A prospective service evaluation of pharmacist independent prescribers in outpatient hypertension clinics at a large NHS trust

Abstract Introduction Hypertension is a chronic condition and a major factor leading to premature death.[1] Approximately 80% of people with hypertension have poor control leading to secondary health conditions and polypharmacy.[1] Uncontrolled hypertension requires management in specialist hypertension clinics which increases clinical and financial pressure on the NHS. Pharmacist independent prescribers, a key part of the NHS 10-year plan to address these pressures, were upskilled to deliver hypertension clinics at a large NHS Trust to support medical consultant workload and optimise throughput of patients.[2] Aim To evaluate the consultations conducted by pharmacist independent prescribers at a large NHS Trust. Methods Prospective service evaluation. Four pharmacists were upskilled through training and shadowing to lead hypertension clinics. The population was patients referred to the hypertension clinic, who are often young patients with hypertension or those with difficult to manage hypertension. Often, these patients require optimisation of antihypertensives along with lifestyle education. All patients were referred to pharmacists using triage criteria developed by the medical consultant team. Criteria included patients previously seen by and had secondary screening completed by the consultant to eliminate any other causes for hypertension such as phaeochromocytoma. Each pharmacist was allocated 30 minutes per consultation. Patient demographics, number of therapeutic interventions and patient outcomes were captured using a structured data collection spreadsheet. Data were aggregated and reported using descriptive statistics. Results A total of 25 patients (16 females, 9 males; median age 50 years; range 19–84 years) were referred to the pharmacist clinic over 5 months (20/05/2025–09/092025), 5 of whom did not attend. Half of the patients that attended (10/20) were taking 5 or more medications. Medication was optimised for 6 (30%) patients by starting a new medication (3 medicines, 3 patients), discontinuation (2 medicines, 2 patients) or dose change (2 medicines, 2 patients). 16 (80%) patients seen by the pharmacists had medication adherence support (4) or one or more type of lifestyle advice offered including dietary (11), exercise (14), or stress management (6). Out of the 20 patients, 6 (30%) patients were discharged to primary care, and the rest were booked for further follow-up in the pharmacist clinic. Anecdotal feedback indicates positive views of the service, with potential reduction in waiting list. Conclusion Pharmacist independent prescriber-led hypertension clinics show promise as an innovative approach to support and redesign the existing medically led model. Pharmacists made a range of clinical interventions beyond medication changes, including exploring wider lifestyle changes and supporting medication adherence. The study was limited by the number of patients and outcomes measured. However, the positive results of this service evaluation support the feasibility of continuing pharmacist led outpatient clinics, with plans for further evaluation of waiting list outcomes and satisfaction, using semi-structured interviews with patients and staff.