PCN pharmacist Gurvinder Najran shares insights into the role of a pharmacist PCN engagement lead and the outcomes of a 12-month hypertension case-finding pilot study

Q. Tell us about your role as primary care engagement lead and your support for community pharmacy

I serve as a primary care prescribing pharmacist within general practice, and I have recently been appointed as the primary care engagement lead for Dudley. In this new role, I am responsible for facilitating referrals from general practices in Dudley to community pharmacies for eligible patients, in alignment with the Primary Care Access Recovery Plan (PCARP) services. These services include Hypertension Case-Finding, Pharmacy First and the Pharmacy Contraception Service.

Enhancing patient referrals for PCARP services will not only improve access to care within general practices but also promote more efficient utilisation of resources. Furthermore, it will empower community pharmacies to expand their capabilities in supporting a sustainable model for the NHS.

Evidence suggests that the implementation of advanced pharmacy services can contribute to a reduction in hospital admissions, and the integration of PCARP services is expected to further minimize avoidable hospitalisations.1

Q. What advantages do you see in general practices and community pharmacy working together?

The implementation of processes to facilitate the signposting of patients from general practice to local community pharmacies contributes to the long-term promotion of patient self-care. Many patients are unaware of the extensive benefits that their local community pharmacies offer beyond traditional dispensing services.

This initiative aims to strengthen the relationship between patients and community pharmacies, ultimately reducing the previous reliance on general practices for such support.

Working towards a sustainable NHS involves engaging community pharmacies to alleviate avoidable workloads in general practice while simultaneously enhancing the skills and capabilities of community pharmacy staff.

The successful implementation of PCARP services by community pharmacies paves the way for the expansion of similar services, ensuring a smoother transition for patients who previously accessed these services through their general practice. This shift enables practices to better support the increasing demands of appointments, and potentially allows previously hospital-based appointments to be completed within primary care.

In my role as primary care engagement lead, I have witnessed the development of closer working relationships between community pharmacies and their respective general practices. This collaboration has led to significant improvements in the care provided by both parties. For instance, within one general practice in Dudley, the introduction of signposting processes for PCARP services has transformed a previously poor relationship into a strong partnership. Community pharmacies now support the training of GP registrars, offering them valuable insights into how community pharmacy can enhance general practice. This collaboration is a notable achievement.

This closer working relationship has also facilitated the resolution of prescription queries, such as stock shortages, and has enabled community pharmacies to engage in active clinical discussions with practice clinicians regarding medication-related inquiries and recommendations. Ultimately, these efforts contribute to the overarching goal of enhancing patient care.

Q. Are there any barriers to working together in this way?

The primary barriers I have observed and helped to address between general practices and community pharmacies largely stem from poor communication, which can lead to potential conflicts if not improved.

One notable example I have seen before involves community pharmacists consulting patients under the Pharmacy First scheme. In cases where a GP appointment was deemed more appropriate, the community pharmacist would signpost the patient to the respective general practice. However, the clinical rationale for this decision was not effectively communicated to the practice, resulting in uncertainty regarding why the patient could not receive treatment under the Pharmacy First service for that particular condition.

To resolve this issue, we developed a process whereby the pharmacy would email the respective general practice (as soon as practically possible following the consultation) with the clinical rationale detailing why the patient was not suitable for treatment under the Pharmacy First service. This information is then documented by the reception team in the appointment notes to assist the on-call clinician during that appointment.

Another challenge frequently encountered was the inappropriate referral of clinically unsuitable patients to community pharmacies from general practice, leading to a significant influx of referrals back to general practices for appointments. After review, it became evident that the triaging process within general practices was not being fully adhered to, resulting in these inappropriate referrals.

To mitigate this issue, I implemented the use of summary sheets – brief and concise documents provided by the local Integrated Care System (ICS) head of community pharmacy clinical services – along with a user guide on how to electronically refer patients to community pharmacies after appropriate triaging.

Many referrals had previously been made verbally, so we promoted electronic referrals and highlighted their benefits from a general practice perspective, such as robust clinical audit trails in patient records and supporting evidence for the practice's patient management access plan. This initiative was well received by the practice teams.

After implementing these new processes, we saw a significant increase in electronic referrals to local community pharmacies and discussions with these pharmacies indicated a notable reduction in inappropriate referrals. This helped to enhance the efficiency of NHS services.

Q. What other work have you been doing in your role locally?

In my role as the engagement lead, I have actively supported the increased accreditation of pharmacies to provide the Pharmacy Contraception Service.

Some pharmacy contractors were previously unaware of the Pharmacy First letter to contractors that said that by 31 March 2025 all contractors delivering Pharmacy First must also offer the NHS Pharmacy Contraception Service and the NHS Community Pharmacy Blood Pressure Check Service to qualify for the monthly fixed payment, in addition to meeting the relevant consultation thresholds.2

I have assisted pharmacy contractors in completing the necessary training as outlined in the service specification for the pharmacy contraception service and encouraged their participation in locally commissioned training events.

Sharing successful practice from pharmacies that have effectively offered PCARP services in high volumes has been useful. By reviewing the referral data from general practices within Dudley, I have been able to identify and prioritise Primary Care Networks (PCNs) with poor uptake, and this insight allows me to share successful processes and strategies employed by other PCNs with higher referral rates, fostering improvements in referral data.

Additionally, organising and attending meetings with general practices to raise awareness of PCARP services has been a significant aspect of my role. Many general practices were previously unaware of these services and, more importantly, how they can support local populations, particularly those experiencing significant health inequalities.

Following these discussions, general practices expressed a strong interest in implementing referral processes for appropriate patients to community pharmacies. This enthusiasm has been reflected in the recent referral data, showcasing a positive impact following our meetings.

Q. One initiative has been collaborative work around hypertension – what problems was this trying to solve?

One of the general practices in my PCN was concerned about the prevalence of poorly managed hypertension, largely attributed to the demographics of the area. In response, funding was secured from the local Integrated Care Board (ICB) to implement electronic referrals from general practice to local community pharmacies, which would be integrated into the EMIS PMR system starting in October 2023. This initiative aims to facilitate electronic referrals for clinic visits and ambulatory blood pressure monitoring (ABPM).

I was entrusted with the lead responsibility for implementing this pilot scheme, which presents a valuable and exciting opportunity to enhance patient care. To achieve the most significant and impactful outcomes, I recognised the necessity of fostering collaborative engagement among all clinicians within the practice.

Q. How did you encourage referrals for BP measurement?

I initiated discussions with the clinicians and GP partners during a clinical meeting at the practice, where I outlined the rationale for introducing this referral pathway and its significance for the local population in terms of addressing the prevalence, diagnosis, monitoring, and management of hypertension.

Given the diverse team of clinicians working within the practice – comprising GP Assistants, Physician Associates, Paramedics, and others – it was essential to ensure that the wider team understood this new function and recognized its potential to enhance prevalence monitoring and patient care.

During our discussions, we explored how the Hypertension Case-Finding Service referral pathway could be leveraged to support patient care and improve workload efficiency. To facilitate this process, I developed a user guide detailing how to utilize this additional referral function for directing patients to local community pharmacies for clinic visits and ambulatory blood pressure monitoring. The guide included a section for clinicians to provide supportive information to local pharmacies, offering context and background for each referral.

I am pleased to report that all clinicians at the practice were very proactive in adopting this additional referral pathway, beginning its use without delay.

Q. What were the findings of this work?

I conducted a review of the data collected from referrals to community pharmacies for clinic and ambulatory blood pressure monitoring (ABPM) between October 2023 and October 2024, and subsequently followed up on the outcomes related to diagnoses and monitoring. During this 12-month period, a total of 244 patients were referred to community pharmacies – 96 for clinic blood pressure checks and 148 for ABPM.

Notably, many patients were referred due to high clinic blood pressure readings recorded at the GP surgery. Among those referred for clinic blood pressure checks, 38.5% exhibited normal blood pressure readings at the pharmacy. This finding suggests that the Hypertension Case-Finding service provided by community pharmacies effectively supports patients experiencing white coat syndrome.

The outcomes of these referrals, which resulted in subsequent normal blood pressure readings at community pharmacies, demonstrate a reduced risk of unnecessary increases in medication dosages or the initiation of new anti-hypertensive treatments. This has further mitigated the potential for avoidable harm, such as hypotension, falls, and possible hospital admissions, which could have occurred if the high clinic blood pressure readings had been addressed solely within the GP surgery rather than through the referral pilot scheme.

Over 73% of referrals made to community pharmacies for clinic blood pressure checks were for readings that were overdue at the surgery, thereby supporting appropriate medication monitoring. This referral capability proved valuable for patients needing overdue checks or those requiring monitoring due to medication changes, particularly following correspondence from secondary care, such as hospital discharge paperwork.

This initiative not only aligned with the practice's Quality and Outcomes Framework (QOF) objectives but also ensured safe medication monitoring in accordance with patient safety and Care Quality Commission (CQC) requirements. The increased awareness within the practice regarding referrals to community pharmacies for blood pressure monitoring has encouraged exploration of additional patient cohorts for referral, such as those over 45 years of age who have not had a blood pressure check in the last five years, thereby supporting the practice's QOF (BP002).

Among the patients referred for ABPM, 18 new diagnoses of hypertension were made, translating to approximately one or two new diagnoses each month. As a result of these referrals, patients received lifestyle advice and anti-hypertensive treatment as appropriate, in accordance with NICE guidelines throughout the 12-month period. Additionally, six patients benefited from medication optimization of their currently prescribed anti-hypertensive medications due to the ABPM conducted by pharmacies, with two patients referred for potential atrial fibrillation diagnosis following symptom reviews and ECG assessments.

The impact of the hypertension case-finding project on patients at the general practice was significant. Discussions with the local pharmaceutical public health specialist and the chair of the cardiac clinical network highlighted a marked improvement in hypertension prevalence and monitoring following the implementation of this 12-month initiative within the local population.

The outcomes of this project have substantially enhanced health equality in the area, reduced avoidable hospital admissions and provided an opportunity to demonstrate the benefits of increasing NHS efficiency through collaborative efforts between community pharmacies and general practices.

Q. What is your advice to other PCNs and PCN/practice pharmacists on collaboration?

I strongly advise initiating discussions with general practices to raise awareness of the PCARP services provided by community pharmacies, emphasising how these services can support the local patient population while directly benefiting the general practice by increasing patient access and reducing avoidable workloads. We found our approach to be successful.

Promoting the communication of local pharmacies during meetings of general practices and PCN meetings can facilitate discussions about existing barriers within working practices and explore potential solutions to overcome these challenges. Enhancing communication will foster a more productive working relationship, allowing the benefits of PCARP services to be fully realised.

Q. And what is your advice to community pharmacies who want to engage with PCNs and PCN/practice pharmacists?

For community pharmacies, I recommend reaching out to the Local Pharmaceutical Committee to arrange a meeting with the respective PCN engagement lead. This meeting should focus on how they can support the improved referral process for PCARP services from general practices, as well as addressing any issues encountered with referrals, such as clinically inappropriate cases.

If they have not done so already, I strongly urge community pharmacies to proactively arrange meetings with their local general practices to discuss the benefits of PCARP services and the processes involved in delivering these services within community pharmacies. Such discussions can provide reassurance and alleviate any concerns that general practices may have regarding the capabilities of community pharmacies. Establishing these dialogues will lay the groundwork for developing long-term, effective communication between community pharmacies and local general practices.

Gurvinder Najran MRPharmS, Dip, I.Presc, PG Cert, Dudley PCN Pharmacist; Black Country ICB Dudley PCN Engagement Lead

Special thanks to all the staff at the pilot scheme surgery and the senior colleagues of the Dudley Pharmaceutical Team. 

References

  1. National Institute for Health and Care Research (2021). Supporting patients to take their new drugs correctly. [online] Available at: https://www.nihr.ac.uk/story/supporting-patients-take-their-new-drugs-correctly.
  2. DHSC. Pharmacy First letter to contractors. [online] Available at: https://www.gov.uk/government/publications/pharmacy-first-contractual-framework-2023-to-2025/pharmacy-first-letter-to-contractors