Case study: NHS community pharmacy blood pressure check service
The NHS Community Pharmacy Blood Pressure Check Service offers free blood pressure checks and lifestyle advice for people aged 40 and over, to help identify hypertension (high blood pressure) and prevent cardiovascular disease (CVD) – which increases the risk of heart attack and stroke.
The Rohpharm Pharmacy serves a diverse community in Newham, London. It was one of the first sites to offer the NHS Community Pharmacy Blood Pressure Check Service as part of the NHS England Pharmacy Integration Programme pilot, which began in early 2020, before becoming a national service in October 2021.
Pharmacy teams offer free opportunistic blood pressure checks to people aged 40 and over who might be visiting the pharmacy. The pharmacy team will engage with people to promote healthy living messages. The team also completes blood pressure checks for people referred specifically to the service by their GP.
People with suspected high blood pressure can be offered ambulatory blood pressure monitoring to carry out at home over a 24-hour period. If necessary, people will be referred to their GP for appropriate management or referred to another service. If people are identified by the pharmacy as likely to develop high blood pressure in the future, they will also be referred to their GP for follow up.
People referred by their GP into pharmacies are contacted within four hours of the referral being received and seen the same day for clinic blood pressure readings and within three days for ambulatory monitoring. Results are sent to the GP practice.
The pilot followed a Primary Care Network (PCN) approach, with all the pharmacies and GPs across the North Newham and Newham Central One PCN area working together. Key parts of the planning were to make sure all the GPs knew about the pilot and were happy to take part, to map out the process in the pharmacy to identify who would do what, and to clarify how to complete 24-hour blood pressure monitoring for people and pass the results to the GP in a timely manner.
- The pharmacy conducted more than 200 blood pressure checks over a seven-month period and made 22 referrals to GPs following high blood pressure readings in the pharmacy
- The whole pharmacy team has been trained and empowered to have conversations about high blood pressure and heart disease, so they are able to approach people and invite them to have a blood pressure check
- The pharmacy is currently carrying out around four blood pressure checks a week. Around 1 in 10 people receiving a blood pressure check at the pharmacy have needed ambulatory blood pressure monitoring, and around half of those have been subsequently referred to their GP
- The pharmacy offers the blood pressure check service to anyone 40 or over and people can also be referred to the service by their GP practice.
Cardiovascular disease (CVD) affects over 6 million people in England, one in four premature deaths are caused by CVD and it is a leading cause of disability. The NHS Long Term Plan focuses on tackling health inequalities and the prevention of ill health and aims to prevent 150,000 strokes, heart attacks and dementia cases as a result of CVD, over the next ten years.
The NHS Community Pharmacy Blood Pressure Check Service 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. This guidance suggests that people aged 40 years and over 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.
Jignesh Patel, pharmacist at the Rohpharm Pharmacy was a member of the national steering group when the pilot was set up. He said:
“There are so many people with high blood pressure who aren’t aware they have a problem. The risk is that within 5-10 years, they may experience a stroke or heart attack – however, through early detection and prevention, we can reduce morbidity and mortality.
“Also, improving access and knowledge among people who consider themselves to be healthy will help raise awareness and encourage them to attend for checks. If blood pressure problems are detected early, lifestyle changes and support with managing the condition can make all the difference and prevent future risk.”
Benefits and outcomes
People with high blood pressure are referred to their GP for treatment and Jignesh says his team has had the satisfaction of seeing people they referred to their GP after a high blood pressure reading in the pharmacy, coming back with prescriptions for hypertension medicines, helping to protect their health.
Using a family orientated approach, the pharmacy has reached out to people visiting the pharmacy, asking them to encourage their family members to attend for a blood pressure check. In this way, they have generated high numbers of people willing to have a blood pressure check who may not otherwise have thought to attend.
Jignesh said: “Our team has developed confidence in engaging people, promoting the service and signposting them to local support. As part of their training, we brought everyone together to practise talking about what the pilot is all about and its benefits, what it means for health and why a referral might be made. Each team member now understands the process and how long it takes and can answer people’s questions about healthy living.”
In addition to the opportunistic checks carried out in the pharmacy, general practices can refer patients for 24-hour ambulatory blood pressure monitoring. All the results are sent to the relevant general practice so records can be updated and appropriate action taken. Ropharm typically receives one or two referrals a week from GP practices for ambulatory blood pressure monitoring.
Jignesh has been working with the North East London LPC to launch the service in a systematic way across north east London, so that information and procedures are consistent.
He has also created communications templates to use in text messages to promote the scheme to people eligible for hypertension screening and to those who could benefit from lifestyle inventions and signposting. Text messages sent after the check has been carried out in the pharmacy guide people to local websites, for advice on making healthy changes to their lifestyle.
Dr Farzana Hussain, partner at The Project Surgery, Plaistow, London which refers patients for blood pressure checks at Ropharm Pharmacy said: “This service really caters for everyone, especially people living in areas of deprivation and contributes to levelling up health inequalities. My patients can’t always make appointment times at the practice, so walking in for a blood pressure check at the pharmacy is very accessible and more convenient for them.
“Working together in this way, we are already picking up lots of new hypertension cases and will undoubtedly prevent strokes and heart attacks and save lives.
“The collaboration between pharmacists and GPs also helps address the barriers to other health inequalities such as people not taking their medication. People can talk to the pharmacist about any new medications they are prescribed and seeing that pharmacists are part of the primary healthcare family, means they are more likely to be happy to see them for other services, such as agreeing to a referral to see the local community pharmacist for a consultation, if they contact us with a minor illness.”
Rita Patel, London Regional Lead for Community Pharmacy Services, NHS England – London Region, added: “These opportunistic blood pressure checks will save lives and for others, it has been timely when it comes to managing their own health conditions. The service is both accessible and convenient for people and provides a genuinely joined-up approach to diagnosing and preventing a very serious health condition.
“We anticipate that this service will be expanded to other community pharmacies across London and will form part of wider range of services to be commissioned on a larger scale in the future.”
Take away tips
- Collaboration between GP practices and pharmacies is crucial – invest time in building strong relationships between community pharmacists and GP practices in the area to ensure a common understanding and approach
- A consistent email messaging system to GPs who then save the information into their systems enables a quick and easy solution – before longer term interoperable solutions become available for PCNs to adopt
- Consider external challenges – for example, during the pandemic, people weren’t coming out or spending more time than necessary away from home, and staff also had concerns about being in contact with lots of people. In response, the pharmacy designed safety into the service e.g. infection control measures, keeping areas clean and sterile and allowing extra time between checks
- Find a way to encourage people to get checked. This service is important in improving access to those people particularly at risk from CVD but who wouldn’t normally engage with health services.
For further information contact: Community Pharmacy Services, NHS England – London Region: firstname.lastname@example.org