Hypertension Case Finding Service
Cardiovascular disease (CVD) is one of the leading causes of premature death in England, affecting seven million people and accounting for 1.6 million disability adjusted life years.
This places a financial burden on the NHS of approximately £9 billion per year.
Hypertension is the biggest risk factor for CVD and is one of the top five risk factors for all premature death and disability in England. An estimated 5.5 million people have undiagnosed hypertension across the country.
CVD is a key driver of health inequalities, accounting for around 25% of the life expectancy gap (27% in men and 24% in women) between rich and poor populations in England. Those in the most deprived 10% of the population are almost twice as likely to die as a result of CVD than those in the least deprived 10% of the population. Additionally, 60% of excess mortality for those living with severe mental illness can be attributed to preventable physical health conditions, such as heart disease.
Residents of the most deprived areas in England are 30% more likely to have high blood pressure (BP) compared to those in the least deprived areas . Community pharmacy BP monitoring has the potential to increase the detection of hypertension within local populations and is expected to positively impact health inequalities by targeting people who do not routinely see their GP or use other NHS services.
The NHS Long Term Plan commits the NHS to reducing morbidity and mortality due to CVD, tackling inequalities and a shift towards prevention strategies. It specifically states that community pharmacy, in collaboration with other providers, will provide opportunities for the public to check on their health through tests for high BP and other high-risk conditions.
Service information
From 1st December 2023, the service can be provided by suitably trained and competent pharmacy staff; previously, only pharmacists and pharmacy technicians could provide the service.
Where non-registered pharmacy staff provide the service, until clinical IT systems are updated to allow their names to be entered within the clinical record, the name and GPhC registration number of the responsible pharmacist should be included in the clinical record.
The service has two stages – the first is identifying people at risk of hypertension and offering them blood pressure measurement (a ‘clinic check’).
The second stage, where clinically indicated, is offering ambulatory blood pressure monitoring (ABPM). The blood pressure test results will then be shared with the patient’s GP practice to inform a potential diagnosis of hypertension.
Contractors opting to provide the service must undertake both stages of it, where clinically required, i.e. it is not possible to just undertake clinic BP readings and not ABPM.
Funding and claiming payment
The following fees have been agreed for the service:
- A set-up fee of £440;
- A fee for each clinic check of £15; and
- A fee for each ambulatory monitoring of £45.
The aims of the service
The service aims to:
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My experience of 24 hour ambulatory blood pressure monitoring – Community Pharmacist in Rushcliffe
| “The case that stands out for me was my first real patient, after shadowing and practising 24-hour Ambulatory Blood Pressure Monitoring (ABPM) on staff. I met my patient during an NMS intervention for ramipril. He had not taken any of this ‘because he wasn’t sure he had high blood pressure.’ With the GPs permission, I did ABPM and the patient actually did have normal blood pressure – outside of the clinic setting. Had I not offered the service he would now be taking unnecessary medication.
Another situation that sticks in my mind is a conversation with a friend who is a GP partner in a different area. They were late home one Friday, because several patients had contacted the surgery at in the half hour before they were due to close because they had been told by the pharmacist that they had raised blood pressure – but not what their blood pressure was! So, the GP had to bring the patients in to check that the blood pressure was not in the very high range. I shared the service pathway and patient letter that I use, with me friend and they went to the local pharmacy to ask them to use this too. When they found out that they could refer patients to the pharmacy they were delighted, the service in their area is now, in their view, running well.
My top tips are:
Emma Anderson
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