PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

48 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFor many NCDs such as diabetes, hypertension, hypercholesteraemia, asthma, and COPD, the entire diagnostic and treatment journey can be overseen in primary care with appropriate support and resources. Hypertension requires multiple blood pressure readings over time. Type 2 diabetes needs fasting glucose or HbA1c confirmation. These conditions, once confirmed, can often be managed effectively in primary care settings with appropriate support and resources. However, not all conditions can be definitively diagnosed in primary care settings. Complex presentations, ambiguous test results, advanced disease progression. The critical challenge is ensuring primary care has both the capability to diagnose what it can manage and clear pathways for referring what it cannot, avoiding both unnecessary specialist referrals that overwhelm secondary care and delayed referrals that compromise outcomes. Missed opportunities and implementation barriers Despite this potential, multiple barriers limit opportunistic detection in practice. Germany’s consultation times average under eight minutes, whilst Greece has only 6% of physicians in primary care versus the EU average of 21% (OECD/European Commission, 2024b). Payment systems that reward volume over comprehensive assessment and which do not reimburse preventive activities during illness visits create additional disincentives Critical gaps in access to timely diagnostics further limit detection capacity, with primary care physicians in many countries unable to access CT scans, MRI scans, and endoscopy without specialist referral. Digital infrastructure could support systematic opportunistic detection, but where digital systems exist, poor integration often reduces its effectiveness. Even when patients present with relevant symptoms, evidence reveals systematic failures to capitalise on detection opportunities. Without clear protocols, elevated blood pressure or abnormal glucose readings during routine visits may be documented but not systematically followed up. Early warning signs may be missed when structured pathways linking opportunistic findings to diagnostic protocols are absent. This fragmentation becomes particularly problematic when conditions require specialist assessment. These issues are explored in greater depth in the following chapter of this report. POLICY LEVERS: SCREENING AND EARLY DETECTION Based on the evidence examined, countries should consider the following integrated approaches to strengthen early detection across all pathways: The evidence reveals unfulfilled potential across both organised screening programmes and opportunistic detection in primary care. Coverage for the same screening programmes ranges from over 80% to under 10% across countries. Meanwhile, primary care, where most early detection could occur through routine encounters, often lacks timely access to appropriate diagnostics and authority to act on findings. These systematic failures mean early detection concentrates among populations who already engage with health services, potentially widening rather than narrowing health inequities. Based on the evidence examined, countries should consider the following integrated approaches to strengthen early detection across all pathways: ■ Implement systematic risk stratification for screening programmes To optimise screening programmes, implement systematic risk stratification using validated assessment tools such as SCORE2 for cardiovascular risk and polygenic risk scores where applicable, going beyond basic age-based eligibility. Accurate documentation of social determinants of health, such as income, occupation, education, and environment, is critical, as these factors