As fundholding has moved to the primary care sector, so has responsibility for ensuring equal access to high-quality medical care throughout the patient's care pathway. Global cardiovascular risk should be estimated in people with a family history of premature cardiovascular disease, or with symptoms suggestive of cardiovascular disease. The aims of prevention are to reduce the risk of heart attack or stroke, to reduce the need for revascularisation in all arterial territories, and to improve the quality and length of life. Stepped therapy for hypertension has provided a logical sequence of drugs to be prescribed before patients are referred to secondary care. Service delivery for cardiovascular prevention has required major reorganisation of primary care services. The Department of Health advocates the use of GPs with a special interest in cardiology to improve access to cardiology services in the community.