Blood Pressure Optimisation

Cardiovascular Disease (CVD) is a leading cause of premature mortality and morbidity in England. The global burden of disease study identified high blood pressure and high cholesterol as leading risk factors that drive mortality and morbidity from cardiovascular disease. These risk factors are high impact but also highly modifiable.

Treatment of high blood pressure and high cholesterol substantially lower the risk of CVD. Despite this, both risk factors are underdiagnosed and undertreated. Around 30% of people with hypertension are unaware of their condition, and the pre-pandemic Quality and Outcomes Framework (QOF) data showed that around one third of people with diagnosed hypertension are not treated to QOF target, with substantial variation across the country.

Prevention of CVD in people with hypertension requires optimal control of both blood pressure and cholesterol. Around 50% of people with established CVD also have hypertension. All men over the age of 55 with hypertension and women over the age of 60 with hypertension who do not have CVD are nevertheless at high risk (with a QRisk score above 10%). These individuals should be offered treatment with lipid lowering therapy, but large numbers are either on no treatment or suboptimal treatment.

Objectives

•  Improve blood pressure and broader cardiovascular disease risk management (especially lipid management) in people with hypertension.
• Improve management of cardiovascular disease risk factors reduced heart attacks, strokes and cases of vascular dementia.
  

Our approach

AHSNs will support Primary Care Networks (PCNs) to implement the UCLPartners Proactive Care Framework for hypertension, to optimise clinical care and self-management of people with hypertension. This will be achieved through:

• Risk stratification to prioritise which patients to see first
• Use of the wider workforce to support remote care and self-care
• Supporting patients to maximise the benefits of remote monitoring and virtual consultations where appropriate.
  

We will also support PCNs to increase the detection of people with hypertension through case finding interventions (including practice case finding through patient record searches, and models that involve community pharmacists as part of the new hypertension community pharmacy scheme). We will support Integrated Care Systems to reduce health inequalities by targeting 20% of the most deprived populations and other local priority groups (applying the Core20PLUS5 framework).

The Blood Pressure Optimisation programme supports systems to take a multi-morbidity approach in supporting patients which hypertension. This approach will enable AHSNs to deliver on the objectives of both the NHS England @home programme and AHSN National Lipids and Familial Hypercholesterolaemia programme.

Case Finding

AHSNs will support Primary Care Networks (PCNs) to implement the UCLPartners Proactive Care Framework for hypertension, to optimise clinical care and self-management of people with hypertension. This will be achieved through:

• Risk stratification to prioritise which patients to see first
• Use of the wider workforce to support remote care and self-care
• Supporting systems to adapt the framework pathways for local implementation
• Supporting patients to maximise the benefits of remote monitoring and virtual consultations where appropriate.

Identifying appropriate patients

UCLP Frameworks are free to access and can be used in all GP systems.

To access you can contact;

UCLP Proactive Care Frameworks Request for access

You will then be able to access and download the search tools you need to risk stratify and prioritise your patients.

To understand more about the UCLP Hypertension framework, click here. 

Project Implementation Resources

We have provided resources on this page to support you to develop your BPO project using QI methodology.

Quality Improvement (QI) helps us identify what works well and where we can make changes. In primary care, we don't have time or resources to spend on things that don't work, don't serve our patients, and that could be done more efficiently or effectively. QI is a commitment to continuously improving the quality of healthcare, focusing on the preferences and needs of the people who use services. (Royal College of General Practitioners 2017)

“In order to practise medicine in the 21st century, a core understanding of quality improvement is as important as our understanding of anatomy, physiology and biochemistry. (Stephen Powis, Medical Director, Royal Free London NHS Foundation Trust, 2015. Academy of Medical Royal Colleges)

Designing your project

1. Complete your Driver Diagram example of a completed Driver Diagram here.

2. See if a PDSA cycle would work for you, have a look here for more details

3. Have a look at the project plan template, it has been designed to aid with structuring your work project.

4. Consider an Action Learning Set format for your team

Community Pharmacy and Hypertension Case Finding

The NHS Community Pharmacy Hypertension Case Finding Service supports risk identification and prevention of cardiovascular disease (CVD).

This service will:

• Identify people over the age of 40 who have previously not been diagnosed with hypertension (high blood pressure), and to refer those with suspected hypertension for appropriate management.
• Promote healthy behaviours to service users.
• Refer people identified as likely to have high blood pressure to general practice, for ongoing care to manage their blood pressure.

You can find your nearest community pharmacy, across Wessex, offering NHS blood pressure checks using the link to the interactive map below;