From the coalface – Managing high blood pressure, a Manchester practice

I am a nurse in a practice in South Manchester with approximately 12,000 patients.  My role primarily focusses on patients with cardio vascular disease including primary prevention. The area has a mixed population but it is well known that Manchester has the lowest life expectancy for women in England and the second lowest for men.  People in Manchester have the lowest healthy life expectancy in England (i.e. they have more chronic ill health than their counterparts in the rest of the country).  Given this demographic and the high number of patients we are helping to manage their high blood pressure (BP), this is a huge undertaking.

With this in mind I spent today training a new cohort of healthcare assistants in ‘gold standard’ blood pressure taking, checking pulses and the basics behind the surgery protocol that is in place to aid the identification and diagnosis of hypertension along with guiding a management plan.  We strongly advocate the use of home BP machines or 24 hour blood pressure monitors for patients with borderline blood pressure readings as per the National Institute for Health Care Excellence hypertension guidelines, and we are able to do this without prior GP approval.  We need to support nurses and health care assistants to feel confident in using this approach to help patients monitor their own blood pressure.

A strong partnership between GPs, nurses and health care assistants at the practice often results in patients having had all relevant investigations performed so that hypertension is often identified prior to an initial GP assessment. This gives us several opportunities to discuss the patient’s lifestyle and provide advice on interventions to help with any lifestyle changes.

Before writing this I had reservations about my credibility in adding my personal opinion on blood pressure to CVD experts in this field.  However I am passionate about my work and believe that to alter the current situation we must address issues around blood pressure at the coalface.

I do not believe we are in any way unique with this approach but I feel the value of using the full practice workforce and having appropriate training improves the patient experience and makes us more able to fully identify an ever-increasing population of people with hypertension.

Alison Morgan, Practice Nurse, Northenden Group Practice, South Manchester

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