The CVD Modern Service Framework will only deliver its promise if we do things differently.

The MSF sets 6 immediate priorities for secondary prevention with ambitious targets for increased uptake of medicines recommended by NICE but under used. The CVDACTION Impact Modelling cited in the MSF shows that increasing uptake of these treatments to modest levels of improvement ("Step Change") will deliver a huge impact on outcomes, demand, cost and wider economic productivity in 3 years.

The MSF is explicit about what needs to be done. But we've known for years that these treatments work in preventing heart attacks, strokes, heart failure and kidney failure. And despite NICE guidance, incentives, data tools and constant improvement projects, we see little more than marginal gains . For example one in three people with hypertension still do not have their blood pressure controlled. Similar under treatment is the norm in high cholesterol, chronic kidney disease and diabetes.

The challenge is not WHAT to do but HOW to do it in real world primary care:

• The CVKM conditions are often asymptomatic - patients have no alert that they need changes to their medication

• GP recall systems are largely based on anniversary of the previous review rather than on clinical need/priority. They are not designed to detect the patients we have missed

• Clinicians have no capacity to take on more work

We have decades of learning in the NHS that just spelling out the guidance, even with added education and incentives, doesn't lead to at-scale improvement. We will not see material change unless we address the real world barriers to acting on data and delivering national priorities. What does it mean to do things differently? 3 actions are critical if we are to deliver the step change the MSF envisages:

1. Look for the patients: Make it routine to search for patients with CVKM conditions who are not receiving optimal treatment - and make it easy for teams to prioritise and act on the data

2. Provide structured support for teams to adapt pathways & use of workforce to optimise treatment at scale and within capacity. We factored the cost of this transformation support into our health economic modelling that showed large scale and rapid return on investment.

3. Set step change targets for achievement - because we know that incremental does not deliver.

"We have a great opportunity now. The MSF is a major step forward with its prescription for high impact interventions and there is a growing appetite to do things differently - with neighbourhood teams, prevention accelerators and PCN hub models for example. Let's make sure we make the most of these opportunities so they deliver the core actions that need to happen for step change."

Dr Matt Kearney, OBE, Co-Founder and CEO, Into-Action.Health