NHS IP Pathfinder – Secondary Prevention Lipid Management Service

Regent Pharmacy, in collaboration with Northamptonshire Integrated Care Board (ICB) and the five GP practices of Grand Union PCN

Project summary

Background and rationale

We were keen to design a service model centred around NHS priorities. Cholesterol management for secondary prevention is a clinical priority, as recognised by incentives in the 2025/26 Quality and Outcomes Framework (QOF)¹. High cholesterol is one of the most significant risk factors for cardiovascular disease (CVD): globally, a third of ischaemic heart disease is attributable to raised cholesterol, and in England it accounts for 7.1% of deaths and 3.7% of disability-adjusted life years (DALYs)¹.

The 2025/26 QOF indicator CHOL003 ensures that patients with established CVD – defined as coronary heart disease, peripheral arterial disease, stroke/TIA or chronic kidney disease – receive cholesterol-lowering treatment per NICE guidance². A high-intensity statin is recommended first line³; where declined or unsuitable, NICE recommends ezetimibe⁴ (with bempedoic acid if needed⁵), PCSK9 inhibitors⁶˒⁷ for persistently elevated LDL-C, and Inclisiran⁸ for LDL-C persistently ≥2.6 mmol/L. Our service was built directly around this pathway.

What we did and how

In October 2025, Northamptonshire ICB introduced a Secondary Prevention Lipid Management Service into the NHS-funded Independent Prescriber (IP) Pathfinder programme, delivered through Regent Pharmacy and the five GP practices of Grand Union PCN. Each practice identifies eligible patients via SystmOne searches (secondary-prevention patients with LDL-C ≥2.6 mmol/L despite maximally tolerated therapy) and refers them in. Our team risk-stratifies the list and invites patients to a face-to-face community pharmacy consultation for a holistic review – medicines optimisation, adherence, lifestyle and shared decision-making (utilising the 'Three-talk model') – with treatment optimised per NICE NG238³ and, where chosen, Inclisiran initiated under NICE TA733⁸. The service runs on NHS-accredited digital systems: pharmacists hold honorary contracts giving SystmOne access, prescriptions are generated via CLEO Solo, and consultations recorded on ConX alongside SystmOne.

Outcomes

Over the first six months (October 2025 – March 2026), pharmacists carried out 133 consultations and issued 132 prescriptions. LDL-C reductions were substantial, frequently taking patients below the NICE NG238 secondary-prevention target of 2.0 mmol/L³ and, in several cases, towards the ESC/EAS ambition of <1.4 mmol/L for very-high-risk patients⁹. Individual results included LDL-C falling from 5.6 to 0.8 mmol/L. Improved lipid management of this kind is estimated regionally to support a 33% reduction in non-fatal CVD events, a 22% reduction in CVD mortality, and savings of around £1.06m per 10,000 patients per year¹⁰ – a strong return for a low-cost, community-based prevention model that also releases GP capacity.