“The A&E doctor said my blood pressure’s sky high — I just need the tablets.”

A single set of raised readings in A&E, taken when someone is in pain and intoxicated or withdrawing, does not diagnose hypertension. NICE NG136 requires confirmation with ambulatory or home monitoring for clinic readings of 140/90 or above, with same-day referral for readings of 180/120 or above with signs of retinal haemorrhage, papilloedema or life-threatening symptoms. The barrier in this case is access, and the solution is local: the NHS community pharmacy blood pressure check service offers clinic and ambulatory readings for adults over 40, many practices loan home monitors, and tests can be bundled into visits he is already making. Heavy drinking raises BP and is itself a major stroke risk; at over 150 units a week with morning withdrawal symptoms he is likely dependent, so he must not stop abruptly and needs assessment for medically assisted withdrawal, with oral thiamine for a harmful drinker with poor nutrition (NICE CG100 and CG115). Missed appointments in people with insecure housing are often a systems failure — letters to an old address — and checking contact details is a concrete act of inclusion. His wish to be a grandad is the lever for change; the GP’s job is to find it and use it, not to lecture.