Hypertension care

Helping patients with HYPERTENSION (High Blood Pressure) to get the best from your doctor and the NHS

This web-site is about helping you to understand how you can get the best out of the practice and other resources. Terms highlighted in RED are key words that you should find in your own medical record. Staff are highlighted in BLUE. Equipment is highlighted in GREEN.

You may ask why?
The most recent patient survey has shown that patients want to be able to see the clinician sooner (ie less than 2 weeks) and on time (ie not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients.

So how can we meet the demand?
Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit.

You may ask how?
There are some simple steps that are essential for you to understand that will help you on your journey of discovery for your health and well-being.

1. What condition do you suffer with?
   95% of patients with high blood pressure suffer with Essential Hypertension which means “high blood pressure of unknown cause”. A few patients develop Hypertension for another cause which you can find in your GP-held electronic health record.
2. What does that condition mean?
   Here are some links for hypertension that you may wish to see:
   
   
   • NHS Choices:
   • Map of Medicine:
   • Summary info:
     
     
3. What help is available for you to use?
   This condition is primarily managed by the nurses. They can check your blood pressure readings, order tests and review them, check any problems you may be encountering and do a medication review for you. They can also advise on things you may wish to consider and discuss things that you may have learned during your journey of discovery. 
   The health care assistants can check your height and weight and do any blood tests you may need as well as check your urine sample.
   Nurse Practitioner Appanah is able to diagnose hypertension and can start treatment including prescribing drug treatments that you may need. She has been specially trained to do this work within pre-defined limits as part of a patient group directive.
   Doctors can see patients whose blood pressure is not getting under control or if you are having difficulties due to possible side effects.
   There is a blood pressure machine in the waiting room for you to check your blood pressure whenever you come to the practice.
4. What does the condition mean for you?
   You need to know what your target blood pressure should be and what other risk factors you have that need to be managed eg whether you smoke or not or if you are obese or whether you suffer with diabetes or raised cholesterol. You also need to know what is expected of you in the course of a year even if your blood pressure is well-controlled. Finally you can monitor your own blood pressure, weight and smoking status and blood tests and urine test as a way of seeing how you are doing. This information should be in your GP-held record for you to see.
5. What needs to happen now and in the future?
   The typical patient with hypertension which is well controlled needs the following:
   • Fasting blood tests and urinalysis once a year with the healthcare assistant– checking their kidney function (Sodium, Potassium, Urea, Creatinine and eGFR), Liver function tests, lipid profile (Cholesterol, HDL, LDL, triglycerides) , diabetes status (glucose) and urinalysis (dip stick urine checking for protein and blood)
   • Blood Pressure reading at least twice a year 6 months apart. You can do this on your own! This is the minimum needed but you are encouraged to do this more often by using the practice blood pressure machine in the waiting room or buying a blood pressure machine yourself so that you can monitor it at home / work yourself. The local pharmacies all sell reasonably priced blood pressure machines and can give you more details about them. There is an informative instructional video on how to use these types of personal blood pressure machines available (see left column).
   • Your smoking status updated
   • Medication Review twice a year usually with the nurse unless you are told otherwise
6. What can you do to help?
   As this is a new way of working, it is worth discussing this with the nurse to see how this can be done the first time you decide to take control.
   • Get access to your GP-held record. Without knowing what is in your records and what you need to do, it will be very hard to know what to do when and with who. This is an essential first step for anybody with any condition or who wants the best from the practice.
   • Ideally we want you to book in with the healthcare assistant for fasting blood tests and urine test if you have not had them done for 12 months or prior to your next medication review. At the same time, ask to book in with the nurse a week later. The nurse will check your records and book you in for you. (This is because the nurse needs to check who is the most appropriate person to do the medication review dependent on what else you may also suffer with).
   • Remember to ask for a yellow topped urine bottle from the receptionist which you can bring with you when you have your blood tests. You can do this when you turn up to the surgery and are waiting for the healthcare assistant or bring it with you.
   • We calculate your risk of having a heart attack in the next 10 years by using the Framingham risk score (www.framinghamheartstudy.org) . This takes account of your sex, diabetes, status, smoking status, blood pressure and Cholesterol: HDL ratio. If the risk is greater than 20% then you will need to start a statin therapy (eg simvastatin) as well as dietary advice to help lower your cholesterol level. You can see your Framingham risk in the values section of your GP-held electronic health record. For patients with just hypertension (ie not diabetes or ischaemic heart disease), we use this score as a way of determining whether you need to be on a statin or not. Click here for further details about statins.
   • Bring your blood pressure readings with you to show to the nurse or doctor if you have been checking them at home. Ideally these will be registered in HealthSpace (www.healthspace.nhs.uk). Usually your last 3 months of readings or the last 10 readings are sufficient. Printing them helps save time or we can look at your readings on-line (but the internet sometimes does not work which could waste everybody’s time – we can always go on-line if need be anyway).
   • Look at the web page – pre-consultation care – and go through it prior to your review with the clinician. This can help us to understand your needs better and what you want out of the consultation. If there are no specific issues AND all the tests are normal and you are well-controlled, it may even be possible to conduct the medication review over the telephone. This must be with the agreement of the clinician and if you are happy with this. We think many people may benefit from this but we do not want to prevent anybody from coming to the surgery of they so wish.. Understanding your needs is key to a successful outcome of the medication review. See the above mentioned websites to help you to understand what your needs are. Initially you may need the clinician to help you understand how to look at the websites and what they mean for you.
7. How are we doing?
   The Quality Outcomes Framework was set up so that practices can look at how successful they are in delivering services to their practice population and also give an opportunity to see how we compare with others around the country. This data is readily available from here (www.qof.ic.nhs.uk/search.asp). Overall we got 996 points out of a maximum of 1000 last year indicating that we are a very high performing practice across the board which is reassuring for you and us. We achieved a maximum score in the Hypertension domain gaining all 83 points that were allocated for this. Although we performed spectacularly, there is still some room for improvement. For instance, have you had your blood pressure done in the last 9 months and recorded in the notes. It may be that you have but for some reason it has not been entered in your records. Or it has been entered but it is too high and it has not been followed up – this is very important if you are handing a blood pressure in that is high. We both need to do something about it – no point in just checking it if it is high. We need to act on it. But there may be other reasons why an individual reading is high so we should not just act on the last reading. Perhaps you could look at your own record and check if we have done everything for you that we should and ask why not if you find a discrepancy. It’s in your interests to get the best treatment and that’s why we want you to check you are getting it!
   
   
   
8. How can you help us do even better and help other patients too?
   This is very important. In your journey of discovery about your health, you may come across odd things that do not make sense about the way the practice runs and you may have a better suggestion. Or you may come across something new that we have not considered that helps you even more. Tell us about it next time you see a clinician or preferably write it down and hand it in or send it as a comment to the Patient Participation Group (PPG) so that they can bring it up with the practice the next time we meet up. Even better, why don’t you join the PPG and become an active member. We are always on the look out for new members and new ideas. 

Instead of having to come to the surgery 5 times a year to check your blood pressure (x2), check blood tests and urine test (x1) and get your results of the blood tests and have a medication review (x2 if you are lucky – x4 if this is not done at the same time), you may find that you only need to come once for the blood tests and urine test and the other things could be done over the telephone as long as everything is normal. That frees up 4 appointments that others could use! This means more appointments available for patients that are more focused for your needs within the time allocated.

Most importantly, by working together and understanding each other’s needs better, we can help you to get the best out of the practice and the wider NHS.