Cardiovascular Disease Modern Service Framework: The Community Pharmacy Readiness Guide

About the framework

On 7 July 2026, the Department of Health and Social Care and NHS England published the Cardiovascular Disease Modern Service Framework (CVD MSF), a ten-year strategic vision and delivery model for reducing premature deaths from heart disease and stroke in England.^1,2 The government has committed to reducing premature deaths from heart disease and stroke among people aged under 75 by 25% over the next decade, supporting delivery of the NHS 10 Year Health Plan.^1,2 The framework was developed in collaboration with charities and patient groups, including the British Heart Foundation.^2,4 It takes a cardiovascular-kidney-metabolic (CVKM) approach. The executive summary highlights seven shared conditions and risk factors: high blood pressure, high cholesterol, high blood sugar (including pre-diabetes and diabetes), obesity, chronic kidney disease, atrial fibrillation and smoking. Heart failure also features prominently in the treatment-optimisation priorities and in the framework's broader case-finding model.²

Around 33,000 people in England die prematurely, meaning before the age of 75, from heart disease and stroke each year.^1,2 The framework sets out 12 immediate priorities for the health and care system to deliver over the next three years, grouped under four themes: finding the missing millions, driving treatment to target, ensuring timely, equitable, high-quality acute care, and living with cardiovascular disease and expanding access to rehabilitation.² If delivered successfully, the government estimates the framework could prevent around 1,600 to 2,400 deaths from heart disease and stroke among people aged under 75 in year 3, rising to around 3,850 to 4,900 in year 10.²

The framework aligns its 12 priorities with existing 2026 to 2027 financial year incentive schemes, naming the Community Pharmacy Contractual Framework alongside general practice's Quality and Outcomes Framework and acute trusts' Best Practice Tariffs as levers it intends to use.² It does not, however, establish a new commissioned community pharmacy service, payment mechanism, eligibility pathway or submission requirement, and a further delivery plan with implementation detail is due later in 2026.² Separately, pharmacy representative bodies have called for an expanded pharmacy role: the Company Chemists' Association has said the sector is ideally placed to do more in cardiovascular prevention, diagnosis and management, citing pharmacy's accessibility and its presence in deprived areas, and the Royal College of Pharmacy has highlighted the role pharmacists already play through blood pressure checks and risk-factor identification.⁵ These are sector calls for greater involvement, not confirmed commissioning decisions.

Diabetes UK is the first organisation announced in a planned series of partnerships supporting delivery of the framework, reflecting the established link between diabetes and cardiovascular risk: more than 4 million people in the UK are living with diagnosed type 2 diabetes, and a further 1.3 million are thought to be living with it undiagnosed.³ The partnership includes a public awareness campaign and greater use of Diabetes UK's existing Know Your Risk tool.³ The Prevention Accelerators programme launched in June 2026: the first accelerators are being established in five areas (Greater London, Greater Manchester, Liverpool City Region, South Yorkshire and the West Midlands), bringing together NHS organisations, local authorities and community partners to improve early detection and uptake of preventative care in those areas.³

How pharmacy teams can prepare

1. Review current cardiovascular activity. Look at delivery of the NHS Community Pharmacy Blood Pressure Check Service, New Medicine Service conversations for newly prescribed medicines on the current eligible-medicines list for an eligible condition (including type 2 diabetes and specified cardiovascular conditions), and Discharge Medicines Service referrals and consultations following a cardiac admission.^6,7,8,13 This gives an accurate picture of what the pharmacy already delivers.
2. Check the Blood Pressure Check Service against its specification. The service most closely aligned with the framework's finding the missing millions theme is the existing Blood Pressure Check Service.^2,6 Confirm the following against the current service specification, rather than assuming performance.
   • Eligible patients are routinely offered the service in line with the specification
   • The pharmacy has both a validated clinic blood pressure monitor and an ambulatory blood pressure monitoring device, with maintenance and recalibration completed according to the manufacturers' instructions⁶
   • Staff understand the urgent escalation procedure for a severely elevated reading
   • All clinic and ambulatory blood pressure results are sent securely to the patient's general practice. Results requiring urgent escalation are communicated immediately by telephone and secure digital transmission; other results are sent through the NHS-assured IT system, NHSmail or another secure digital process in accordance with the service specification and locally agreed arrangements⁶
   • Non-attendance for ambulatory monitoring is managed in accordance with section 4.19 of the specification⁶
   • Activity is recorded using the pharmacy's NHS-assured IT system
3. Use existing patient contacts to support risk-factor awareness. Dispensing consultations, New Medicine Service conversations, Discharge Medicines Service referrals and consultations, and the Blood Pressure Check Service all provide opportunities to raise awareness of cardiovascular risk factors such as smoking, high blood pressure and known diagnoses of diabetes or chronic kidney disease. This means using conversations that are already commissioned, not creating a new pharmacy-led check. Any input should be limited to brief intervention, risk communication and signposting: diagnosis, laboratory testing and treatment initiation must take place within an authorised commissioned or employed pathway and within the prescriber's competence, governance arrangements and indemnity.
4. Review delivery of medicines-optimisation services relevant to cardiovascular medicines. Review delivery of the New Medicine Service, Discharge Medicines Service and any locally commissioned medicines-optimisation services relevant to cardiovascular medicines. The New Medicine Service applies to newly prescribed medicines included on the current eligible-medicines list for an eligible condition, including type 2 diabetes and specified cardiovascular conditions, not to every patient already taking a statin, antihypertensive or glucose-lowering medicine.^7,13 Structured medication reviews remain a Primary Care Network responsibility for selected high-risk cohorts under the Network Contract Directed Enhanced Service: only include them in pharmacy planning where a pharmacist holds a separate commissioned or employed role delivering them.¹⁰
5. Consider the inequalities focus, within existing resources. The framework places a strong focus on reaching communities with the greatest cardiovascular burden, including areas of higher deprivation.² Any additional outreach, screening or targeted case finding beyond the current service specification should be appropriately commissioned, resourced, clinically governed and indemnified before it is offered. Do not assume the pharmacy should alter contracted hours or take on unfunded activity in response to the framework.
6. Check whether the pharmacy is linked to a Prevention Accelerator footprint. The first Prevention Accelerators are being established in five areas: Greater London, Greater Manchester, Liverpool City Region, South Yorkshire and the West Midlands.³ Ask the integrated care board whether the pharmacy falls within a specific Prevention Accelerator footprint or delivery partnership. Location within one of the five named regions does not itself confirm participation.

The framework's four priority themes and where pharmacy fits

The CVD MSF groups its 12 priorities under four confirmed themes.² The table below maps each theme to where existing community pharmacy activity is most relevant.

The 12 priorities and their national standards are set out in the main framework, with the equity metrics in Annex B.² A separate technical annex provides the supporting evidence and explains how the priorities were selected.¹⁴ A national delivery plan and further implementation detail are expected later in 2026.

Suggested internal readiness evidence

• These are optional internal notes for the pharmacy's own planning. They do not replace record-keeping already required under the Blood Pressure Check Service, New Medicine Service and Discharge Medicines Service specifications.^6,7,9 Where mandatory equipment, training, procedures or an NHS-assured IT system are missing, this requires corrective action to meet the service specification, not simply a note for later.
• A note of which cardiovascular-related services the pharmacy currently delivers: Blood Pressure Check Service, New Medicine Service, Discharge Medicines Service, or any locally commissioned service
• A note of any gaps identified against the current Blood Pressure Check Service specification, such as equipment, staff training or ambulatory monitoring availability
• Complete clinical records and evidence that all required results, notifications and referrals have been transmitted under each existing service, kept within the pharmacy's NHS-assured IT system and in line with each service's own specification
• A note of whether the pharmacy is linked to a Prevention Accelerator footprint, and any contact made with the integrated care board

Key takeaways

• The Cardiovascular Disease Modern Service Framework is a ten-year strategic and delivery framework targeting a 25% reduction in premature deaths from heart disease and stroke among people aged under 75, built around 12 priorities under four themes: finding the missing millions, driving treatment to target, timely acute care, and rehabilitation.
• The framework aligns its priorities with existing contractual levers, including the Community Pharmacy Contractual Framework, but does not create a new commissioned pharmacy service, payment mechanism or submission requirement. Calls for an expanded pharmacy role come from sector bodies, not the framework itself, and a delivery plan is due later in 2026.
• Pharmacy teams can prepare now within existing services: reviewing Blood Pressure Check Service delivery against its specification, checking New Medicine Service activity for newly prescribed medicines on the current eligible-medicines list for an eligible condition, reviewing relevant Discharge Medicines Service referrals and consultations following hospital discharge, and finding out whether the pharmacy sits within a Prevention Accelerator footprint.

Download the checklist