApoB) and lipoprotein(a), two markers increasingly recognised as important predictors of cardiovascular risk that aren't included in a standard NHS lipid panel.

References

1. NHS England / Office for Health Improvement and Disparities. NHS Health Checks: applying All Our Health. 2022. GOV.UK

2. Snook J, Bhala N, et al. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut. 2021;70:2030-2051

3. National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE guideline [NG238]. 2023. NICE

4. National Institute for Health and Care Excellence. Type 2 diabetes: prevention in people at high risk. NICE guideline [PH38]. Updated 2024. NICE

5. National Institute for Health and Care Excellence. Thyroid disease: assessment and management. NICE guideline [NG145]. 2019. NICE

6. National Institute for Health and Care Excellence. Chronic kidney disease: assessment and management. NICE guideline [NG203]. 2021. NICE

7. Scientific Advisory Committee on Nutrition. Vitamin D and Health. 2016. GOV.UK

8. World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. 2024. WHO

9. World Health Organization. Anaemia factsheet. 2023. WHO

Written by Dr James Coleman, GP and founder of Brooksby Medical. Dr Coleman is a practising General Practitioner who founded Brooksby Medical to give patients direct access to the blood tests and clinical interpretation they need, without waiting lists.

Medically reviewed: March 2026 | Next review due: March 2027

Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual symptoms, medical history, and clinical picture. If you have concerns about your health, please consult your GP.