Hypertension is the second largest known global risk factor for disease and disability, accounting for approximately half of all cardiac events (1). In England there are 5.5 million people with undiagnosed hypertension (1) The NHS Long Term Plan commits to the prevention of 150,000 strokes, heart attacks and dementia cases by 2029.
Reviewing PCN data identified opportunities to improve healthcare for Nottingham West’s population, 2020/2021 data showed Nottingham West PCN (NWPCN) was under achieving for hypertension diagnosis against estimated prevalence (Appendix 1). Therefore, Nottingham West PCN set up a radical PCN/ Pharmacist-led Hypertension case finding and management initiative, created by Dr Paul Scullard, Clinical Director, NW PCN. This at-scale initiative utilises highly skilled and experienced prescribing pharmacists and a pharmacy technician, in partnership with community pharmacies, to identify those at risk of hypertension, as per pathway protocols (Appendix 2,3). By screening, diagnosing and managing patientsin line with NICE guidance, including referral to secondary care when appropriate (2) the service reduces workload for GPs, standardises care across a large diverse PCN, achieving excellence in patient care. Initially 9,000+ patients were identified for whom this intervention may have a significant impact. Patient records were reviewed, those suitable invited via letter attached to a text message, to opt into this pathway. Once opted in, patients chose to either complete attend a local pharmacy for ambulatory BP monitoring (ABPM) or 7 days of home BP monitoring. The team reviewed all results, ordering further investigations where appropriate. All hypertension diagnoses continue to be managed by the team until the patient achieves an optimal BP, at which point the patients care is transferred back to their GP for annual follow up.
In eleven months of data collection, more than 3,000 patients were included. 82% of patients were suitable to be invited, 53% opted in, resulting in 22.1% hypertension diagnosis rate. Nottingham West PCN has so far achieved 312 people newly diagnosed with hypertension, freeing up 3,103 General Practice appointments, preventing 1.9 heart attacks (£16,521) and 2.8 strokes (£41,176) over the next three years.
Based on our results we estimate that nationally the NHS could prevent: 1174 Heart attacks and 1735 Strokes, saving the NHS £35,550,145 and freeing up 1,911,921 GP appointments. Costs for the service were paid out of Additional Roles Reimbursement Scheme (ARRS)and through Achievement of Investment and Impact Fund (IIF) targets.
We are so proud that this work has been nominated for the NHS Parliamentary awards by MP Darren Henry.
