Community Pharmacy Prescribing to Reduce Hypertension Inequalities

NHS South East London Integrated Care System

Project summary

The Community Pharmacy Independent Prescribing (IP) Pathfinder Programme in North Southwark was designed to reduce health inequalities and unwarranted variation in hypertension management. Our aim was to remove barriers and work in an integrated and collaborative way to bring medicines optimisation and prescribing closer to people least well served by existing routes of care.

Local insight and use of population health data highlighted that residents from the most deprived areas had poorer outcomes and were in greatest need of hypertension management. We therefore worked with community pharmacies located in deprived neighbourhoods that opened for extended hours and at weekends, to offer residents a convenient alternative to care, whilst maintaining integration with existing GP services.

The programme created a new neighbourhood level model in which pharmacist prescribers from three community pharmacies working in partnership with local residents, a GP federation and three GP practices, South East London (SEL) Local Pharmaceutical Committee and SEL ICB. Patients with untreated or uncontrolled hypertension were proactively identified through EMIS searches and invited for structured pharmacy-based consultations delivered under a shared governance framework, with shared clinical supervision and documented in a shared electronic health record system (EMIS).

Pharmacist led consultations included blood pressure assessment, home and clinic monitoring, medication review and optimisation, lifestyle advice, ordering of phlebotomy, and shared decision making. All activity, including prescribing was completed directly within the patients GP electronic patient health record, ensuring seamless communication and continuity of care.

During the first six months, 73 patients were managed through the pathway. The cohort reflected local need: average age 55, BMI 32 kg/m², 49% Black ethnicity, 42% from Core20 neighbourhoods and for some, English was not their primary language. Median baseline systolic BP was 156 mmHg and the average reduction achieved was 6.4 mmHg. More than half of participants reached target BP (<140 mmHg), typically within two to three consultations. Patients reported improved understanding of their condition, feeling more supported, and valuing the continuity and accessibility of pharmacist led care.

The programme has now expanded to include lipid optimisation and asthma pathways, with replication of the hypertension pathway being considered across SEL. The model demonstrates how integrated community pharmacy prescribing can strengthen neighbourhood teams, reduce unwarranted variation, and improve cardiovascular health outcomes in underserved communities.