Improving the Uptake of Lipid Lowering Therapy for Primary Prevention of Cardiovascular Disease: A Primary Care Led Quality Improvement Approach

Sussex CVD Prevention Team

Project summary

Cardiovascular disease (CVD) remains a leading cause of premature mortality and health inequality in England. National guidance recommends the use of the QRISK® calculator to identify individuals at increased CVD risk and to offer lipid lowering therapy (LLT) where 10‑year risk exceeds 10%. Despite this, uptake of LLT in primary prevention remains suboptimal.

In 2024–2025, NHS England introduced a target for primary care to increase LLT in patients with a QRISK® score ≥20% to 65%.  Improvement in towards this target is Sussex - a population of approximately 1.8 million people - was minimal in the 6- month period March 2024 (58.26%) to September 2024 (58.67%) and on the current trajectory it was clear that the 65% target would not be achieved (CVD Prevent data). Furthermore, Sussex achievement was significantly below national levels.

Further analysis of the Sussex CVD Prevent data showed significant variation among practices’ performance which ranged from 41.6% to 80.1% with factors contributing to variation including gender (females undertreated compared to males), age, deprivation and possibly ethnicity.

The project was undertaken in a 6 -month period (April – September 2025). At the start of the project Sussex achievement was at 59.93% (compared to national at 63.32%) ranking Sussex as 36th out of 42 ICBs with an estimate that 5165 would need to be commenced on LLT to achieve the 65% treatment target.

We implemented a system‑wide quality improvement programme across all 156 Sussex GP practices, combining targeted data searches, structured patient cohorts, incentivised outcome‑based payments, and multidisciplinary education on lipid management and shared decision‑making. Practices were supported through clinical leadership, project management, and tailored resources.

Of 148 practices submitting data (94.9% of practices), 13,633 patients were offered LLT and 5,482 initiated therapy (40.2% acceptance). Overall LLT uptake increased to 63.79%. This significant uptick in trajectory in Sussex as a result of this project moved Sussex to 19th in ICB ranking (previously 36th) and to within 0.16% of national achievement.

There was an increase in the number of practices achieving the 65% target overall and marked reduction in those at the low level of achievement. The 65% target was exceeded in both males and females demonstrating targeted improvement in those with the most life years to gain for primary prevention.

This programme demonstrates that coordinated system leadership, targeted incentives, and workforce development can substantially improve LLT uptake for primary prevention. The methodology is scalable and transferable to other clinical priorities.

1.CVDPREVENT. The Cardiovascular Disease Prevention Audit https://www.cvdprevent.nhs.uk/