Cardiovascular disease causes around 33,000 premature deaths in England every year, a quarter of all deaths in people under 75, and after decades of progress the improvement trend has stalled. Obesity levels are rising, healthy life expectancy has declined since the pandemic, and the populations most affected, those in the most deprived communities, are also those where the gap between diagnosed risk and treated risk is widest. The Cardiovascular Disease Modern Service Framework, published jointly by DHSC and NHS England on 7 July 2026, sets a 10-year ambition to cut those premature deaths by 25% and identifies 12 priorities for doing so. It is the first Modern Service Framework to be published under the NHS 10-year plan.
For pharmaceutical and medtech companies, the framework identifies specific clinical gaps where evidence-based treatments are underused, names the technologies needed in neighbourhood settings, quantifies the economic case for investment, and directly calls on industry to help implement what works and find new solutions. It’s an explicit invitation with a delivery infrastructure behind it.
The framework's central argument is that the biggest gains in cardiovascular outcomes are available now, from better identification and treatment of known risk factors, not from new medicines. Millions of people in England live with undiagnosed or poorly managed high blood pressure, high cholesterol, atrial fibrillation, diabetes and chronic kidney disease. The framework refers to these as the “missing millions” and makes finding them the first of its 12 priorities.
The scale of the opportunity is substantial. The framework cites the CVDACTION Impact Model’s estimate that consistent delivery of four NICE-recommended treatments — blood pressure management, lipid-lowering therapy, anticoagulation for atrial fibrillation and weight management — across three years could:
The framework takes a cardiovascular-kidney-metabolic (CVKM) approach, recognising that high blood pressure, high cholesterol, diabetes, obesity, chronic kidney disease and atrial fibrillation share common causes and cluster in the same individuals. Treating them in silos, as NHS services have historically tended to do, means missing both the interactions between them and the compounding risk they create. The CVKM framing also explicitly includes mental health, reflecting the relationship between mental health, long-term conditions and people’s capacity to manage their physical health — linking directly to the prevention and comorbidity arguments we set out in our earlier post on mental health as a national priority.
The framework’s most direct implication for pharmaceutical companies is in secondary prevention. The evidence base for medicines that prevent recurrent cardiovascular events in people who have already had a heart attack or stroke is strong, the treatments are largely established, and the treatment gap is wide. Optimising prescribing in this population, getting more patients onto the right therapy and keeping them on it, is where the framework anticipates the fastest gains.
The framework names several specific treatment areas where performance is currently inconsistent: blood pressure management, cholesterol-lowering therapy, anticoagulation for atrial fibrillation, diabetes management and heart failure treatment. For companies with medicines in any of these areas, the framework strengthens the commissioning case by quantifying the population-level impact of closing the treatment gap and tying that to NHS England’s own delivery targets.
The neighbourhood health model changes where those commissioning conversations happen. As the framework emphasises the shift from hospital-based to community-based care, primary care networks and neighbourhood teams become the primary locus for identifying and treating high-risk patients. Medicines that have historically been initiated in cardiology or nephrology outpatient settings will increasingly be expected to flow through primary care pathways. That changes what companies need to demonstrate at the point of NHS engagement: not just clinical evidence, but how a medicine fits into a primary care workflow, what prescriber support is available, and how adherence is sustained in a community setting.
The framework also signals growing opportunity in newer therapy areas. GLP-1 receptor agonists for patients with a history of cardiovascular events are explicitly referenced as an emerging treatment priority, with draft NICE guidance recommending semaglutide for patients with a BMI above 27 and a prior history of heart attack, stroke or symptomatic peripheral arterial disease. Companies in this space will find the framework’s population health infrastructure, including the CVDACTION data tool that identifies eligible patients at GP record level, creates a faster route from NICE recommendation to clinical uptake.
The framework co-chairs made an observation worth quoting directly: current NHS technology for cardiovascular diagnosis is too often “time-intense, gold-standard” where what is needed is “simpler, more accessible technology, delivered by non-specialist staff within neighbourhood settings.” The specific conditions named are heart failure, fatty liver disease and peripheral arterial disease. All three are conditions in which earlier detection significantly changes outcomes and where current NHS diagnostic capacity is concentrated in secondary care.
The neighbourhood health model creates new procurement routes for diagnostic technology. Neighbourhood ProActive Care Teams (PACT), referenced throughout the framework as the delivery vehicle for proactive identification of high-risk patients, need tools that work in community settings without specialist operators. Point-of-care testing for blood pressure, cholesterol, glucose and urine albumin is already growing; the framework’s explicit support for expanding this into neighbourhood settings, workplaces and transport hubs, as the Liverpool City Region prevention accelerator programme has piloted, extends the addressable market considerably.
Digital tools for population health management are central to the framework’s delivery model. The CVDACTION platform, which searches GP records to identify patients not on optimal preventive therapy and stratifies them by risk, is one example of the kind of tool the framework expects to see scaled across all ICBs. For companies developing similar population health management, risk stratification or remote monitoring tools, the framework provides both a clinical mandate and a commissioning framework against which NHS partners can justify investment.
The framework is also explicit that the NHS has been too content with pilots. The co-chairs appeal directly to ICBs to “avoid duplicating pilots and instead trust this expert consensus to support decision-making.” For medtech companies, that is a signal that the framework is intended to create the conditions for adoption at scale, not another round of local evaluation. Companies whose technologies have already demonstrated effectiveness in NHS settings are better positioned to move quickly.
The framework is direct about inequalities in a way that most NHS policy documents are not. In the most deprived communities, cardiovascular risk is higher, diagnosis rates are lower, treatment initiation is slower and adherence is worse. The framework’s proportionate universalism approach, targeting greater support toward high-risk individuals, practices and neighbourhoods, means that the populations with the greatest unmet need are also those the system is explicitly prioritising for investment.
For industry, this is relevant beyond the equity argument. Medicines and technologies designed and evidenced for average NHS populations routinely underperform in the deprived communities where cardiovascular burden is highest. Evidence packages that include data on performance in high-deprivation settings, in patients with multiple comorbidities and across diverse ethnic populations, are better positioned for NICE evaluation and for ICB procurement decisions in the areas where the framework’s 12 priorities are most pressing.
The Liverpool City Region prevention accelerator is deploying digital health kiosks in high-footfall community locations including transport hubs and leisure centres, targeting working-age adults who are less likely to access CVD prevention services through primary care. Early evaluation data from related Cheshire and Merseyside kiosk programmes has shown strong engagement from working-age men and people living in high-deprivation areas, the populations where cardiovascular risk is highest and treatment gaps are widest. The framework's backing for scaling that approach nationally creates a clear context for community-facing prevention technologies.
The CVD Modern Service Framework is structured as an action plan with named priorities, delivery metrics and a monitoring commitment from DHSC. Unlike many NHS strategies, it has a clear accountability model and a timetable: a further implementation document will be published later in 2026 to support local systems in prioritising existing resource against the 12 priorities.
For pharmaceutical companies, the near-term priorities are clear: engage with the secondary prevention treatment gap in the named therapy areas, build primary care pathway evidence into market access strategies, and position post-launch real-world evidence programmes around the outcome metrics the framework will use to monitor progress.
For medtech and digital health companies, the framework maps directly to the neighbourhood health infrastructure being built across ICBs. Technologies that are simple to deploy in community settings, that connect to primary care data, and that generate the outcome data commissioners need to justify continued investment are the ones the framework is designed to pull through. Those that require secondary care infrastructure, specialist operators or extensive local piloting before adoption face a harder path in the environment the framework is creating.
The government has set a 25% reduction target for premature cardiovascular deaths within a decade. That ambition, backed by a costed delivery model and an explicit call to industry, makes cardiovascular prevention one of the clearest commercial opportunities in NHS life sciences in 2026. The treatment gaps are documented; the populations are identified, and the case for investment is quantified. The question is whether industry engages with it on the NHS’s terms.
CHASE works with pharmaceutical, medtech and digital health companies on NHS commercial strategy, market access and NHS–Industry Partnerships. Our teams support companies navigating NICE evaluation, evidence generation, NHS procurement and NHS partnership programmes across cardiovascular, prevention and other priority therapy areas. Get in touch to find out more.
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