Cardiovascular disease: risk assessment and reduction, including lipid modification

Overview

We delivered a system-wide quality improvement project aimed at increasing the uptake of lipid-lowering therapy (LLT) for primary prevention in people with a QRISK score of 20% or more. We used NICE's guideline on cardiovascular disease: risk assessment and reduction, including lipid modification as the standard for this project.

The programme included education, the provision of standardised searches for the cohort at practice level, as well as GP and consultant pharmacist clinical leadership with ongoing engagement support by the ICB medicines optimisation team.

To close the treatment gap towards national ambitions (65% of people in this cohort to be prescribed LLT) and reduce unexplained variation in achievement, all practices were given a core target of increasing LLT by 2 out of 1,000 list size, and the lower achieving practices were given a stretch target of an additional 5% or 10% uplift. The standardised searches provided the list in 4 cohorts sorted by gender and age (40 to 79 years) to allow practices to focus on where the treatment gap was within their practice. People newly identified during the project period were excluded, with practices tasked with managing these additional people in line with NICE guidelines.

The payment incentive scheme was outcomes-based, as practices were only paid for the prescription of LLT, but structured to recognise that more consultations than the target number would be needed and that a longer consultation would be beneficial to allow for shared decision making.

The project ran over a 6-month period between April and September 2025.