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Q1: I am retiring shortly, aged 63, and and pretty well for my age. I feel I should have an annual check up as a prudent measure. I do not have private health care. How should I go about arranging this and can I get it done on the National Health - and what should it cover? For example can eyes and teeth be part of the check up? Name and address withheld.

A1: Doctors' opinions vary about annual checks. Fifty years ago they were the hallmark of a good general practice and it was almost obligatory to carry them out on all older patients. If necessary regular visits to the patients' houses were arranged several times a year - the number of times depending on how frail they were. Some of my patients in a rural practice were visited weekly although it was only to make certain that they were taking their treatment and didn't have any worries. That type of general practice went out of date in the 1970s but by then annual check-ups were organised by many companies and a few GP surgeries but the routine home visit became a distant memory.

I am a great believer in the annual check-up. It has many purposes. The first is that it gives a patient a long period of time that has been set aside for him or her to talk to their doctor about anything that is disturbing them. It may be a physical symptom, a worry about some psychological problem or concern over a member of the family. As well as the standard physical examination, such as can be carried out in the doctor's surgery, it should certainly include a full blood count to check the level of anaemia, if any, the number and state of the red and white blood cells, the number of the blood platelets - these are the small particles that are involved in clotting, and two tests to assess the level of the ESR and the C reactive protein. The latter two tests detect inflammation and are therefore a non-specific test for many diseases.

The other group of blood tests that are essential are the biochemical ones. These should show the overall cholesterol level (for this reason you shouldn't have eaten before going to see the doctor), the level of the HDL - the good cardioprotective cholesterol and the pernicious low density lipo protein, the LDL, that is the bad cholesterol. The serum triglycerides, another blood fat, needs estimating. Only to know the level of the cholesterol and not of the LDL and other tests is totally inadequate.

The liver function tests should be assessed. It is not often remembered that the most common cause of cirrhosis of the liver in this country is neither alcohol nor hepatitis C but obesity. Obesity is always checked not only by weighing but by measuring the waist at the maximum point around the belly, men should be under 40 inches (preferably under 37) women under 35 (preferably under 32).

Kidney function tests are important. These are classified and given a grading, known as the eGFR. The marking is very stiff and so allowance has to be made for age etc. so that panic doesn't break out when the reading is checked against the classification awarded to the patient.

It is as well to test for gout. Usually the levels of serum calcium and phosphate are also measured.

Diabetes must be checked for. The quick test with a strip dipped into urine to test for sugar is inadequate. The blood sugar level (fasting) must be estimated so that it is possible to see how well glucose metabolism is working. I like to do glucose tests on any plump patient or in somebody who has a borderline blood glucose an HbAic test. This can be done on the same sample of blood and gives a good idea of how well the glucose has been controlled over the last few weeks.

Men should have their prostate tested annually over the age of fifty, or over forty if there is a family history of prostatic cancer by having the PSA blood test.

The more complex tests, mammography in women, need to be done more often and more frequently started earlier than is recommended by the NHS. Men should have a resting ECG - this is easily done in the surgery. The question of whether exercise testing can be adequately carried out or should be attempted in the surgery is disputed. Any man who has noticed early impotence needs a full cardiovascular test, impotence is more often the first symptom of coronary troubles and angina. Women should have annual smears and preferably HPV cultures - these are not well established.