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How to optimise your hypertension case-finding service

In this ‘how to’ article, three contractors talk to Saša Jankovic about how they are optimising the community pharmacy hypertension case-finding service

The NHS community pharmacy hypertension case-finding service was commissioned on October 1 2021.

It offers free opportunistic blood pressure checks in pharmacies for people aged 40 and over to identify hypertension and prevent cardiovascular disease.

Read more: Hypertension case-finding service set for October launch with extra ‘incentive’ fees

The pharmacist sends all results to the patient’s GP and, depending on their readings, also offers various interventions at the end of a consultation:

  • Normal blood pressure – promote healthy behaviours.

  • High blood pressure – offer ambulatory blood pressure monitoring (ABPM) from the pharmacy and promote healthy behaviours.

  • Very high blood pressure – urgently refer the patient to their GP within 24 hours and inform the patient’s GP practice.

  • Low blood pressure – provide appropriate advice and refer the patient to their GP if there are concerns.

GPs can also refer patients to a participating community pharmacy for a blood pressure reading or for 24-hour ABPM. 

 

How much can pharmacies earn from the service?

 

Under the contract, participating pharmacies initially received a set-up fee of £440, £15 for each clinic check, and £45 for each ambulatory monitoring.

Those delivering five ABPM interventions in 2021/22 were able to claim £1,000.

Read more: One third of patients register high blood pressure, NHS pilot results show

The claimable incentives were reduced to £400 in 2022/23 for 15 interventions. It will stay at £400 in 2023/24 for 20 interventions.

 

A numbers game

 

Reshma Malde is superintendent pharmacist at John Bell & Croyden in London. She says running the service is a numbers game.

“Numbers are the most powerful tool you have to engage with patients,” she explains.

This is “because you can use this information to ask what they want to do to make a difference to their health”, she adds.

This can “support [patients] to change their habits for a period of time, come back to see you, and look at their numbers again”.

Ms Malde says the service is incredibly beneficial to patients as well as the pharmacy staff “because it encourages people to come back and build relationships with us”.

It “also builds our relationship with GPs once they know we offer this service”, she says.

Read more: More than 400k pharmacy blood pressure checks done in 10 months

When looking to raise awareness about the service, Ms Malde says she has taken up offers to speak on the radio.

“The mechanisms and tools to connect back with GPs that were set up [during the COVID-19 pandemic]” have been useful for her, she says.

These have “created an audit trail of information back to the GP” meaning “the patient doesn’t have to relay information themselves”, she adds.

Ms Malde’s advice on how to make the most of the hypertension service is to be proactive.

“Don't wait for patients to ask for it,” she recommends.“Make every contact count as an opportunity to ask people if they have had a blood pressure check.”

 

Boosting footfall

 

Alex Hill is superintendent pharmacist at C&H Barton Pharmacy and Travel Clinic in Barton-le-Clay, Bedfordshire. He calls the service “a breath of fresh air”.

This is because “it is pharmacy-led, rather than things like the Community Pharmacy Consultation Service, which needs somebody else to send patients to you”.

Originally seeing 64 people “in one go”, Mr Hill's service now deals with “a steady trickle” of about three patients a week, and he says it has gone down really well with patients and GPs.

“Patients like it as it shortcuts any issues they may have around getting in to see their GP,” he explains.

Read more: One in two unaware of pharmacy blood pressure services, NPA finds

He adds “the local GP practice is on board with it too as they have not offered ABPM fitments since COVID-19 started”.

Mr Hill's top tip for encouraging footfall is flyering.

“You want to target people over 40 who don’t know they are hypertensive,” he suggests.

To do this, you should “put flyers on prescription bags”. Even better, “if you have capacity, get staff in the street asking people if they know their blood pressure, and if not, if they would like to”, he adds.

 

Challenges to consider

 

“The big challenge is always the pharmacist's time,” Mr Hill says.

“If you are busy enough, you might justify a second pharmacist to help run services,” he suggests.

However, he acknowledges that it can be tricky for contractors who want to offer services, but can't afford to employ another pharmacist.

Find FREE C+D learning modules on cardiovascular health here

Another issue is only having one ABPM machine so no more than one patient can be seen at a time for 24 hours.

“Our surgery lets us use their other one, so we are lucky,” he says. “Otherwise you get a bottleneck.”

 

Measures of success

 

Rohpharm Pharmacy in Plaistow was one of the pilot sites for the service as part of the Pharmacy Integration Programme pilot, which began in early 2020.

Three tips for boosting profits

  • Stock at-home blood pressure monitors for customers to measure their levels themselves.

  • Further signpost patients to stop smoking and weight management services if you offer them.

  • Raise awareness of extensions to the new medicine service, such as extra support for patients newly prescribed an antidepressant. This will be available from April.

Co-founder and independent prescribing pharmacist Jignesh Patel now receives 100% of the ABPM referrals from his three local GP practices, which equates to about six or seven patients a week.

He says that “around one in ten people receiving a blood pressure check at the pharmacy have needed [ABPM]”.

"We have then referred around half of those to their GP,” he adds.

 

Team engagement

 

As with any service, Mr Patel says success lies in getting the whole pharmacy team involved.

“Since setting up my travel vaccination service 10 years ago, and subsequently with our COVID-19 vaccination service, I’ve learned the key to these working well is when frontline staff are confident speaking to customers, and can signpost them to the service,” he explains.

He continues: “Before we started the hypertension service, we got everyone to have a go with the machines and roleplay as the patient, so they understood how best to get people engaged to take up the service.”

The next step is telling primary care networks (PCNs) and other professionals that you are offering the service.

“The main message is relationship building between local pharmacists in the PCN, then the wider network of local authorities and [integrated care boards], and having systems in place that are consistent,” he adds.

Mr Patel goes on to say: “Look at what you need to do collaboratively to make this work.”

“If you do it well, there is lots that will follow from GPs and NHS England,” he predicts

However, he warns that if you do it poorly, “pharmacy will ‘shoot ourselves in the foot’ and not get any more services”.

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