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It's better if you turn your microphone. All good afternoon everybody. My name is Michaela Nuttall. I'm a cardiovascular nurse and I am going to spend the next half hour also. Um Certainly not more. We might be less. You never know having a really quick look at BP. Um Share the pressure and getting it right in pharmacy. As always, I've got a set of slides to show you what I will do. Share them. Now, for anybody that is new to medal, you're probably sitting there having a sandwich or you've got me on in the background. Don't worry, we're not seeing your cameras. You were not seeing your audio, but there is a lovely chat function that you can use and I'll pop my quick. Hello in there as well. So you can do it. So let me know where you're from, which pharmacy you're from. Um Yeah. Now for anybody that's watching on demand, you don't get to see any of this chat function. You just get to listen to me. Um and I will read out any questions or comments that happen though. Hello to anyone that's meeting us on demand. Um So as I said my name is Michaela and I am part of share the pressure and I share the pressure is a joint initiative between the race equality, foundation, smart Health Solutions, younger lives and BP UK. And we are funded by the Bed It Trust for Nursing. And we're really looking at high BP amongst Black African and Caribbean people using a shared decision making tool. And we're focusing this in Southeast London. Now, I know people who join the people who watches later are not all from South Islam's and that's absolutely not a problem, the more the merrier, but that's where we happen to have it focussed currently. Um That's where they're, you know, this is where the, the flyers get sent to and stuff like that. Um We just don't send them outside of Southeast London at the moment. If you haven't used Medal High Geeta from Ramly Lovely. I mean Bromley as well. I'm actually, I'm in West Wickham, that bit of Bromley. So lovely to have people from South East London here with us on this program. So for anybody that hasn't used medal before, you will fall in love with it rapidly. Yes, there is that bit where you have to sort out your verification and stuff, but now you're in, you're in and um at the end of this session, I'll be popping the feedback button that gets you access to slides, it gets you access to your evaluation forms and it gets you access to lots of other training that is around any problems. Just let the guys from Medal know they are amazing. High. Mayor. Hi, Kelly. Oh, and we've got mayor is from, uh, from, hey, philosophic. Hey Flor, half, low, half less. So. The pharmacy in Suffolk. Oh, this is really exciting. I was just on a call with Ash yesterday. Um, and he's the, he's the, that happened. So, Ash and safety and we're both, we're all very excited about this session here. So what I'm going to be doing is talking a little bit about what share the pressure is and why it's important. A little bit about heart age and thinking about how the BP service in pharmacy might run and some of the considerations that are there and the latest update that's come out. So we've got Jacqueline for Max Pharmacy and Pens and we've got Jane from Tick Hill and Doncaster. Um, well, we've got Dara from local pharmacy and Greenwich. Brilliant, brilliant, brilliant. So now this isn't going to be a session all about BP and pharmacy. Okay. As a service, I will be touching on it. Okay. I will be touching on it and there are the service specifications that are out there, although I will give you a bit of an update. It's seeing how we can get the two in together. So if you haven't currently set your service up, not a problem. But, and if you have that put in, but we've got Reena from the LPC. Fantastic. So a little bit about share the pressure a bit more just very quickly. And what we've done is shed, the pressure is not just training, it's not just a concept, it's not just focus, which it's a combination and working together between the different organizations. What we've done is, um, I started to think about how we engage with people in Southeast London. And that's been done by the Race Equality Foundation. And what they've been doing is a lot of focus groups and some of the messaging I'll show in the moment has come out of the focus groups and people with hypertension from South East London who are black African Africa, Rib Ian. We've also done it with the engagement of the ics. Now, these things take time as you know, so we've been working closely with the different boroughs and the ics and the Kessel, the clinical advisory group and everything, what we say is underpinned by their guidelines. We also have a heart age tool which I'm going to show you an arraignment. Now, heart age tool is not a new concept. It's been around for a while, but what we've done is taken it and put it in the context of people who hypertension your part of the training program. And I'll show the other elements of the training program as well that are available for you to join in on at any time. And of course, at the very end of it all, we will be wait in the program. So at the moment, like with many of these things, we have short term funding, which is always a challenge. And so our funding for our training engagement, like what we're doing now ends at the end of August, but things will still be available afterwards. You'll still be able to join in, you'll still be able to watch. It's just that we stop the clock and have to start evaluating then and looking at who's attended what they've said, that sort of thing. So why did we cheese? Why did we choose this? We'll share, the pressure is not new. We've done a share the pressure part one and that hopefully is coming out for publication in the British Journal of Cardiology in October. And that was looking at anybody with hypertension anywhere in the country we did it during COVID, which made it a challenge. But what we learned from that first go round was instead of going everything for everybody, let's make it something for some people somewhere. And that's what we've done here. And we changed ethnicity as a, as a, as a marker of why we should tailor it down because we know that when it comes to cardiovascular disease, ethnicity is a massive risk factor, particularly for people who have African or Caribbean descent. Then that high BP really disproportionately affects them and not just the BP, the impact that has whether it's to be with strokes or end stage real and failure. Because did you know, when black people are diagnosed with hypertension, the numbers are usually higher when they're diagnosed with CKD, it's usually worse and say by intervening in a variety of different ways, we're hoping to be one something in your toolbox amongst everything else that's going on in your toolbox to try and address these inequalities that are there. We also know that people, particularly men are less likely to come forward and particularly screening programs and not only are they less like these conformers and less likely to get BP controlled as well? Not through choice. I will say that it's less likely controlled and then there's, you know, quite justifiably. So suspicions. Um, yeah, and COVID made everything worse and it wasn't good in the first place. So really placing that is why it's really, really important. So, um what do people say to us? Well, in the beginning, we did some focus with high IV. It's lovely seeing everybody they're saying hi for those of you on demand. You don't know who I'm talking to, but I can see everybody in the chat here and these were focus groups that were around just before Christmas and the beginning of 2023 by the Race Equality Foundation. And it was really about looking at the language and how we adapt the tool and how we adapt what healthcare professionals are saying to patient's. How do we make sure we get this right. And there were some quite clear messages that came through. It was about wasn't talking about aging, it was about being younger. So although we talked about heart age, it's about years, you can take off how you can stay younger. There was something about taking control, you know, not it being passive, not avoiding something bad in the future, but you can take control now to make the present here and now better. There is a lot around symptom myths and we try and dispel them through and some of the face to face training that, that we delivered that we've been doing and through some of the quizzes, we're trying to spell the myths there as well. Take you around things like symptoms. It's totally anonymous. And, um, if you ever get to use the tool, that patient's or signpost, patient's towards the tool, um, that it has to be, it is absolutely anonymous. No one knows anything that gets filled in. We've started to fill it at the back end where to go to locally because that's what they asked for. And we were tailoring to start with, with African and Caribbean diets. And then the feedback we got was hang on. You know, it's not just, it's all foods, you know, people were saying I still go to KFC, I still go to mcdonald's. I still have a roast dinner, you know, don't just assume. So. Um, that's what we did. So we've had to try and take it to all different diets. Now, that's there. So, based on that, we've taken those concepts forwards and we've moved them forward now into what we are delivering. So we have heart. Oh, this is very small. But hopefully I'll encourage you to do. So, it's a simple online tool. And on the left hand side now, even if you can't see what the questions are, you can see the answers. This is like, do you, are you taking BP? Have you got existing cardio cardio vascular disease? Yes. No. What is your height? What is your age? What is your aide? What is your gender? What is your ethnicity? We ask the same Q risk questions, same as the Q risk algorithm, but we display it in a different way. Now we're not because we're not coming up with a percentage risk. It's not, we're not saying, oh, you know, you must go on a statin or anything like that. What we're doing is displaying it in a different way. So for the dummy patient, I put in here and it's all freely available online and totally anonymous and I'll show you where to go in a moment. You get this result. And this result shows that the person that I filled in here, there was a couple of fields to fill in. Um This person is 51 and their heart ages 66. And by kicking, kicking this button here it 12 and it shows you how much you can reduce your heart age, how much you can get younger as it were. And in this person, they could reduce their heart age by 15. So it could get them down to their biological age and then square the down, it tells them you can do that by stopping smoking, losing weight, getting control of your BP, whatever the fields are on the left, there's another bit that people can go on to do if they click the next button, which is the pink button at the bottom of the right hand side screen. And that looks into sort of motivation and confidence. So we're taking people beyond it now, heart age, as I said, isn't here. And we've seen from some studies that actually just knowing your heart age makes you make lifestyle changes more than knowing your cardiovascular risk more than just no what your BP result is. So that's why we feel quite confident that this can be a great tool for everybody to use. Now, it's readily available on the website called heart UK, uh called share the pressure dot com. You can get it from scanning here. Don't worry about scanning it. Now, you'll get a copy of all of these sides and I will show you everywhere to go to, to pick this stuff up. Now, one of the reasons why I got really excited about this in BP. And Pharmacy is you have your, you know, this national program now and it's a fantastic system that's happening. I've been a huge fan of pharmacies for many, many years. Worked with pharmacies from all over a lot in Southeast London. How even went to, what was it called? Chemist and druggist, chemist and druggist, something like that with a load of BBg farmer at one point. So that was quite good fun. But so when I was talking to the guys back at the back, at back at base as it were Ash and Sophie, um I wanted to come in at, you know, because I'm not replacing everything you need to go know about changing, about delivering the service. I wanted to touch on certain elements of your service that you're going to do and it's not just measuring the BP. Okay. That's a really big important bit to find out. It's not just let me put the cuff on you and let me press the button and let me tell you the number. That's not what this is about. Your service is a real opportunity to make a difference, to make a difference, to patience to people, the population and two BP. Now, of course, you will be doing the BP, you will be doing the BP. Now, depending on the results of that BP defines what you do next. And uh the next slide will show the actual numbers. If you find your BP is really very high, OK, is high and I'll show you what the elevated one is, then you should be offering your ambulatory BP service, um which is fantastic that pharmacies are going to be able to do that. Now, now it says the pharmacist, I'll show you the update where we're going to come to on that one. However, if it's very high, if it's very high, you need to do something different. And that's that getting the patient towards urgent care, getting them towards somewhere. Really? Um Yeah, so you, I always talk about it. You're passing the baton onto somebody else, okay. That's what you got to do. You've got to intervene at that very high BP. If the BP is low, then that's back down to you to interpret. Now, remember when we're looking for hypertension, but you're going to be finding low BP at the same time. Now, low BP itself is quite fine for most people. In fact, it's better than having high BP and this is what the NSPC has come out for SNS pmpsnc. Sorry, I get a bit dyslexic and all the letters go around the wrong way. So this is telling you what to do. This is really tailoring it down a bit more. This is all part of the specs. So when you're looking at your blood pressures if it's coming out in what's called the normal range and that's 1 40/90 unless you're doing it on an A BPM, which is 1 35/85 then if it's normal, then you just send them off in your sort of, there's, there's nothing urgent about sending that information back into General practice and we'll talk about that one if it's high, okay if it's high. Um, and, um, then you're either going to do it yourself and just follow up with an A BPM or you're going to send that back to general practice if it's very high. Okay. And when we're talking about very high, uh, 180/100 and 20 that person needs to be followed up quite quickly. And I would actually, you know, your, I would suggest that what you're going to do is, um, contact the GP practice, pass that baton on and get them to decide what they're going to do with that person. Now, it might be that you're doing the service out of GP hours and then you might have one way able to phone 111, they should be able to give you some advice or it may even be, um, it might be that you have to speak to the pharmacist and you might have to go to a, and the patient that might have to go to A and E that's the real end of the spectrum. That's so rarely happens, but you need to know that. Okay. You need to know that because that actually somebody's human dramatic compromising where that, you know, they're going to kill over and die. You, you don't want to happen on your pharmacy floor. You want that out somewhere else in acute settings, there is often a worry about. What about that? Low BP? Now, low blood pressures for most people is absolutely fine. Um, it's only if they have symptoms and the symptoms are, the symptoms are usually fainting. So patient's are fainting, let them tell them the GP, you know, it's not an urgent thing. If they're fainting like seven times a day, they're probably not coming into your pharmacy for it. But you do get people who do that and that's usually with a condition called postural tachycardia syndrome, which is sitting quite closely at the moment with our long COVID. Although it happened long before long COVID, if you get patient with a low BP and they're not feeling dizzy and they're not feeling faint or nearly fainting, then it's pretty okay to have that BP. It's quite, it's quite good. It's better to have a low BP than a high BP. Now, you may also remember be finding an irregular pulse and if you detect an irregular pulse, now, that's either because before you take your BP, you're palpating the pulse, which is what we should do or if you've got a bit of kit that will show that it's there, then that person also needs to be followed up because they will need an ECG just because we're looking for a F in that way. So who is eligible for your pharmacy service? Well, it's for anybody over 40 although you can be over 35 if you based on your clinical judgment, if you think, ok, this person's got a family history, this person might be after Caribbean. You know, let's think of a reason why we want, want to include those people in. So wondering now talking about your pharmacy project before we share the pressure, this is your pharmacy project. It's not for anybody who's had their BP checked in the last six months. Okay. They're not there. And, and now when you're looking for the opportunistic checks, the opportunity BP checks. It's not for anybody who's hypertensive. However, you might be sent people from the GP practice and if you've been sent people by the GP practice, they may or may not have a diagnosis of hypertension, okay, then you can see those patients' and you might be doing ambulatory BP checks on those. So now the decision for this is really down between you your local area and your local GP practices. So there's a bit of extra work I think that needs to go on on really making that happen. So that is that the who is eligible. So when you're providing this as a service. What do you need to think about? Well, there's a variety of things and the first, but is about your, your environment that you're going to provide this service in. So you need a waiting area. You need somewhere. You can't just have people. Well, you can, if you've got somebody coming straight in and sitting and sitting down, you're not gonna take their BP straight away. Remember, we need five minutes of seated before we take any BP. Otherwise we're gonna get really high results. So you might need to consider, have you got a chair somewhere for people to sit on to weight, then you, of course, you need your room. Um and everyone's got a room now. So that's good. Are you going to run an appointment system? Are you getting now? So this services can work amazingly well. And I remember in Lewisham, that's fantastic practice that did lots of health checks, run a fantastic appointment system. Again, it's down to you how you're going to manage that. And it's not just about the BP that you check, it's that follow up who may need to go on for ambulatory. And Ash was telling me so few people now at the moment are going on for ambulatory is they're becoming eligible, but then they're getting lost. So that's a really key thing to pick up to make the most of this opportunity that's there. And then of course, there's a kit and your kit needs to be validated. You need to get it from the proper place. And that's usually by looking on the British and Irish Hypertension Society websites for approved kit, for BP monitors, you have to look in the one that says for home use rather than specialist use. It only has, it has specialist at home. What they mean is in hospital and outside of hospital. So that's one consideration. Another consideration is the patient. What are you going to do with those guys? But it's not just telling them the number of the BP, you've got to be able to interpret it for them and communicate the results of that BP. Beyond just saying it's 1 43/20 over 87 you know, really trying to get to grips with that along with the risk of that. And this is where we think share the pressure can come in for you guys. Um You can either do it there and then with a person it takes minutes, but you do need to have access to a computer of course or you can and don't know if you haven't got the cholesterol so you can do it without a cholesterol test. It does like a Q risk pools in an assumed one or you can get people to do it themselves when they go home and that might make them more likely to want to act upon their BP. How are you going to give them the result? Have you got any information? And I often use a lot of the, and I'm looking around for it now. The BP uk's literature, that's all really, really useful that you can send off to have a selection of that available. It comes in different languages. Um Yeah, really useful. And then okay. What are we going to do with patient's? Have they got to come back? Are they coming back for another check? Are they coming back for ambulatory? Do you have to send them off to practices? It's not just a final forget thing. You know, it's about building a nicer longer term relationship with those patients'. Although some of you have amazing long term relationship already and then of course, there's primary care and um uh this can be a tricky one. This can be a tricky one. So let's start with the middle one here. First of all this, communicating those results. So you've got different ways of doing it. Of course, if it's an urgent, you can pick up the phone. If you're sending the results off, whether you are, they're gonna do that via the system that's there. And I forgot the name of your systems that are in pharmacy, uh farmer outcomes. It was your other one that I've forgotten the name of. That's their farmer outcomes is one of them or you might be emailing it. It's whatever it's been agreed in your local area with your local practices. Another thing to think about is, have you started to engage with the local practices? Have you started to speak to them, reach out to them, tell them that this service is being offered that you can do this now over the years, um you know, uh practices and pharmacies are getting closer and closer and there was always the movie that you're fighting over the same few patient's, there's so many patient's to go around and there was so much work we need to do for hypertension that there is masses I think we can do in working together. So yeah, reaching out, speaking to your local practices, letting them know that actually we're going to run these dropping BP appointments every Tuesday between three and four. Now that might not be your quiet time. Well, not that pharmacy has a quiet time, but you know what I mean? Your quieter time, let them know. So then they can tow that same sign pasting and then remember that results back and that follow ups that might need to happen back in brandy care, particularly if somebody gets diagnosed. So hot off the press for you. Okay. I got this yesterday from Ash and Sophie while the spec says about pharmacists all the way through pharmacist, this pharmacist that's not just pharmacist. Pharmacy, technicians, of course, are able to now get involved in this at every step of the service So, that is absolutely brilliant because, you know, pharmacists, you're, you're dispensing, that's your call business. So, um, it doesn't mean you've got to be taken away forever for this. Now. It's making it more of a team service for your A BPM measurements. That's only during waking hours. Patient's don't need to have for this bit of a diagnosis of hypertension for something else. They might need it slightly longer. Um, but it's for waking hours so they could come in in the morning, have it fitted at 89 o'clock or something, nine o'clock and they come back at the end of the day and have it taken off. That means you can get it cleaned and ready for the next morning. It also means patient's don't need to sleep with it on because it's a complete nightmare to sleep with it on. Um So we know what we're looking for is those 14 measurements to be captured throughout the day. Critical bit is if you want to be paid for this, then you have to claim within three months. That's a hard cut off at three months. So if you don't claim with it within those three months, that's it. You've missed that window of opportunity, that's there. So really, really, really important to do that one. So this was just a bit of a floaty teaser type thing to let you know a little bit about heart ege to let you know a little bit about share the pressure to re emphasize the bleeping and pharmacy initiative that's out there and give you some bits to start to think about. We also have lots of free training for you to participate in this at the moment is the last of the live ones. The rest of them all one on demand and they're on the same place where you came and booked this one, but we will follow you up with it as well to show you where and we've got that fly that I know came out from, from the, from the ics and the LPC I think it came out. So we've got webinars, they're all of a, they'll all be available on demand and this one will be available in the next couple of days and those webinars include things. It's a bit blurry to see when we put these slides up here. They go a bit blurry, but that's about and what is share the pressure, understanding BP we doing on another about what is heart age, BP and lifestyle medicines for managing BP and BP at home. We have a series of podcasts that you can listen to and those ones. Now, these webinars on demand are all about 30 40 minutes. So they don't take too much out of your world and you get to collect your certificates, which is always really healthy for any form of revalidation. The podcast, we've done two so far we're gathering some more as we go along. Uh, there's some quizzes and then there's all the local resources we sign, post all back to the Kessel. And um, yeah, just have a little route around and play. Now, there are two quizzes once for you. One for patient's, it's only 10 questions. You get instantly results. We don't know when we know what the aggregators answers now, but I won't know that, you know, whoever John down in, in Sydney um has got this answer. I won't know that, but I'll know that, you know, 32 people took the quiz and half of them got all the questions right. I'll know that level of information and that allows us to see where the gaps are in knowledge too. So I'm going to end with, well, there's a guy that works with us on this project called David Acor. Oh, and I did this session with David A Cory last week and he said, oh, give me a picture with Denzel Washington. And I'll say that's what I used to look like before. I had high BP, although David is just as gorgeous. And um he did a bit of a session on what he wished. He'd been told when he had his BP checked and he found out he had hypertension um because he had, he had his done in practice and he just got told you got high BP, that's it. And he had his tablets and I'll see you in about six months. That was his journey and what he really wanted to know was, but how did it happen? He said I didn't smoke. I wasn't overweight. I'm quite fit. Um, and hadn't fully appreciated just what ethnicity made a difference into BP. Also, his BP was running high. His diet wasn't as healthy as it could have been. There was a lot of salt going on. So, um, yeah, so really, how did this happen? He also wanted to know what I'd be on medication for the rest of my life. Um And you know, for many people, it's yes, that's what's going to happen. But we also know the power of lifestyle and how that can really help to improve our BP. He went off and did a lot of searching on the internet for complementary medicines and I think that's a really common one and I think as pharmacies doing this, this is a great way to intervene with. Not about dishing out a load of complementary medicine, not that I don't disappear. No, not that I don't have a problem with it, but it's not replacing some of the other stuff we might need. And a really big bit was how will I will I have to change my lifestyle? What can I do differently? And so I think that's the extra bit that you guys are going to be able to bring in. You're going to be able to do those opportunistic checks. Follow up with the ambulatory BP. Work out what that BP is as well as helping people to understand what their risk is. Give lots of great explanations around medication. Help to explain how it happens and really think about lifestyle changes that will help people to have a better BP for the rest of their life and reduce the chances of those strokes, heart attacks, chronic kidney disease, that's there. And so I think that was me done. Who thought you could do that in 58 in, in 30 in 28 minutes? So we've got time for a question or two if you have any. Absolutely not a problem. If you haven't, I'm going to pop into the chat function. Now the feedback form, which means you go straight to their, once I finish this, I will be uploading the slides into the feedback form. But I'm also going to put in here the link to all of the other training if you haven't already come across it and you go in the bit that's for the healthcare professionals and you can watch any of the training that you want to. So for those people that are joining us online, you get to do your, if you're joining us on demand, you get to do your evaluation as well when you finish the session and I'll already upload as well for the on demand sessions. A copy of the slides and the little flyer about where to go and get more training. So mayor getting the A BPM kit that is beyond what I know, I'm afraid I know in your specification in the specification it talks about go and make sure you buy it from a reputable place and that is from making sure that it's uh first of all that, you know that it's validated and it works and we get that from the British and Irish Hypertension Society. And the link for that is in the is in the service specifications. Um and maybe you can find out locally so that each, each area has a local lead for this within the community. And of course, we've always got ash as well and um we've got ash and yeah, so zero is put in daytime. ABM much more appealing. So there is actually hypertension nurse that works quite closely with us and find out that actually you'll get a greater uptake of service there as well. So mayor, yeah, I'm sorry, I can't tell you where to go and get the kit from. I also don't know where you're going to get your money for your kit from. I'm really about share the pressure. Oh, there you go. Reena is going to email you the details. Oh, perfect, perfect, perfect. Right. It is two o'clock now. So I'm going to give us a lovely hard stop. Thank you for all these PCN substance patient's a BPM for the nighttime. Absolutely. That can happen for the nighttime dip. You can do that. Absolutely. But that's different. This is a different sort of thing that you're doing here. You're looking to that diagnosis, that's there. I'm gonna end it here because I promised everybody would have a hard stop at two o'clock. So lovely to meet you all. Hopefully that was useful and hopefully I'll see you again somewhere else. Good luck with all those blood pressures. Take care of you one by.