Community pharmacies are to ‘urgently’ refer patients with an irregular pulse for a GP appointment on the same day, under a new hypertension case-finding scheme launched by NHS England.
The community pharmacy hypertension case-finding scheme aims to identify eligible patients with high blood pressure and to ‘refer them to general practice to confirm diagnosis and for appropriate management’.
Pharmacies should also urgently refer patients with ‘very high’ blood pressure or low blood pressure with regular experience of fainting or falls or the feeling they might faint, according to the service specification, published last month.
Patients with less urgent hypertension should be booked in to their GP practice within three weeks, NHS England said.
What the service specification says
‘All test results must be sent to patients’ registered general practices’, with those that do not require an ‘urgent’ referral sent by NHSmail or an ‘other secure digital process’ as part of a weekly summary.
Patients with ‘very high clinic blood pressure’ – defined as 180/120mmHg or higher – or those with blood pressure ‘lower than 90/60mmHg that experience regular fainting or falls or feel like they may faint on a daily/near-daily basis should be booked for a same-day GP appointment.
Any ambulatory blood pressure monitoring (ABPM) that indicates ‘stage 2 hypertension’ – defined as average blood pressure of 150/95mmHg or higher – should also be booked for a same-day appointment.
Those with blood pressure below 90/60mmHg that experience dizziness, nausea or fatigue will receive ‘advice promoting healthy behaviours and be advised to see their GP within three weeks’.
Those whose ABPM confirms high blood pressure with an average of 135/85mmHg or higher but lower than 150/95mmHg will be referred to see their GP within three weeks Patients should be given a record of their test results.
Doncaster LMC chief executive Dean Eggitt said he has ‘several concerns’ about the service specifications, which he said are ‘risk-averse’ but ‘rightly so’.
He told Pulse: ‘Clinically it’s the right thing to do – if someone has an irregular pulse, there’s a risk of atrial fibrillation and with atrial fibrillation there’s a risk of stroke, so it needs urgent treatments to thin the blood to reduce the chance of having a disabling or deadly stroke.
‘The problem we’ve got at the moment of course is that we can’t guarantee access to any patient at an urgent rate at the moment, so quite how we’re going to be able to follow up on the promise of an urgent same-day appointment I don’t know.’
He added that this leaves GPs in a ‘really difficult moral position’ as they have a patient they know is ‘at risk of disabling stroke and death’ but can’t guarantee seeing them.
Dr Eggitt said: ‘If that is the case, the only thing that we can do if we can’t guarantee seeing them is send them to A&E – so those patients may indeed actually just be forwarded to A&E which is absolutely the wrong thing to do.’
He added that pharmacists should be enabled to manage patients rather than just ‘diagnose and signpost’ them to GPs.
He said: ‘What we probably need to do though is to start considering how to work the world of medicine without putting everything either through a GP or A&E.’
The specification said that those eligible for the service include:
- Adults aged 40 or over who do not have a current hypertension diagnosis
- Patients under the age of 40 who ‘request the service because they have a recognised family history of hypertension’ – ‘at the pharmacist’s discretion’ and ‘by exception’
- Patients aged 30-39 who are ‘approached about or request the service’ – ‘at the pharmacist’s discretion’
- Adults ‘specified by a general practice’ for either clinic or ambulatory blood pressure measurement, via a ‘locally agreed process’
Pharmacies should refer any patient identified as eligible but where the ‘smallest/largest cuff available does not fit and therefore an accurate blood pressure cannot be obtained’ to their GP, it added.
The advanced service specification was ‘informed’ by a hypertension case-finding pilot that took place across a group of PCNs, NHS England said.
All pharmacies in England have been able to offer targeted cardiovascular (CVD) screening to patients aged over 40 since October as part of the hypertension case-finding service.
This is backed by the PCN incentive scheme, which rewards PCNs on the ‘follow-up’ of patients with one-off high blood pressure readings to ‘confirm or exclude’ hypertension, as well as the resulting rate of hypertension diagnoses.
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