Dear Member,
This is a message to give an update on where Pharmaplus is with the NHS Hypertension Case Finding Service recently negotiated by the PSNC.
Background: Funding available for the service in 2021/22
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Set-up fee
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£440
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Clinic check (standard BP check)
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£15 per check
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Ambulatory monitoring check
Should be provided where a patient is identified as having high blood pressure (140/90mmHg or higher, but lower than 180/120mmHg)
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£45 per check
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Incentive fee – if you complete five ambulatory checks by March 2022
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£1000
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We have been looking at options available with HBPM (Home Blood Pressure Monitors) and ABPM (Ambulatory Blood Pressure Monitors). The issues that have arisen are noted below.
As you are undoubtably aware, HBPMs measure the blood pressure on a single occasion while ABPMs measure the blood pressure over multiple occasions; normally over a period of 24 hours.
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Price and Availability of ABPMs
The two issues to consider are price and availability. There are a number of machines on the market. Cheap machines are not necessarily the type of device you should use.
As an example of how fluid the situation is, a machine has been offered by a supplier: It is cheap, and is being offered at £650 + VAT. However, there appears to already be a shortage of these machines.
Furthermore, we received information from another source who states;
“The offer (from this supplier) is now closed. They are offering a hugely inferior and very basic ABPM. I believe it only has one of the special patient validations that we have (for children). This means that they have not passed all the others and will therefore be inaccurate in these patient groups”.
The source continues to state …
“With our product [which costs] £1000
· We also offer a 5-year warranty (I think [the other supplier's] is 3 years)
· We are the only manufacturer with MDD certification for AFIB detection.”
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To Rent or Buy?
Needless to say, ABPMs are expensive. It is a large investment in your pharmacy to buy these machines, and to ensure that it is properly serviced and maintained. This is the reason why cheaper alternatives may not necessarily work in your interest; especially if there are warranty issues.
However …
We are considering other ways for you to provide the Hypertension service. One example is to consider RENTING the ABPM, instead of buying it outright. There are also problems with this method as well. For example, the machine may not necessarily be available to the patient on the preferred day. Also, consider the issues if a patient does not return the machine and the impact it will have on subsequent users who have been promised the machine. There could also be issues for both
clinical and financial liability if machines go astray.
The Ideal Situation
The ideal situation is that we recommend that you consider purchasing a GOOD ABPM for your own pharmacy. However, we are also looking at a number of other models, and we are dealing with difficulties that we need to iron out first.
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Other Factors for Consideration
- Is maintenance and training included in the purchase price?
- If equipment is broken, does the supplier provide a spare whilst it is being repaired?
- Calibration versus replacement cost and the carbon footprint of both activities.
- Frequency/cost of cuff replacement and other consumables.
- Complexity of use – time taken to use (and explain use, in the case of ABPM);
- For clinic meters, do they automatically take 3 measurements and flag irregular pulse (this feature is very beneficial, but optional)?
- The usability of any inclusive software to support set up for the patient and interpretation of readings. Additionally, software and hardware compatibility with existing pharmacy IT systems needs to be considered, e.g. can you plug the meter into a USB port on a PC in the pharmacy; and
- Insurance to cover accidental damage to either type of meter and to cover the theft or failure of a patient to return ABPM.
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Conclusion
As you can see, there are many issues that you will need to take into consideration before buying a machine. Cheap is not necessarily the best option. Renting may not be the best option.
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We hope that this has given you some food for thought.
This communication is to highlight that PharmaPlus is absolutely on the case with this. We are currently talking to suppliers, and clinicians, on how best to manage this. We will let you know as soon as our queries have been completed.
Regards,
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