Josh Pinder, pharmacy area manager at Lincolnshire Co-op, talks to Saša Janković about running the community pharmacy hypertension case finding service clinics
NHS hypertension case-finding service clinic days
Name and location of pharmacies
Lincolnshire Co-op Pharmacies throughout the society (Lincolnshire, Yorkshire and Norfolk).
Name of pharmacy area manager
When did you start offering this service?
This launched the service in April 2022 in our branches, and we piloted running a clinic in collaboration with Cliff House Medical Practice at our Burton Road Pharmacy Lincoln in March 2023.
Why did you start offering this service?
With increasing demand on primary care, it is difficult for surgeries all over the country to be able to find the time, rooms and staffing to run a clinic of their own, but when looking at longer term prospects of complications, prevention of cardiac events is always going to be better than trying to cure.
While community pharmacy taking on the role of checking and identifying undiagnosed hypertension is incentivised by the HCFS funding, I value this collaborative effort more as a means of building stronger relationships with surgeries in the area, promoting the positive impact that pharmacy can make on their workload and how we can improve outcomes for their patients.
How much did it cost to set up the service?
This isn’t cheap to set up. Initially, you are looking in the region of £700 to £1,000 for one ABPM machine. Up to 31 March 2023, when 15 consultations had been done, £1,000 could be claimed back as an incentive payment for providing the service, but this has now increased to 20 consultations (if you had not received the payment already).
The clinic BP machines are much more sensibly priced, and every pharmacy probably has one already – but check calibration and that the model is listed as approved for the service.
What, if any, training did you or other team members have to undergo?
Pharmacies have been checking blood pressure for years, so pharmacists should already be competent at this. However, the service specification explains suggested training and being familiar with NICE guidelines for hypertension.
There is a useful flowchart in the service specification which shows inclusion/exclusion criteria, what results are normal and when to refer including timescales, and similarly for ABPM. For example, a clinic BP of over 140/90 is GP referral within three weeks or for ABPM in pharmacy. Clinic BP over 180/120 is immediate referral.
In a nutshell, what does the service involve?
As we ran this clinic in collaboration with the GP surgery, they sent a text out to all patients that they needed up-to-date results for, so in essence, all patients were GP referrals to us.
We ran this clinic as a drop-in session, so patients could attend at a time suiting them for a free check. If they were eligible, we fitted them with a 24-hour ABPM monitor there and then, or alternatively booked them an appointment for one fitted that week either in that branch, or any other of our local branches. This meant we got lots of up-to-date clinic readings, and performed lots of ABPM measurements – plus any patients newly prescribed an antihypertensive were then eligible for an NMS.
As well as providing lifestyle advice as part of this service, on the day we also had a member of our community team there to promote the free-for-patients guided ‘health walks’ that we provide with trained volunteers in local areas. We have found that providing these walks is very beneficial, not only for physical health and wellbeing, but also mental health and wellbeing – and is an easy way in to becoming more active.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
You could possibly recommend a BP machine to monitor at home, but we mainly offer lifestyle advice around diet – fats/salt intake/caffeine/alcohol – smoking cessation, physical activity and weight management.
How have patients responded to the service?
Patients really liked the drop-in session and footfall from the number of patients the surgery texted was much higher than anticipated. We already have a strong relationship with Cliff House Medical Practice which did help to get this first clinic started. It shows patients that we do work collaboratively, and by initiatives like this checking the patients the surgery deem a higher risk we are actively improving health in the local community.
Additionally, at our local NHS hospital trust (as quoted on their website), the average wait time for an outpatient cardiology appointment is 19 weeks if a patient were to be referred there for ABPM fitting. With us, routinely patients can be fitted with an ABPM the same day, or if not then usually within one week - again, linking back to improving patient outcomes and starting appropriate treatment sooner.
Roughly how often each month do you carry out the service?
This clinic was a pilot to see how the collaborative push could work. Now we know it was successful we will try to work on it with other surgeries in our local communities. However, outside of running clinic days, we do still offer this service on a day-to-day basis in all of our pharmacies for GP referrals and for patients identified by the pharmacist as being eligible.
How much do you charge for the service?
This is free to the patient.
Roughly how much a month do you make from offering the service?
As per the PSNC website, the fee works out as follows:
- Set-up fee of £440
- Fee for each clinic check of £15 and
- Fee for each ambulatory monitoring of £45.
In addition, the following incentive fees across years 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 in 2022/23 and 20 in 2023/24).
If a pharmacy hasn’t already received the incentive, they can get it by completing 20 ABPM from April 23/March 24.
Would you recommend offering this service to other contractors?
Yes. It is something we had been offering for free in pharmacy for far too long, and it is a valuable service which really can make a difference in our communities. Throughout the two-day clinic we saw three patients in need of a same day referral, and the clinic resulted in any ABPM fittings in our pharmacies.
Collaborative working is the takeaway message. At Lincolnshire Co-op our purpose is ‘to bring together ideas, energy and resources to make life better in our communities’, and working in/with our communities to improve health and wellbeing is a big part of this.