Lisa Olins, pharmacist manager at Crown Pharmacy in Shenley, Hertfordshire, talks to Saša Janković about a tie-up between ambulatory blood pressure monitoring (ABPM) and NMS services
Service type: Ambulatory blood pressure monitoring and New Medicine Service
Name and location of pharmacy: Crown Pharmacy, Shenley
Name of pharmacist: Lisa Olins
Why did you start offering this service?
At the end of 2022 Community Pharmacy Hertfordshire did a lot of work with our GPs and the PCN about referring patients for ABPM into pharmacy, and we decided to get involved. We started NMS a long time ago, and the hypertension case finding service began in 2022, but since the start of 2023 we have been focusing on ABPM referrals coming from our GP practice.
How much did it cost to set up the service?
Only the cost of the ABPM machine.
What, if any, training did you or other team members have to undergo?
For the ABPM service, I did a CPPE hypertension course and had to do the training on how to operate the machinery, which is not difficult but fiddly. We use an A&D ABPM machine and the manufacturer is helpful when I've had any issues. It’s definitely worth knowing you can get support if you need it.
In a nutshell, what does the service involve?
Ambulatory blood pressure monitoring takes two days for one person, and we only have one machine, but if the service continues, we would likely get a second monitor. Monday is the fitting; then they bring it back on Tuesday. I read it on Wednesday, and then we clean the machine ready to fit the next person, who will bring it back on Thursday. I’ll make them an urgent appointment if they need it.
I also focus on the New Medicine Service as part of my daily practice, which is also really valuable as a tool to support our trainee pharmacists now, as they can do it under supervision as long as I’m there.
The NMS has always been an amazing thing to do because we are speaking to the patient in their own home and they can tell us whatever they want. It’s interesting that often people don’t want to tell their doctor if something is wrong, not because they are frightened of them but because they don't want to upset them by saying they don't like the medicine they are on – but they are happy tell us what's worrying them about their medicines.
The NMS is such a powerful tool, because if people start taking their medicines and something happens they know that someone is going to call them and check up that they are okay. At least once a week, something happens that means we have to refer back to the surgery as it is clinically necessary for their GP to see them. For example, often they are on blood pressure medicines, taking their own blood pressure, and it’s not decreasing, but these problems are easily resolved as long as the GP knows about them.
Asthma inhaler use is another benefit of the NMS since it was added to the list. There are so many different sorts of inhaler now for asthma and other respiratory conditions, and all are used in a slightly different way. That’s valuable as it forces the pharmacists or technician to demonstrate how to use it properly, to talk about safe and eco-friendly disposal of the inhalers, and allows us to explain simple tips so the patient’s inhaler use won’t negatively impact their lives. Plus in the first month of using it they get a call that reassures them if it’s not working immediately or not doing what they expect we can review their technique again to support them using the device.
How have patients responded to the service?
They are pleased when it catches something. I had one ABPM patient who, sadly, had had to have his dog put to sleep on the same day I saw him. He had very high blood pressure but, unsurprisingly perhaps, it spiked on that day, so I reported that back on the GP referral form and they asked me to do another reading. That one was still high so his doctor referred him and he had a stent fitted and felt much better – and I did a lot of new medicines for him after that.
Roughly how often each month do you carry out the service?
I do two or three a week, but I'm hoping that with the new rules for VAT on fees – which have meant only the pharmacist can do certain services – a medicines counter assistant or qualified technician or trainee pharmacist can provide these services if supervised by the pharmacist. This would mean we’d be able to do more in a week as I wouldn’t be the only one who can do them.
How much do you charge for the service?
Both services are offered free of charge.
Roughly how much a month do you make from offering the service?
NMS depends on the number of prescriptions you do. ABPM pays £45 for the whole thing, which is all the patient consultations, fitting the monitor, interpretation of the results and any associated administration. We did get a one-off payment at the start for set-up costs, and there is a bonus for doing so many in a certain timeframe, but unlike GPs we pay for our own equipment which is why we only have one machine.
Would you recommend offering this service to other contractors?
You have to prioritise which services you think will most benefit your patient cohort. As a service the NMS can be underestimated and it’s not the best remunerated, but it is well worth doing. I would love to do every service going but, practically, the thing I can do well that is making the most impact on my local community and supporting my local GP surgery right now is the ambulatory blood pressure monitoring.