Hypertension Case-Finding Service reminder (#3): How do I engage with my general practices?

This is the third of a series of articles to help pharmacy owners and their teams to maximise the potential of the Hypertension Case-finding Service (HCFS).

The re-launch of the service, including the ability to use the wider pharmacy team to provide parts of the service, allows pharmacy owners to review how they provide the service and this series of articles will focus on a range of topics to support you in doing that.

A key requirement of the service specification, is for pharmacy owners to engage with local general practices and/or primary care network (PCN) colleagues to make them aware the pharmacy is providing this service.

How could this service assist general practices?

Uncontrolled hypertension is a leading risk factor for cardiovascular disease. High blood pressure, often described as a ‘silent killer’, affects an estimated 32% of adults. As the condition rarely has any symptoms, approximately 3 in 10 of these remain undiagnosed, equating to 4.2 million people in England. The aim of this service is to assist general practice to identify these missing patients.

Hypertension management in general practice was significantly impacted during the COVID-19 pandemic. While progress on recovery is being made, the NHS ambition is to have 80% of the expected number of people with high blood pressure diagnosed by 2029 and 80% of those diagnosed with high blood pressure treated to target by 2029.

A key strength for community pharmacies, is that they are highly accessible. People also visit their local community pharmacies for other reasons and a proportion of these visitors may not routinely access services from a general practice. This means that community pharmacy teams are well placed to proactively approach individuals to support finding these undiagnosed populations as part of a making every contact count approach.

To assist with reduction of workload in the practice, general practices may also want to consider referring patients to the pharmacy for blood pressure checks (clinic blood pressure checks or ambulatory blood pressure monitoring (ABPM)).

Are there any resources to assist with general practice engagement?

A letter / email template to support pharmacy owners to notify GP practices that the pharmacy will be / are providing the service is available. This template also makes an offer to the practice for the pharmacy owner / pharmacist to meet to discuss the service and to seek to understand how best to support any practice needs regarding the service. This could be a standalone meeting or as part of a practice meeting.

A Briefing to provide information for general practice teams on the HCFS is available and this may assist pharmacy owners to engage their local general practice colleagues.

Both these resources can be found at cpe.org.uk/hypertension.

Are there any examples of activities that general practices have undertaken to jointly work with community pharmacies as part of this service?

General practices are able to perform searches of their clinical records systems to look for patients whose last or latest blood pressure value is in the at-risk range for hypertension but where the patient has not yet been diagnosed with hypertension. This would allow the practice to invite these patients to provide a blood pressure measurement, visit the practice for this or visit their community pharmacy to have a blood pressure check carried out. An example of this approach in Surrey and Sussex was highlighted in a recent case study.

Practices can also review patient records, to make similar offers to those who have not had their blood pressure recorded in the last five years but who would meet the age inclusion criteria for the service, or for patients who are due medication reviews where an up-to-date blood pressure reading would be of benefit to the reviewing clinician.

While these are all options for a practice to consider, pharmacy owners can utilise tools such as the CVDPREVENT Quality Improvement Tool to review how big a priority, or not, this may be for their PCN and/or local practices.

Is there a defined process for referrals from general practice?

No. Where practices wish to refer patients to a pharmacy for a blood pressure check, pharmacy owners should agree a local process with the practice by which this will work. There are no specific requirements set for this process. It could involve the practice agreeing that a specific list of patients can access the service or a cohort of patients could be specified and invited to attend the pharmacy.

Practices can also refer patients requiring ABPM; in this scenario it is recommended that this referral is made electronically to the pharmacy. A template referral is also available at cpe.org.uk/hypertension in the absence of other electronic routes to support referral.

How can a practice identify which pharmacies offer the service?

The service finder on the NHS website lets patients and healthcare professionals search for a pharmacy that provides blood pressure checks as part of the HCFS. The tool also provides information on who is eligible for the service.

What other frequently asked questions (FAQ) have there been from general practice about the service?

A range of FAQs, including questions raised by general practices, can be found at cpe.org.uk/hypertension.