Alex Hill, owner and superintendent pharmacist at C&H Barton Pharmacy in Barton-le-Clay, talks to Saša Janković about running an NHS-funded blood pressure service.
Service type: NHS hypertension case-finding service
Name and location of pharmacy: C&H Barton Pharmacy, Barton-le-Clay, Bedfordshire
Name of superintendent pharmacist: Alex Hill
When did you start offering this service? October 2021
Why did you start offering this service?
As pharmacists, we’d been caught in the middle in the pandemic where local GPs were not taking blood pressure but still wanted people to get it checked. This meant patients were either having to buy their own blood pressure monitor machines or come to us for a check. I felt guilty for charging people, but we had to because of the amount of time it was taking up, so it was a breath of fresh air when this was commissioned as an Advanced service from 1st October 2021.
How much did it cost to set up the service?
There is a cost to setting this up, but I think the service is funded very fairly. You have to spend over £1,000 on a blood pressure machine but if you reach a patient threshold in the first year it triggers an incentive that covers about 90% of the cost of the machine, and in subsequent years it should end up being cost neutral.
What, if any, training did you or other team members have to undergo?
I’d be surprised if no one knew how to take blood pressures, but there is suggested CPD and you have to be familiar with NICE guidelines around what you are doing. For example, you need to know what timeframe is expected if you are referring someone to the GP – which should be to be seen in 3-4 weeks – but if their blood pressure is over a certain level that’s an immediate referral.
In a nutshell, what does the service involve?
People can book in for my time for a check if they fit the NHS criteria: if they are over 40 then it’s NHS funded, and if not then we now do it for free anyway, for everyone. You can also accept referrals from the GP as well, regardless of their age.
Even better, the service goes above and beyond just checking blood pressure – if you find someone with hypertension it also funds you to fit them with a 24-hour blood pressure monitor, which is something the GP would normally do, so this allows us to offer a real end-to-end service.
My very first customer had high blood pressure so I fitted her with the ABPM monitor and then I was able to send the reading back to her GP as a referral 24 hours later. This meant the GP could start the person on blood pressure medication as soon as they got the appointment, and then when they come back to us with the prescription from the GP we can also support them with an NMS.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
If you wanted to sell someone a blood pressure monitor you could. And of course as a part of the service process you run through a form with the patient which has sections on healthy living you are meant to mention, so you can talk to them about stop smoking services and give healthy living advice on diet and nutrition, salt, caffeine, alcohol, weight management, physical activity and so on.
How have patients responded to the hypertension service?
Everyone has been very grateful and most people are surprised as they are not expecting us to be able to do this kind of thing. Patients like it as it shortcuts any issues they may have around getting in to see their GP, and the local GP practice is on board with it too. They have not offered ABPM fitments since Covid started and have been loaning regular blood pressure monitors out to patients for a week instead, but since I started offering this service we’ve been speaking about how we can get ABPM readings back into their GPs’ toolkit by using referrals to my service in the pharmacy – and I am obviously delighted by this positive outcome.
Roughly how often each month do you carry out the service?
It’s been busy so far – in the very first week we did three fittings with the ABPM 24-hour monitor.
How much do you charge for the service?
It’s free to the patient.
Roughly how much a month do you make from offering the hypertension service?
As per the PSNC website, the fee works out as follows:
- A set-up fee of £440;
- A fee for each clinic check of £15; and
- A fee for each ambulatory monitoring of £45.
In addition, the following incentive fees across Years 3, 4 and 5 of the CPCF 5-year agreement are available to pharmacies that reach a threshold of ABPM activity:
- An incentive fee of £1,000 if 5 ABPM intervention are provided in 2021/22;
- Followed by a payment of £400 in the subsequent years if the pharmacy reaches the thresholds for those years (15 ABPM interventions will be required in 2022/23 and 20 in 2023/24).
Would you recommend offering this service to other contractors?
Yes. I can see where some things about it might be a bit intimidating – fitting an ABPM and the cost of it perhaps, especially as you are not allowed to charge a deposit for this £1,000 piece of equipment you are sending people away with – but read up about it and you will change your mind.