Blood pressure testing outside of general practice
A range of community partners in Cheshire and Merseyside use a common approach to do blood pressure (BP) checks
Summary
In 2017 the British Heart Foundation (BHF) awarded £100,000 funding for people to have potentially life-saving blood pressure (BP) checks, after the Champs Public Health Collaborative were successful in their bid for a BHF grant to support a community-based project in Cheshire and Merseyside (C&M).
High BP is a silent and potentially deadly condition that significantly increases a person’s chance of a heart attack or stroke. The funded programme aimed to increase opportunities for BP testing and monitoring outside of GP practices across C&M.
Background
The C&M Directors of Public Health and the C&M Blood Pressure Partnership Board, established in November 2015, agreed that a sub-regional system-wide approach to tackling high BP was a key priority. Over 625,000 people are thought to be affected by high BP in C&M and almost half this number are thought to be unaware that they have the condition. It is critical that urgent action is taken to prevent, identify and manage those at risk.
In May 2016 the C&M 5 year cross-sector strategy to tackle high BP, ‘Saving lives: Reducing the pressure’ was launched. The nationally and internationally recognised strategy sets out the vision, aims, objectives and high-level action plan for prevention, detection and management of high BP. It aims to relieve the pressure on health and social care services by empowering healthier lifestyles and self care.
What was involved
A combined approach was taken to maximise provision of BP checks. It aims to shift the detection of raised BP into the community so that people can be managed in alternative settings, freeing clinical space for higher risk patients.
One key aim of the C&M BP strategy is to develop innovative approaches to testing and treatment of new high BP cases by working closely with key partners. Learning from service users, providers and existing intelligence is paramount to the success of the strategy.
1. C&M Fire and Rescue Service (FRS): improving public access to information, BP measurement, and signposting in community settings
Both Cheshire and Merseyside Fire and Rescue services are undertaking BP checks as part of their Safe and Well Checks. Cheshire FRS has piloted the approach and starts to roll out amongst the whole fire service from February 2019. The BHF funding has been used to equip FRS teams with standards compliant BP machines, and for staff to receive relevant training.
The C&M BHF Steering Group will review progress at the end of June 2019. So far 52 fire service staff (advocates and crew) have been trained with Merseyside FRS, undertaking 612 BP checks.
2. Warrington Wellpoint kiosk
The BHF Funding has been used to deploy a state of the art kiosk at various venues throughout Warrington. The kiosk detects not only BP but body mass index (BMI), body fat and pulse and QRisk2 Heart Age. The kiosk has been extremely popular with approximately 2,400 individuals using the kiosk in the first 12 months.
3. Halton and Healthy Living Pharmacies: using a conversational tool to activate participation in BP testing and behaviour change
Evidence suggests that identification of high BP alone does not always lead to behaviour change. The way BP is explained to people can influence their willingness to adopt new behaviours.
In 2016, a qualitative study identified effective ways to use conversation to motivate behaviour changes around risk factors, self care and medication adherence.
The Heart Age tool (HAT), co-developed with the BHF, Public Health England (PHE) and UCL, helps people understand their risk of heart disease and offers a way to encourage more participation in BP testing and lifestyle change.
The BHF funding has been used to develop a conversational ‘toolkit’ (including training programmes, and workshops for professionals and health workers) to engage people, encourage participation in BP testing and promote the adoption of healthy behaviours.
They will do this using the HAT and behavioural insights to change the way health workers introduce the concept of BP to people. The aim will be to test whether this can impact people’s willingness to learn about BP and motivate them to look after it by adopting healthier behaviours.
What went well
7,515 checks have so far been carried out (this exceeded the 5,000 target in under 12 months).
Of these checks:
- 4,676 (62.2%) were female and 2,838 (37.8%) were male
- 2,119 (28.2%) had a high or very high BP (>140/90 mmHg)
- high BP was more common in men (36.5%) than women (26.6%)
- a high proportion of tests are being conducted on residents in the most deprived areas (32% of tests in the most deprived quintile)
Pharmacy tests are accelerating following training provision and NHS England C&M is launching an extension to the standard pharmacy contract remunerating BP testing activity (after pilot requirements have been met) to improve sustainability.
Cheshire FRS is pleased with the initial pilot and has put a memorandum of understanding in place to continue the BP testing in Safe and Well checks.
A sub-regional ‘Happy Hearts’ website was launched in September 2018 in partnership with NHS RightCare and is being used to promote pilots.
What could be improved
Conversational tool: IT equipment (tablets) availability in pharmacies is mixed, limiting the ability to use the conversational tool on the ‘front line’ in this setting.
Evaluation: there is limited access to IT or email in some sections of the public, for example, the elderly visited by FRS Safe and Well Checks. This is limiting national evaluation in some settings.
Next steps
280 Cheshire FRS staff are to be trained in February and March 2019 to deliver BP checks during Safe and Well visits.
A local evaluation has been commissioned, to be conducted by Liverpool John Moores University. There is also a national evaluation being conducted by Cordis Bright, commissioned by the BHF national team.
Champs Public Health Collaborative has recently been awarded further funding from the BHF after its latest successful partnership bid.
The new programme will enable further detection of high BP at scale and pace by embedding BP checks within wellbeing at work programmes. All 9 C&M areas are taking part in this innovative programme in addition to Merseyside fire authority.
Further information
Helen Cartwright, Head of Commissioning and Mobilisation, Champs Public Health Collaborative.