Management of blood pressure in community pharmacy has tremendous potential.

By Mike Maguire

Midnight is where the day begins. That’s a line from a U2 song, and Community Pharmacy has witnessed its “midnight” come and go. Taking your biggest customer to a Judicial Review isn’t a great place to be, but the dawn is starting to break on new opportunities.

The scars

Naturally, such a challenging time will leave scars upon the way Community Pharmacy feels, thinks and behaves.

However, there is grave danger in playing the role of victim for too long. Victims are, by definition, helpless and passive, and this mindset will inhibit the ability to spot opportunity and act pro-actively.

The opportunity

There’s a great opportunity beckoning Community Pharmacy right now, and there are other opportunities on the horizon, but only if we can deliver consistently across our whole network. There are a number of open doors in front of us, but the risk is that we don’t actually walk through them, either because we feel that we don’t have the capability or confidence, or just because we don’t realise that we need to.

The Community Pharmacist Consultation Service (CPCS) is one such opportunity. Never before has Community Pharmacy been invited to play such a key role in the Urgent and Emergency Care landscape.

Never before has Community Pharmacy been able to position itself in such a way, that if it delivers high quality in a consistent manner, then there will be no going back.

I’ve seen some great services, Smoking Cessation to name one, that have been decommissioned, not because of a failure to deliver, but because of circumstances outside of our control.

The potential

The CPCS is a service that, if we all get it right, will give us a voice at the table that is unprecedented. The initial NHS111 referrals are a breakthrough, but they will be overtaken in magnitude by the potential of GP Referrals for low acuity conditions.

There could be as many as 20 million patients referred into Community Pharmacy each year by General Practice. This could be a game-changer not only for Community Pharmacy, but for Primary Care as a whole.

The management of blood pressure in Community Pharmacy in a consistent and structured way, also has tremendous potential. All adults should have their blood pressure checked every five years as this helps to prevent heart disease. Community Pharmacy has the potential to not only detect undiagnosed high blood pressure, but also to diagnose it.

A current British Heart Foundation-funded project in Newcastle rewards the Community Pharmacy, only when a patient is diagnosed by the pharmacist as hypertensive and is referred into their General Practice.

The agenda

The new Community Pharmacy Contractual Framework refers to a range of additional prevention and detection services which it would like to be tested with a view to being mainstreamed if effective. The first of these services specified for testing is “A model for detecting undiagnosed Cardiovascular Disease (CVD) in community pharmacy and referral to treatment within Primary Care Networks, complementing the CVD service specification in the new Network Contract”. So, the direction of travel is clear.

By April 2020, it will be an essential requirement to be a Level 1 Healthy Living Pharmacy (HLP). This further reinforces the message that Community Pharmacy is a great place to influence lifestyle choices. We know that lifestyle has a tremendous impact on the risk of developing and exacerbating Cardiovascular Disease, and increasing the numbers of HLPs highlights the potential value of Community Pharmacy in the prevention and detection agenda.

In the future, it is not beyond the realms of possibility that having started on a clinical management plan for hypertension, patients are supported on their journey in the Community Pharmacy.

Pharmacists are already reviewing and managing patients successfully in General Practice and in Care Homes, and the local Community Pharmacy would provide a convenient location for many patients to attend for the management of their blood pressure by their Community Pharmacist.

The reality

So how much of this is blue-sky thinking and how much is reality?

Well, for once, Community Pharmacy is starting to position itself to take control of its own destiny. The challenge currently is that so many Community Pharmacies are struggling financially, and they are firefighting daily in a desperate attempt to stay afloat.

The pressure is intense, and it is very difficult to detach, zoom out and view the bigger picture as a whole. Those that don’t detach and take appropriate action will continue to struggle. Those who can re-position themselves to take advantage of the new landscape not only will survive but will prosper.

The new dawn of Community Pharmacy looks very bright if we can open our eyes wide enough to see it.

Mike Maguire is Chair CNE Local Professional Network (Pharmacy)

This article also appears in the November issue of Pharmacy Business.

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