NHS England has updated the community pharmacy hypertension case-finding service (HCFS) to “better reflect its primary purpose” and focus eligibility for patients “who do not have a current diagnosis of hypertension”.
Patients who have already been treated for hypertension are excluded from clinic blood pressure checks and only one clinic blood pressure check is permitted every five years.
“Repeat clinical checks” are out of the scope of the service, outside of “exceptional clinical cases”.
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Some “limited specified exceptions” include patients under the age of 40 without a hypertension diagnosis who might qualify because of family history or an “increased risk” of developing hypertension, such as South Asians and African-Caribbeans.
Changes to the services have been agreed by Community Pharmacy England (CPE) and will begin from September 3, after they had been previously agreed as part of the 2025/26 community pharmacy contractual framework.
“Too restrictive”
The Independent Pharmacies Association called the increase to the years between each check is “too blunt” and “risks missing patients whose blood pressure or health circumstances have changed”.
Its chief executive Dr Leyla Hannbeck said a “two-year interval would provide a much more sensible balance” as the new checks are “simply too restrictive”.
“We should be using the accessibility of community pharmacies to identify those changes early, rather than excluding people simply because they have had a check within the previous five years,” she said.
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National Pharmacy Association chief executive Henry Gregg said the 5-year limit is a “clear retrograde step that flies in the face of efforts to prevent disease” and will “undermine the government’s ambition to promote health prevention”.
“This is a sledge hammer to crack a nut,” he said. “Pharmacies need the freedom to make public health interventions without constantly worrying about whether they will be reimbursed for their work. If some people are checked more frequently than every five years, that is a small price to pay.
“If the NHS has evidence that blood pressure checks are being done unnecessarily frequently on some individuals, they need to take this up with the individual contractors rather than put in place arbitrary rules that undermine our shared goal of reducing the number of cases of undiagnosed hypertension.”
Changes
The HCFS was launched in October 2021 CPE said this is the “second major update” the advanced service has had following updates in December 2023.
The HCFS was introduced to “support risk identification and prevention of CVD” and help pharmacies identified undiagnosed hypertension through clinic blood pressure checks and ambulatory blood pressure checks.
CPE said other changes include referrals from general practice are now restricted to adults aged 40 and over and who do not have a diagnosis of hypertension and have not had a blood pressure check in the last five years.
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Rules have been tightened to limit off-site provision to four days per financial year and to continue to get integrated care board (ICB) approval to deliver the service in this way, with guidance on this process added.
Optometrists, dentists and other healthcare professionals commissioned to support case-finding can now request ambulatory blood pressure monitoring (ABPM) at pharmacies “following clinic checks undertaken at their practices”.
ABPM
ABMP requirements have been clarified, with an average measurement to be recorded during a patient’s “usual waking hours” and calculated using “at least 14 measurements” and to share this “key measure” with GPs to support the diagnostic process.
It said best practice is for ABPM appointments to be in the morning, and patients should wear the ABPM device “for as long as possible to obtain wake and sleep time readings”.
A working and appropriately calibrated blood pressure monitor and ABPM monitor needs to be available for inspection at the pharmacy, but if ABPM equipment is unavailable and the full service cannot be offered, the service should be removed from the pharmacy’s NHS website profile.
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And pharmacies should make “at least two attempts on separate occasions” to contact patients who miss an ABPM appointment within seven days to rearrange, and then contact the GP on or after the seventh day a patient has failed to attend.
Patients need to be told prior to the HCFS that they may be offered ABPM, and all blood pressure checks “should be carried out with due consideration for the patient’s overall health”.
It means pharmacy staff should consider referring patients to other healthcare providers if needed, or use the national early warning score (NEWS) 2 to “determine the global clinical impression of the patient”.
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Advice for the HCFS including on claiming, monitoring and post payment verification has also now been “aligned with the requirements in other advanced service specifications”.
Any clinic blood pressure measurements undertaken in other healthcare settings should “not be repeated in the pharmacy” and input it into the clinical record.
Pharmacies that de-register from the service cannot re-register for four months from the de-registration date.
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It comes as the Company Chemists’ Association has urged policymakers to expand community pharmacy’s role in preventing cardiovascular disease, with the pharmacy blood pressure check service expanded as “a first step”.
And in June, an ICB has worked with community pharmacies, libraries and council offices to deliver over 15,000 blood pressure checks in since September.
