High street heart checks on the NHS

Pharmacists are set to offer rapid detection and help for killer conditions like heart disease as part of a major revamp of high street pharmacy services.

The high street heart checks are part of an ambitious target the NHS in England has set itself as part of its Long Term Plan to prevent tens of thousands of strokes and heart attacks over the next ten years.

Plans are underway for both GPs and community pharmacists to lead the fight against common conditions that cause cardiovascular disease (CVD) and stroke, building on successful pilots which have reduced strokes by a quarter.

General practices will identify those at risk and optimise treatment in people with high blood pressure, high cholesterol and irregular heart rhythms – called Atrial Fibrillation (AF) – all high risk conditions that that most commonly cause heart disease and stroke, as well as many cases of dementia.

And from October 1st, as part of their new £13 billion five-year contract, community pharmacists will start to develop and test an early detection service to identify people who may have undiagnosed high-risk conditions like high blood pressure for referral for further testing and treatment. If successful this could be rolled out to all community pharmacies in 2021-22.

Accelerating prevention of life-threatening illness such as heart attack and stroke is central to the NHS Long Term Plan and, in addition to a substantial commitment to tackle obesity, alcohol dependence and smoking, the blueprint for the health service outlines an ambition to tackle CVD, affecting six million people and accounting for a quarter of deaths in England and costing the NHS £7 billion a year.

As the NHS expands health help in every community across England, community pharmacists will offer an ever-increasing range of clinical health checks and treatment, alongside their core offer of medicines advice and prescriptions and consultations for minor illnesses such as earache, sore throats, coughs and colds.

This will include developing and testing an early detection service to help identify people who may have undiagnosed cardiovascular disease for onward referral for further testing and treatment if required.

Pharmacists will case-find and offer blood pressure tests to people showing symptoms, provide clinical and lifestyle advice or referral, and record the data, joining up services and treatment with GPs and other local services, to speed up access to care.

England’s top doctor, Professor Stephen Powis, said: “Heart disease and strokes dramatically cut short lives, and leave thousands of people disabled every year, so rapid detection of killer conditions through High street heart checks will be a game-changer.

“Reducing lifestyle risks and treating high-risk conditions such as smoking, obesity, poor diet and physical inactivity are key to preventing serious ill health, and the NHS Long Term Plan will help people take positive action for their own wellbeing, while investing in life-changing services, close to home, when Ill health hits.”

Professor Powis, NHS national medical director, described as “a game changer” the historic £4.5billion extra investment in primary and community care that sees substantial funding for new multidisciplinary teams of clinical pharmacists, social care link workers and others working in practices, doing things differently to improve outcomes for patients.

Work to identify and treat people with high blood pressure and AF has already been tried successfully in Lambeth and Southwark, Dudley and West Hampshire, where there has been substantial improvement in rates of diagnosis and optimal treatment – at the same time freeing up clinical time for GPs.

In the locally commissioned trailblazer by Lambeth and Southwark Clinical Commissioning Group, GPs worked with specialist nurses and specialist AF pharmacists to identify patients who had been diagnosed with AF but not received anti-coagulation medication.

Over a 12-month period, 1,400 patients were reviewed across 92 practices, whom were identified as not currently receiving anticoagulants. In total, 1,300 of those patients are now anticoagulated, preventing an estimated 45 strokes a year.

The two CCGs have since seen a 25% reduction in the rate of AF-related stroke.

As a result of the successful Lambeth and Southwark pilot, a new £9 million programme to spot heart conditions aimed at saving at least 200 lives and offering protection to thousands more, has been rolled out to 23 CCGs across England.

Helen Williams, Consultant Pharmacist for Cardiovascular Disease, Lambeth and Southwark CCGs, said: “We have seen a substantial increase in the number of patients with Atrial Fibrillation who are prescribed anticoagulant therapy, and an associated reduction in AF-related strokes. We are delighted that NHS England has invested in this model so that more patients across the country can benefit.”

To support this approach, NHS England will commission a regular national primary care audit, called CVDprevent, making it easier for practices to systematically identify people whose treatment could be improved, and risk reduced.

Keith Ridge, Chief Pharmaceutical Officer, said: “The priority of the NHS Long Term Plan is to give the public convenient access to the health care, help and advice that they really want, which is why patients can now expect to benefit not just from continued excellence in medicines advice and help for common conditions from their pharmacist, but also from development of a range of new clinical services to tackle deadly diseases earlier on the frontline.

“This new contract makes the most of the clinical skills of local pharmacists and establishes pharmacies across England as local health hubs – open in the evenings and at weekends – where people can go for an ever-increasing range of clinical health checks and treatment.”

In another locally commissioned scheme in Cheshire and Merseyside, which precedes NHSE&I’s commissioning of its new national pilot, community pharmacists are delivering a blood pressure screening service which is vital in the early detection and prevention of heart disease.

There are an estimated 260,000 people in the region who have high blood pressure but don’t know it and the Cheshire and Merseyside Pharmacy Local Professional Network has been working with the Champs Public Health Collaborative to influence the CVD strategy.

A network of over 320 Healthy Living Pharmacies has been established with trained staff and approved equipment, working in partnership with the British Heart Foundation to deliver the screening service aimed at the prevention, detection and management of high blood pressure.

In Phase 1, completed in April 2019, 116 Healthy Living Pharmacies delivered over 3,500 blood pressure measurements, and a further 210 HLPs have been recruited to the next phase.

Hassan Argomandkhah, Senior Clinical Pharmacist and Chair of the Pharmacy Local Professional Network on Merseyside, said: “This new service will increase detection of high blood pressure, not only to identify people who may develop problems in the future but, importantly, give members of the public the right support and advice to manage any potential risk.

“What we have achieved in CVD prevention is down to the hard work of all partners including community pharmacy, NHS England and the directors of public health. The success is linked to having a fully engaged pharmacy network.”