Service case study: Identification of undiagnosed hypertension

Community Pharmacy Surrey and Sussex worked with NHS Sussex to develop a pathway to maximise the use of the Hypertension Case-Finding Service to increase the detection rate of undiagnosed hypertension.

The pathway was developed using a digital communication platform and bespoke secure messages to patients. The initiative, utilising digital tools and messaging, facilitated collaborative working at a primary care network (PCN) level between general practices and community pharmacies, by targeting specific patient cohorts to increase detection rate.

This allowed alignment between the pharmacy service, cardiovascular disease prevention and Core20Plus5 population health management priorities.

Scope of the service

A general practice or PCN designated colleague identified a cohort of patients that met the target requirements using search criteria that reviewed patient records. The patients were sent a secure text message inviting them to either, take their blood pressure (BP) at home (BP@Home) and upload the results using the secure link on their smart phone, or to visit a participating pharmacy.

The aim was to give the patient choice and for PCNs to work together incorporating and aligning workstreams. A Google map was developed and the link embedded within the text message, so patients would only visit or contact those pharmacies who were able to offer the service. The maps created, were specific to each Integrated Care Board (ICB) – Surrey and Sussex. The pathway was further adapted to include in the national service finder link, as this allowed patients to identify and access the Hypertension Case-Finding Service outside of the area if they wished to.

The cohort of patients were defined as those who did not have a BP check in the last five years and those patients who were recorded as having a high BP at their last reading but were not on a hypertension register.

Outcomes and potential impact

In total, 2,683 patients were invited. Of these, 1,519 responded and of those, 77 patients were diagnosed as a direct result of the pathway. These patients would otherwise have remained undiagnosed, waiting on the general practice list of over 1,000 patients requiring a recall in each place.

The pilot in Bexhill PCN showed a 40-50% acceptance rate and a 50/50 split with patients who chose to go to the pharmacy and those who had their own BP monitor. Across the three pilot sites, there were no reported capacity issues and no patient complaints.

The initiative has been shared with various Local Pharmaceutical Committees, NHS England, Cardiovascular Disease networks and presented at meetings with ICBs, Public Health, Academic Health and Science Network and PCN boards to highlight the service and shape the GP referral element to provide beneficial outcomes for practice, pharmacy, and the patient.

In response to the initiative, Community Pharmacy Surrey and Sussex and NHS Sussex have been recognised and won several awards including Most Innovative at the NHS Sussex Population Health Celebration and Digital Innovator of the Year Highly Commended at the HSJ Digital Awards 2023. They also received High Commendation at the Independent Pharmacy Awards for best supporting local representation. Community Pharmacy Surrey and Sussex were runner-up for the South East Region in The Excellence in Primary Care and Community Care Award and The Health Equalities Award at the NHS Parliamentary Awards 2023.

Speaking about the service, Marie Hockley, Deputy Chief Officer at Community Pharmacy Surrey and Sussex, said:

“We are proud to have been recognised for this innovative project alongside our colleagues at NHS Sussex. Our goal, is to inspire colleagues to think outside the box and work together across organisations for the benefit of our patients.

“The NHS Blood Pressure Check service is a fantastic opportunity for community pharmacy to showcase our skills and work collaboratively across our PCNs to support the identification of undiagnosed hypertension and encourage patients to choose how to access their healthcare.

“Developing the pathway with Dr Suneeta Kochhar, CVD Clinical lead for NHS Sussex ICB, paved the way to a truly collaborative approach, supporting the implementation and integration of this Advanced service to enable cohort identification, promote patient choice, facilitate PCN collaboration, as well as utilisation of GP referral element in line with population health management and tackling health inequalities.

“The availability of the NHS Service Finder will now allow patients to choose a pharmacy to access blood pressure checks. We are now using this national link to add into text messages as this project continues to roll out and be offered as an additional resource to support our GP colleagues.”