Blood Pressure Case Finding: The NHS Advanced Service Guide

About this service

The NHS Blood Pressure Check Service enables community pharmacies to identify undiagnosed hypertension, provide lifestyle advice, offer ambulatory blood pressure monitoring (ABPM) where indicated, and refer patients to general practice in line with NICE NG136 and the NHS service specification.

The service is commissioned as an NHS Advanced Service in England. Pharmacies must register on the NHSBSA Manage Your Service (MYS) portal before providing it and should notify their local general practices that the service is available.

The service can be provided by suitably trained and competent pharmacy staff under the supervision arrangements described in the service specification. The responsible pharmacist remains responsible for ensuring staff competence.

Who to offer the service to

Include

• Adults aged 40 and over who do not have a current confirmed diagnosis of hypertension.
• Adults between 35 and 39 who approach the pharmacy or are identified as at risk, at the discretion of the pharmacy professional.
• Patients under 40 with a recognised family history of hypertension, at the discretion of the pharmacy professional.
• Patients of any age, with or without a prior diagnosis of hypertension, referred by their general practice for a clinic blood pressure check or ABPM.

Exclude

• Adults under 40 without a recognised family history or a general practice referral.
• Patients whose blood pressure is already regularly monitored by a healthcare professional, unless referred by their general practice.
• Patients who require daily blood pressure monitoring for any period.
• Patients where no appropriately sized cuff is available: direct these patients to their general practitioner.

How to deliver the service

1. Identify eligible patients and gain consent. Proactively approach patients who meet the inclusion criteria. Explain the service and confirm verbal consent before taking any measurement. Record consent in the clinical record, noting that results will be shared with the patient's general practice.
2. Prepare the patient. Ask the patient to sit quietly for at least five minutes. The back should be supported, feet flat on the floor, and the arm resting at heart height on bare skin. The patient should not have consumed caffeine or smoked in the preceding 30 minutes.
3. Take the clinic blood pressure reading. Use a validated monitor from the British and Irish Hypertension Society approved list.
   • On first attendance, measure blood pressure in both arms.
   • If there is a difference of more than 15 mmHg between arms, repeat the measurements.
   • Use the arm with the higher blood pressure reading for future measurements and for ABPM if required.
   • Take two readings and use the lower of the two readings for clinical decision-making.
   • Record the systolic and diastolic values.
4. Act on the result. Refer to the outcomes table below. Give the patient a written record of their readings regardless of the outcome.
5. Give lifestyle advice. Brief every patient on healthy behaviours in line with NICE NG136. Record the advice given.
6. Record and submit. Record the consultation in the clinical record. Send results to the patient's general practice via NHSmail or another approved secure channel using the correct subject line for the urgency level. Submit data to MYS monthly.

Assessment: results and next steps

Ambulatory blood pressure monitoring (ABPM)

Fitting and setup

1. Fit the device. Apply the cuff to the arm with the higher clinic blood pressure reading. Ensure a valid reading is obtained before the patient leaves. Confirm contact details.
   • ABPM is a 24-hour recording; the diagnostic average used for classification is calculated from waking-hour readings only.
2. Instruct the patient.
   • The device takes readings automatically every 30 minutes during usual waking hours (for example 08:00 to 22:00).
   • The device must not get wet. Baths and showers must be avoided.
   • The arm should be kept still and relaxed during each reading.
   • Provide written instructions.
3. Set the device correctly.
   • Programme the monitor to take two readings per hour during waking hours.
   • Re-set the device between patients.
   • At least 14 valid waking-hour readings are required to calculate a diagnostic average.
4. Interpret and return. At the follow-up appointment:
   • Retrieve the device.
   • Calculate the average systolic and diastolic blood pressure from at least 14 valid waking-hour readings.
   • Explain the results to the patient.
   • Send the full ABPM report to the GP.

ABPM results and next steps

Healthy lifestyle advice to give every patient

• Reduce salt to less than 6 g per day. Check food labels for sodium content.
• Eat a balanced diet with plenty of fruit, vegetables, and wholegrains; reduce saturated fat and processed foods.
• Aim for at least 150 minutes of moderate-intensity exercise per week (for example brisk walking, cycling, or swimming).
• Keep alcohol within recommended limits (no more than 14 units per week, spread over at least three days).
• Stop smoking and signpost all smokers to the local stop-smoking service.
• Maintain a healthy weight; even modest weight loss can meaningfully reduce blood pressure.
• Discuss stress management, sleep, and wellbeing where appropriate.
• Advise moderation of excessive caffeine intake.

Recording and submission

• Record verbal consent before taking any measurement, including:
  • Date
  • Patient name
  • Date of birth
  • NHS number
  • Address
• Record:
  • Clinic reading (systolic and diastolic)
  • Arm used
  • Date of measurement
• If ABPM is performed, record:
  • Date device fitted
  • Date returned
  • Average systolic and diastolic readings
  • Number of readings obtained
  • Action taken
• If a patient declines ABPM or fails to attend, record this and notify the GP accordingly.
• Send results to the patient's general practice using the agreed NHSmail subject line corresponding to the urgency: same day, within 7 days, within 3 weeks, or weekly summary.
• Complete the consultation record using the pharmacy's approved clinical recording platform and ensure the claim is submitted via MYS.
• Submit the required dataset to MYS in line with the service specification each month.
• Retain all records for a minimum of three years for post-payment verification.

Key takeaways

• A clinic reading of 180/120 mmHg or above with symptoms means call 999; do not wait.
• Measure both arms initially; use the higher-reading arm going forward, but use the lower of the two readings taken for clinical decision-making.
• ABPM should be offered whenever the clinic blood pressure is 140/90 mmHg or above and below 180/120 mmHg.
• Record consent, act on the result, send information to the GP within the correct timeframe, and submit activity to MYS monthly.

Download the checklist