3. Secondary prevention

What is it?

Systematically detecting the early stages of disease and intervening before full symptoms develop – for example, prescribing statins to reduce cholesterol and taking measures to reduce high blood pressure.

Why is it important?

  • Secondary prevention is based on a range of interventions that are often highly cost-effective and that, if implemented at scale, would rapidly have an impact on life expectancy.
  • There is substantial variation between practices in the systematic implementation of approaches towards secondary prevention – for example, use of disease registers. Only a minority of patients receive all recommended interventions.
  • Evidence suggests that this is an area where the 'inverse care law' applies and those in greatest need are least likely to receive beneficial services.
  • Identifying those at risk and intervening appropriately is one of the most effective ways in which GPs can reduce the widening gaps in life expectancy and health outcomes (Marmot Review 2010).

What is the impact?

  • Successful secondary prevention would have a major impact on health outcomes, in terms of improvement in life expectancy and reduction in complications.
  • Modelling by the Department of Health (2009) has shown that systematic and scaled-up secondary prevention is a cost-effective, clinically significant and fast way to tackle inequalities in health in local areas. The National Audit Office (2010) suggests that improving cholesterol levels and hypertension control have not been adopted at a sufficient scale. If they were, they would have a significant impact on inequalities.
  • Cost savings are likely to accrue over the medium term, as patients are prevented from experiencing a wide range of adverse events as their life expectancy lengthens.

How to do it

Secondary prevention largely involves the systematic application of standard, low-technology interventions. The key actions for commissioners are:

  • ensuring appropriate coverage of key secondary preventive interventions and processes including managing disease registers systematically by modelling expected versus actual prevalence and incidence, and thereby identifying practices where improvement is needed
  • systematic screening, where appropriate and known to be cost-effective
  • ensuring systematic control of hypertension, cholesterol and diabetes among clinical commissioning group's populations
  • working systematically with local authorities and other partners to ensure secondary prevention forms part of a broader strategy on public health
  • working with community and voluntary sector groups to both develop more tailored joint strategic needs assessments and health and wellbeing strategies, and to engage with and provide services to patients who are not reached by mainstream health services.

Useful resources

For further information