How does the hypertension case-finding service work?
It is a two-stage advanced service: a clinic blood pressure check, then ambulatory blood pressure monitoring (ABPM) where the clinic reading is raised. Community Pharmacy England (CPE) records that the service has been commissioned as an advanced service since 1 October 2021. Patients know it as the NHS Blood Pressure Check Service.
NHS England states the aim plainly: to identify people aged 40 and over with undiagnosed high blood pressure and refer them to general practice. It puts the number of people in England with undiagnosed hypertension at about 5.5 million. The service is built on NICE guideline NG136.
Stage one is the clinic check, offered opportunistically to eligible adults or at a GP's request. NHS England's service page sets out four outcomes. A normal reading gets healthy living advice. A high reading gets an offer of ABPM plus advice. A very high reading gets an urgent GP referral within 24 hours by NHSmail or an agreed platform. A low reading gets advice, and a referral if there is concern.
Stage two is ABPM. The pharmacy fits a validated monitor, the patient wears it through a normal day, and the results go to the GP practice. CPE's briefing 016/26 on the revised specification says an ABPM episode needs "at least 14 measurements" during waking hours. ABPM can also be provided at the request of other healthcare professionals, which is where much of the volume should come from. CPE reminds contractors that ABPM devices "must be reset for each service user".
Volume is large. The Department of Health and Social Care's (DHSC) 2026/27 settlement document, published on 29 May 2026, counts "3 million hypertension case-finding service consultations" between April 2025 and January 2026. The service is bigger than Pharmacy First clinical pathways, which delivered more than 2.75 million consultations in the same ten months.
How much does the service pay?
£10 per clinic check and £50.85 per ABPM episode. The DHSC settlement document for 2024/25 and 2025/26, published on 31 March 2025, states: "The fee for a clinic check consultation will reduce from £15 to £10. The fee for an ambulatory blood pressure monitoring (ABPM) consultation will increase from £45 to £50.85". The 2026/27 settlement of 29 May 2026 put its whole uplift into the single activity fee. Service fees were left unchanged, as our guide to the 2026/27 contract explains.
| Fee | Before April 2025 | From 2025/26, unchanged in 2026/27 |
|---|---|---|
| Clinic blood pressure check | £15 | £10 per check. |
| Ambulatory blood pressure monitoring | £45 | £50.85 per episode. |
The set-up money has shrunk to a single payment. CPE's FAQs explain that incentive fees "were available in 2021/22, 2022/23 and 2023/24" to help fund equipment, and that "only the setup payment for the service is now available". One structural point matters for 2026/27: CPE's briefing 009/26 says the service "will be combined with the core CPCF sum". Its fees now come out of the £3.636bn contract envelope. CPE's briefing 016/26 spells out the consequence: "any money not spent on this service will instead be used to fund pharmacies to provide other elements of the contractual framework".
The arithmetic that follows is simple. Five ABPM episodes earn more than 25 clinic checks. A pharmacy doing 40 checks and two ABPMs in a month earns £501.70. The same pharmacy converting eight of those checks to ABPM earns £806.80. Nothing else in the service moves the total as much as that conversion.
Claims go through the NHSBSA's Manage Your Service (MYS) portal, populated by the API from one of four assured IT systems: HxConsult, Pharmacy Manager, PharmOutcomes and Sonar Health. CPE's FAQs say claims "should be submitted within one month of provision and no later than three months from the claim period". That is the standard three-month window, not the one-month window that still applies to Pharmacy First.
Who is eligible for a check?
Adults aged 40 and over who do not have a diagnosis of hypertension. From 3 September 2026 the revised specification adds a second test. CPE's FAQs put it this way: clinic checks are for adults aged 40 and over without a prior diagnosis "who have not had their blood pressure checked in the last 5 years". People signposted for a clinic check "need to be 40 years or older".
There is an exception for younger adults. CPE's briefing describes patients "under the age of 40 who do not have a current diagnosis of hypertension" being seen by exception. The trigger is a family history of hypertension or raised cardiovascular risk. NHS England's page names people from South Asian and African-Caribbean communities among those who may qualify. The reason for including an under-40 has to be recorded in the clinical notes, because post-payment verification can ask for it.
ABPM has its own route. It can be offered to adults aged 40 and over at the request of other healthcare professionals, and from 3 September 2026 the revised specification names optometrists and dentists alongside general practices. Someone already treated for hypertension is not eligible for a clinic check under the service. The check is for finding new cases, not for monitoring known ones.
Who can carry out the checks?
Any suitably trained and competent member of the team. CPE's FAQs say that "suitably trained and competent pharmacy staff (pharmacists, pharmacy technicians and other non-registered members of the pharmacy team) can now provide the service". Trainee pharmacists can too, if trained and competent. The NHSBSA dates the change: the expanded service "launched on Friday 1 December 2023 which allows non-registered staff to take blood pressure readings".
Responsibility does not move. The NHSBSA says readings taken by non-registered staff "should, for now, be recorded under the responsible pharmacist's name and General Pharmaceutical Council (GPhC) number". The reason it gives is that "the pharmacist continues to be responsible for the delivery of the service". CPE adds that the VAT rules were changed so that pharmaceutical services provided by other staff under a pharmacist's supervision do not attract VAT.
Three things have to be in place before anyone takes a reading. Staff must be familiar with NICE NG136 and the service specification. They must complete the equipment manufacturer's training on the monitor. And the monitors must be validated by the British and Irish Hypertension Society, with validation, maintenance and recalibration carried out periodically to the manufacturer's instructions. A structured induction covers most of this; see how to onboard new pharmacy staff in the first 30 days.
Distance selling pharmacies can join, but only off-site. The specification says "DSP pharmacies may only provide the service where it is delivered off the pharmacy premises". Off-site provision anywhere needs prior consent from the integrated care board and is limited to four days a financial year; for distance selling pharmacies that cap applies from 1 April 2027.
What are the 2026/27 caps?
Unknown, because they have been agreed in principle and not yet designed. The DHSC settlement document says: "We have agreed to implement high level caps for the hypertension case-finding service and Pharmacy First minor illness service to restrict highest volume outliers". Details are to be agreed and implemented during the year. CPE's briefing 009/26 describes the same commitment as "setting high level caps on the HCFS and the Minor Illness strand of Pharmacy First". It adds that caps on Pharmacy First urgent medicine supply consultations will be reconsidered.
Three points follow. First, the caps are new: the service had no volume cap before 2026/27, unlike Pharmacy First clinical pathways, which the NHSBSA already bands and caps every month. Second, the stated target is outliers, not the typical pharmacy. Third, as of 8 August 2026 no figures, bands or start date had been published by DHSC, NHS England, the NHSBSA or CPE.
| Cap | Status on 8 August 2026 |
|---|---|
| Hypertension case-finding "high level cap" | Agreed in principle in the 2026/27 settlement; figures and start date not published. |
| Pharmacy First minor illness "high level cap" | Agreed in principle in the same settlement; details pending. |
| Pharmacy First clinical pathways caps | Live; bands and monthly caps published by the NHSBSA each month. |
| Off-site provision | Four days per financial year with ICB consent, in the revised specification from 3 September 2026. |
What a cap will mean in practice depends on its design. If it is set at a level that only the highest-volume sites reach, most pharmacies will never touch it. Until the figures appear, assume clinic checks and ABPM are paid in full. The constraint you will feel first is the new five-year eligibility rule, not the cap.
How does it feed the Pharmacy First payment?
Registration for the hypertension service is a condition of the Pharmacy First fixed payment. That payment is worth £500 a month for 20 to 29 clinical pathway consultations and £1,000 for 30 or more. CPE's briefing 009/26 says the "bundling" requirements "will be retained, with no further additions to the requirements". Those requirements mean owners must be registered for the hypertension case-finding service and the contraception service to receive the monthly payment.
That last clause removed a planned target. The 2025/26 settlement had proposed that contractors deliver one ABPM consultation a month from October 2025 as a further bundling condition. CPE's Pharmacy First page now says: "We were able to gain agreement that these further, additional 'bundling' arrangements would not now be introduced." Registration is the test. ABPM volume is a revenue question, not a gateway.
So the service earns twice. Once through its own fees, and once by keeping the door open to a fixed payment that can be worth £12,000 a year. A pharmacy that de-registers to save the bother loses both. For the threshold mechanics, read how to make Pharmacy First actually pay.
What changes on 3 September 2026?
Eligibility narrows, referral routes widen and off-site work gets a formal cap. NHS England published a revised service specification on 6 August 2026, agreed with CPE, and the changes take effect on Thursday 3 September 2026, four weeks after publication. CPE says the changes were agreed in the 2025/26 CPCF negotiations. Its briefing 016/26 lists the main ones.
| Change | What briefing 016/26 says |
|---|---|
| Five-year rule | Clinic checks only for people with no diagnosis "who have not had their blood pressure checked in the last 5 years". |
| Repeat checks | A general exclusion of anyone who has had a clinic check at the pharmacy under this service in the last five years. |
| Treated patients | Anyone "already being treated for hypertension" is not eligible for a clinic check. |
| Under-40s | Seen by exception where there is a family history or raised cardiovascular risk, with the rationale recorded. |
| ABPM referrals | Offered to adults aged 40 and over when referred by healthcare professionals including optometrists and dentists, with at least 14 waking measurements. |
| Off-site provision | ICB permission through a new Annex F form; limited to four days per financial year. |
The reason for the tightening is in the briefing. The changes "align with NICE guidance" and reflect the service's "primary purpose of hypertension case-finding". NHS England's data showed patients using the service for regular blood pressure measurements, which is monitoring rather than case-finding. For a pharmacy whose clinic-check volume relied on repeat customers, September is the month the numbers change.
Between now and then, check three things. Update the standard operating procedure and retrain the counter team on the five-year question. Make sure the IT system's eligibility screen matches the new criteria. And tell local GP practices, opticians and dentists that ABPM referrals are welcome, because those referrals replace the repeat clinic checks you are about to lose.
How do you raise ABPM numbers?
Convert more raised readings, and take more referrals. Those are the only two levers, and most pharmacies pull neither hard.
Every raised clinic reading is a £50.85 episode waiting to be booked. The specification already tells staff to offer ABPM at that point. The pharmacies that earn from this service fit the monitor the same day, or book a fixed slot before the patient leaves. They keep enough validated devices that nobody waits. And they count the clinic-to-ABPM conversion rate every week, alongside the Pharmacy First tally.
- Script the offer: a raised reading leads straight to "we can fit a 24-hour monitor today", not to "see your GP".
- Hold at least two validated ABPM devices per busy site, reset between users, so a raised reading never waits for a monitor.
- Fix the return time when the monitor goes on, and send the results to the practice the day they come off.
- Ask every local practice, and from 3 September 2026 opticians and dentists, to refer patients for ABPM instead of booking their own.
- Let trained counter staff run the clinic checks so the pharmacist's time goes on ABPM fitting and interpretation.
- Track checks, ABPMs and the conversion rate weekly; see which numbers a pharmacy owner should check every week.
Two cautions. Do not chase clinic-check volume among people who were checked recently; from 3 September 2026 they are ineligible, and repeat checks are exactly what the revised specification is designed to stop. And keep the records tidy: the under-40 rationale, the referral source for each ABPM and the same-day GP notification are what post-payment verification will ask for.
Key takeaways
- The service pays £10 per clinic check and £50.85 per ABPM episode, set by the 2025/26 settlement and unchanged for 2026/27.
- Registration for the service is a condition of the £500 and £1,000 Pharmacy First fixed payments; the planned one-ABPM-a-month condition was dropped.
- The 2026/27 high-level caps are agreed in principle to restrict the highest-volume outliers; no figures or start date had been published by 8 August 2026.
- Pharmacists, pharmacy technicians and trained non-registered staff can take readings, recorded under the responsible pharmacist's name and GPhC number.
- From 3 September 2026 clinic checks are limited to adults aged 40 and over with no diagnosis and no blood pressure check in the last five years, with under-40s by exception.
- From the same date optometrists and dentists can refer for ABPM, and off-site provision is capped at four days a year with ICB consent.
- The money is in converting raised readings to ABPM: 40 checks and eight ABPMs earn £806.80 against £501.70 with two.
Sources and further reading
- Hypertension Case-Finding Service (Community Pharmacy England)
- Briefing 016/26: Main changes to the Hypertension Case-Finding Service specification (Community Pharmacy England)
- NHS Community Pharmacy Hypertension Case-Finding Advanced Service (NHS England)
- Community Pharmacy Contractual Framework 2024 to 2025 and 2025 to 2026 (GOV.UK)
- Community Pharmacy Contractual Framework 2026 to 2027 (GOV.UK)
- Pharmacy First service (Community Pharmacy England)
- Community pharmacy (NHS England)
FAQs
See every raised reading before it walks out.
The money in this service is the conversion from a £10 clinic check to a £50.85 ambulatory episode. Dataforge PMR flags each raised reading, books the monitor fitting and return, and sends the GP notification, so the follow-up happens by process rather than memory.
See Dataforge PMR