Pathways and referrals


A new referral pathway has been developed for adult patients with severe hypertension.

The pathway was developed with two hypertension specialists, Professor Philip Bath and Dr Mark Glover, along with GPs and the NEMS Clinical Navigation service in response to areas of improvement raised by the hypertension specialists.

Patients with severe hypertension (systolic BP>220mmHg or diastolic BP>120mmHg) do not always need urgent acute admission, and in fact admission can reduce the quality of their care because they may not see hypertension specialists. The new referral pathway aims to reduce the number of patients with severe hypertension who are admitted at hospital by having the Clinical Navigation Service redirect appropriate patients to an urgent slot in the specialist outpatient Hypertension Clinic in the Nottingham Treatment Centre. This will also help to improve the patient experience by avoiding admission when it is safe to do so, whilst maintaining a safe and appropriate system of referral for the very small number of patients who do urgently require same-day assessment.

New referral pathway
  • Where patients present with severe hypertension, GPs should call the NEMS Clinical Navigator on 0115 846 2376.
  • The Clinical Navigator team will ask for details about the patient to determine whether it is safe to book them into the next available urgent Hypertension Clinic slot. The criteria have been set by the hypertension specialists and urgent appointments have been identified within each of the weekly Hypertension Clinics specifically for this group of patients. Details provided will need to include the grading of hypertensive retinopathy, signs and symptoms of hypertensive encephalopathy and suspected impending acute end organ damage.
  • Where it is deemed clinically safe for the patient to be seen in the outpatient Hypertension Clinic the NEMS Clinical Navigator will book this appointment. 
  • GPs will be given clinical management advice by NEMS Clinical Navigator to maximise the efficiency for the patient at their outpatient appointment.
Patients identified with accelerated (malignant) hypertension, hypertensive encephalopathy and/or impending end organ damage will continue to be directed by NEMS Clinical Navigator to the urgent hospital assessment or admission unit.

For any further information please email This email address is being protected from spambots. You need JavaScript enabled to view it. .

pdfDownload further information.
pdfDownload the pathway.