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 terms of the systematic implementation of approaches towards secondary prevention – for example, use of disease registers. Only a minority of patients receive all recommended interventions.
• There are many patients who would benefit from secondary prevention but are not currently benefiting. Evidence suggests that this is an area where the 'inverse care law' applies and those in greatest need are least likely to benefit. This suggests significant opportunities exist to improve care.
• 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.
• Cost savings are likely to accrue over the medium term, as patients are prevented from going on to suffer a wide range of adverse events as their life expectancy lengthens.

How to do it

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

• ensuring appropriate coverage of key preventive interventions and processes
  – managing disease registers systematically through modelling expected versus actual prevalence and incidence
  – ensuring systematic control of hypertension, cholesterol and diabetes among the consortium’s population
• understanding the key drivers of local health inequalities and identifying where and how to intervene to have the biggest and quickest impact
• working systematically with local authorities and other partners to ensure primary care prevention forms part of a broader strategy on public health
• working with community and voluntary sector groups to offer interventions to patients who do not engage well with mainstream health services.

Several free resources exist to support this, such as the London Health Observatory's 'Health Inequalities Intervention Tool', which can be used to help commissioners understand where to focus their efforts to have the greatest effect in their local area. Modelling tools can be used to measure expected and actual numbers of people on disease registers, and thereby identify practices where improvement is needed.

Useful resources

• The Department of Health's health inequalities intervention tool available at the London Health Observatory was developed on the basis of the criteria of the most cost-effective interventions that would have the quickest impact, most of which are secondary prevention interventions in primary care.
• The Health Inequalities National Support Teams' 'how to' guides for secondary prevention in primary care and related resources.

For further information