NHS Community Pharmacies in selected Primary Care Network (PCN) areas are running a hypertension case finding pilot to test the model of care for risk identification and prevention of cardiovascular disease (CVD).
This pilot aims to:
- identify people over the age of 40 who have previously not been diagnosed with hypertension (high blood pressure), and to refer those with suspected hypertension for appropriate management;
- promote healthy behaviours to service users;
- test a community pharmacy model that is able to refer people identified as likely to have high blood pressure to general practice, for ongoing care to manage their blood pressure; and
- explore accessibility, engagement and impact in areas of differing demographics and deprivation levels.
CVD and why it is important
Cardiovascular disease (CVD) is the second most common cause of premature death in England, after cancer, affecting seven million people. One in four premature deaths are caused by CVD, and 1.6 million disability adjusted life years can be attributed to it.
High blood pressure significantly increases the risk of having a heart attack or stroke, but early detection and treatment can help people live longer, healthier lives. The NHS Long Term Plan focuses on tackling health inequalities and the prevention of ill health and aims to prevent 150,000 strokes and heart attacks as a result of CVD, over the next ten years.
High blood pressure and CVD
The NHS pilot model is based on published research, previous pilots and the NICE guidance for high blood pressure, which includes using ambulatory measurement to confirm a diagnosis of hypertension. It suggests that people aged over 40 years should be considered for treatment of hypertension if they have a confirmed high blood pressure reading following ambulatory monitoring and taking certain risk factors into account.
What the service will provide
A pharmacist or trained pharmacy team member will opportunistically measure the blood pressure of consenting adults who come into the pharmacy, by offering anyone a free blood pressure check who:
- appears to be over the age of 40;
- has not previously been identified as having hypertension or a related condition; and
- has not had their blood pressure measured by a health professional within the previous six months.
At the end of a consultation, where readings indicate:
- normal blood pressure, the pharmacist or trained pharmacy team member will promote healthy behaviours;
- high blood pressure, the pharmacist or trained pharmacy team member will offer Ambulatory Blood Pressure Monitoring (ABPM) either from the pharmacy or through a local diagnostic pathway and will also promote healthy behaviours;
- very high blood pressure, the pharmacist or trained pharmacy team member will urgently refer the patient to see their GP within 24 hours and the pharmacist will inform the patient’s GP practice by NHSMail or via another locally agreed platform; and
- low blood pressure, the pharmacist or trained pharmacy team member will provide appropriate advice and may also refer the patient to their GP if there are any concerns.
The service is accessible, appropriate and sensitive to the needs of all service users.
Community pharmacies must be in one of the specified PCN areas in order to provide this pilot service. These areas include:
- Chesterfield PCN
- Dudley Netherton PCN
- Urban Health PCN (Birmingham)
- Darlington PCN
- North Newham and Newham Central PCNs (London)
The pilots went live early 2021 and if successful will expand into other areas as part of an evaluation. The outputs from the pilots will inform the Community Pharmacy Contractual Framework negotiations for 2021/22 and the role community pharmacy will play in the general practice PCN direct enhanced service specification for CVD planned for 2021/22.