Hypertension case-finding gets a reset: what the September changes mean for general practice

The service, which has been operating since 2021, enables participating community pharmacies to provide blood pressure checks and, where appropriate, ambulatory blood pressure monitoring (ABPM). The updated specification was published by NHS England on 6 August following agreement with Community Pharmacy England as part of the 2025/26 Community Pharmacy Contractual Framework negotiations.

A clearer focus on undiagnosed hypertension

One of the most significant changes is clarification around eligibility for a pharmacy clinic blood pressure check. From September, this element of the service is aimed at adults aged 40 and over who do not have a diagnosis of hypertension and who have not had their blood pressure checked by a healthcare professional within the previous five years. Patients already being treated for hypertension are not eligible for a routine clinic check through the case-finding service.

The change is designed to prevent the service becoming primarily a means of providing routine blood pressure monitoring to people who already have a diagnosis, and instead ensure that its capacity is directed towards finding people whose hypertension has not yet been identified.

The role of general practice remains important

The changes do not mean that responsibility for hypertension is simply being transferred from general practice to community pharmacy. Instead, they reinforce an important primary care–pharmacy pathway.

General practices can refer eligible patients to participating pharmacies for clinic blood pressure checks and can also refer patients for ABPM. Pharmacy results are then shared with the patient's GP practice so they can inform diagnosis and subsequent management. Local arrangements should be agreed between practices and pharmacies to facilitate referrals and enable patients to choose their preferred participating pharmacy.

For primary care teams, this makes it worth reviewing whether there is a clear local process for referrals, receiving results and acting on abnormal readings.

An opportunity for proactive prevention

The change also comes against a significant cardiovascular disease prevention challenge. NHS England estimates that around 5.5 million people in England have undiagnosed hypertension, while hypertension remains a major risk factor for cardiovascular disease.

Community pharmacies can provide an accessible setting for people who may not otherwise have their blood pressure checked. The service can also be provided in community locations with prior ICB approval, potentially allowing local systems to target particular populations and settings. Off-site provision is currently limited to four days per financial year.

This gives PCNs and ICBs an opportunity to think beyond simply signposting patients to their nearest pharmacy and consider where undiagnosed hypertension may be concentrated within their local population.

A Core20PLUS5 connection

The development is particularly relevant to the Core20PLUS5 health inequalities framework because cardiovascular disease is one of its five clinical priority areas. The pharmacy service provides a practical mechanism for taking a population-health approach to one of the major modifiable risk factors for CVD.

For general practice, the opportunity is therefore to connect population data, targeted case-finding, community pharmacy, ABPM and subsequent primary care management rather than treating blood pressure checking as an isolated activity.

What should practices consider?

For GP practices and PCNs, the September changes provide a useful prompt to consider:

• whether local pharmacy referral pathways are clearly understood by practice staff;
• which participating pharmacies are available to patients locally;
• how ABPM referrals and results are managed;
• whether pharmacy blood pressure activity is reaching people who are less likely to engage with routine primary care;
• how the information generated by the service feeds into wider CVD prevention work; and
• whether local population data could identify particular groups or communities where targeted case-finding would be beneficial.

The bigger picture is a shift from simply measuring blood pressure towards actively finding people whose cardiovascular risk has not yet been identified. For primary care, effective collaboration with community pharmacy could make the revised service another tool for proactive prevention and reducing inequalities in cardiovascular outcomes.

The revised service specification took effect on 3 September 2026. Practices should use the current NHS England specification and locally agreed arrangements when implementing the service.