Hypertension Case-Finding Service

The service requirements are included in the service specification, which pharmacy owners must read before deciding whether to provide the service.

Download the service specification

Service specification Annex A – Blood pressure check process flowchart

Service specification Annex B – Guidance on clinic blood pressure check

Service specification Annex C – Clinic BP flowchart

Service specification Annex D – ABPM flowchart

Service Directions & Determination (published September 2021)

Briefing 035/23: Updated guidance on the Hypertension Case-Finding  (22nd November 2023)
This Community Pharmacy England Briefing provides additional guidance for pharmacy owners and their teams on the service.

The service has two stages – the first is identifying people at risk of hypertension and offering them a blood pressure measurement (a ‘clinic check’).

The second stage, where clinically indicated, is offering ambulatory blood pressure monitoring (ABPM). The blood pressure test results will then be shared with the patient’s GP practice to inform a potential diagnosis of hypertension.

Pharmacy owners opting to provide the service must undertake both stages of it, where clinically required, i.e. it is not possible to just undertake clinic BP readings and not ABPM.

The service should be provided by suitably trained and competent pharmacy staff. The Responsible Pharmacist must ensure that delegated tasks are being undertaken safely by competent pharmacy staff.

The pharmacy owner must ensure all pharmacy staff providing the service are appropriately trained and that clinical supervision for the service is being provided by the pharmacist.

Pharmacy owner checklist

Once a pharmacy owner has decided they wish to provide the service, our implementation checklist will guide them through the steps they need to take to prepare to provide the service.

Download the pharmacy owner implementation checklist (22nd November 2023)

Following the publication of the latest service specification, pharmacy owners who are already providing the service can use our existing provider checklist to guide them through the steps they need to take to continue to provide the service.

Download the pharmacy owner checklist (existing providers) (22nd November 2023)

BP meters to be used in the service

As part of preparations to provide the service, pharmacy owners will need to purchase or rent equipment for each of the two stages of the service – Clinic blood pressure check and ABPM – unless they already have equipment which meets the required standards.

Equipment that is to be used in the service must be validated by the British and Irish Hypertension Society (BIHS), so pharmacy owners must use a ‘normal’ BP meter and an ABPM which are included on one of the two following BIHS lists:

Validated BP Monitors for Home Use

Validated BP Monitors for Specialist Use

Points to note:

• ABPMs must be reset for each service user;
• To meet the service specification requirements, validation, maintenance and recalibration of both clinic blood pressure monitors and ABPM devices should be carried out periodically according to manufacturers’ instructions; and
• Infection control measures and cleaning must be carried out as per the instructions of the manufacturer or supplier and in line with current infection control guidance.

Considerations before purchasing/renting equipment

Pharmacy owners may find it useful to refer to the Medicines and Healthcare products Regulatory Agency guidance on the purchase, management and use of blood pressure measurement devices and the Point of care testing in community pharmacies guide when selecting equipment for this service.

Consultation room

Pharmacies must have a consultation room that will be used for the provision of the service which meets the requirements in the Terms of Service. The consultation room should also comply with the following requirements:

• When measuring blood pressure, the patient must be able to rest their arm on a table/bench at a suitable height; and
• It must have IT equipment accessible within the consultation room to allow contemporaneous records of the consultations provided as part of this service to be made.

Further information for provision other than in the pharmacy consultation room can be found on the CPE website.

Sign up to provide the service

Pharmacy owners must notify NHS England that they intend to provide the service by completion of an electronic registration through the NHS Business Services Authority’s (NHSBSA) Manage Your Service (MYS) application.

Standard Operating Procedure

Pharmacy owners must have a Standard Operating Procedure (SOP) for the service, which all staff participating in provision of the service must be familiar with and follow. SOPs must include the process for maintenance and validation of the equipment used.

Various pharmacy support organisations provide template SOPs which their members can personalise for use in their pharmacy.

Following changes to the service specification, pharmacy owners are advised to review any existing SOPs for the service, to ensure any relevant changes to these SOPs have been made. When developing or updating the SOP, pharmacy owners will need to decide the role of different staff types within the provision of the service, including how the pharmacist will be involved, including providing clinical supervision of the service.

Select an IT system

Pharmacy owners must use an NHS-assured clinical IT system to make their clinical records and payment claims for the service.

These IT systems  allow pharmacy staff to make a clinical record for the service and the data in the record will then be used by the IT system to populate a claim for payment within the NHSBSA’s MYS platform.

The transfer of data via the API will happen throughout the month, as data is entered into the IT systems. The service provisions will then be available to view in MYS from the 1st of the following month. For example, service provisions in December will be available to view in MYS on 1st January. Pharmacy owners will then need to log into the MYS platform to check that the data matches the details in their IT system, and they will then need to submit their claim for payment.

The full dataset for the Hypertension Case-Finding Advanced service can be found in Annex F of the service specification.

The NHS approved clinical IT system will also send messages containing the patient’s results to their general practice.

The following four IT suppliers have developed their systems to include functionality to support the service, but over time, it is hoped other suppliers will add the service to their systems:

Pharmacy owners providing the service will need to consider which system they want to use and will then need to enter into a contract with that supplier.

Read more about the IT requirements for all CPCF clinical services

Full details on how to provide the service can be found on the CPE website.

The following fees have been agreed for the service:

• 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. An incentive fee of £1,000 will be payable in the first year of reaching the specified ABPM threshold for the service provision, followed by a payment of £400 in subsequent years if the pharmacy reaches the specified thresholds for those years.

Pharmacy owners who sign up after 2021/22 must achieve the ABPM activity thresholds specified for the given financial year and will receive £1,000 as a first payment. If a pharmacy owners signs up in 2021/22 and fails to do 5 ABPMs, they can earn £1000 by doing 15 ABPMs in 2022/23. Followed by a payment of £400 in 2023/24 if the pharmacy reaches the threshold of 20 ABPM interventions in that year.

Pharmacy owners who signed up in 2021/22 or 2022/23 but not achieving 5 ABPM interventions in 2021/22 or 15 ABPM interventions in 2022/23 and pharmacy owners who signed up in 2023/24 must achieve 20 ABPM checks in 2023/24 to receive the £1,000 payment. As the incentive fees are only available for thresholds achieved up to 31st March 2024, no further incentive payments will be made after this period.

These incentive payments are funded separately (i.e. from outside the pharmacy global sum) by NHS England to incentivise case finding in line with the ambition outlined in the NHS Long Term Plan.

To achieve these targets, pharmacy owners will need to first identify people in whom ABPM is indicated, i.e. people with high clinic blood pressure measurements who then accept ABPM with accompanying support and advice.

The incentive fees will help pharmacy owners to fund the capital cost of purchasing a suitable clinic BP meter and an ABPM.

If clinic blood pressure measurements or ABPM are provided at the request of a general practice, the service fees set out above will be paid to the pharmacy owner.

If a pharmacy owner de-registers from the service within 30 days of registration, they will not qualify for the £440 set-up fee. In this event, if the £440 set-up fee has already been paid to the pharmacy owner, this money will be claimed back.

Claiming payment

Data from the NHS assured IT system will be submitted to the MYS portal via an application programming interface and will be used by the NHSBSA to populate a payment claim within the MYS portal.

The pharmacy owner needs to review this payment claim and then submit it. Claims for payment for this service should be made monthly, via the MYS portal and no later than three months from the claim period for the chargeable activity provided. Claims which relate to work completed more than three months after the claim period in question, will not be paid.

If the pharmacy owner is commissioned to deliver any related services, e.g. the Pharmacy Contraception Service (incorporating BP clinic measurement), the pharmacy owner may not claim twice for the same activity.

Data will only be submitted by the NHS assured IT system for completed service provisions. For example, where a clinic check has been undertaken and an ABPM is required, which will be undertaken in the following month, the data for the complete service provision will be reported once both elements of the service (clinic check and ABPM) have been completed.

The full dataset for the Hypertension Case-Finding Service can be found in Annex F of the service specification.

Training requirements

To provide the service, pharmacy staff must:

• Be familiar with parts of NICE guideline Hypertension in adults: diagnosis and management [NG136] relevant to the role they are undertaking within the service;
• Have read and understood the operational processes to provide the service as described in the service specification; and
• Have completed the recommended training on how to use the blood pressure monitoring equipment which should be provided by the equipment manufacturer/supplier.

The British and Irish Hypertension Society have a short video that staff can watch to show them how to take blood pressure with patients.

Additional optional training

Pharmacy staff wanting to undertake further training on hypertension, understanding vascular risk and behaviour change interventions can do so on an optional basis to support their own continuing professional development (CPD).

Support with additional CPD can be found on the:

• CPPE hypertension case-finding service page
• Pharmacy courses page of the Health Academy website.

Pharmacy team training

The whole pharmacy team can proactively promote this service and support with the recruitment of patients. Teams should be briefed on the service and coached on how to best approach people about the service.  A pharmacy team briefing and a guide on how to recruit patients is available to assist pharmacy owners to engage and coach their team members.

Download the Community Pharmacy England Briefing for pharmacy teams on the service (22nd November 2023)

Webinars

Pharmacy owners and their teams can now watch an on-demand recording of Community Pharmacy England’s webinar on the re-launch of the Hypertension Case-Finding Service.

Watch the Hypertension Case-Finding Service webinar.

The Department of Health & Social Care launched a new ‘Get your blood pressure checked’ campaign on 11 March 2024.

Campaign details and resources for Pharmacy can be found on the DHSC website.

Visit the Hypertension case-finding FAQ page.