Smoking, obesity, excess alcohol, and physical inactivity underlie the development of most common noncommunicable diseases including type 2 diabetes, heart disease, stroke, and some cancers (World Health Organisation, 2023). Globally, governments and health systems have attempted to increase implementation of preventive healthcare interventions that address these risk factors (NHS England and NHS Improvment, 2019; Litt, 2016; U. S. Preventive Services Task Force et al., 2022). Healthcare professionals in primary care are tasked with vital parts of this secondary prevention work including providing support for weight management, smoking cessation, alcohol reduction and physical activity (National Institute for Health and Care Excellence, 2014). However, the COVID-19 pandemic had marked effects on what and how primary care services were delivered (Monaghesh and Hajizadeh, 2020; Mann et al., 2020). In England, government messaging advised the public to ‘stay home and protect the National Health Service (NHS)’ and there is evidence this reduced other types of care such as acute presentations and urgent cancer referrals during this time (Mansfield et al., 2021; Gathani et al., 2021).

Based on patterns observed for other conditions (Mansfield et al., 2021), it is likely that delivery of preventive services in primary care decreased in this period. To our knowledge, there have been no studies investigating how the pandemic affected the delivery of preventive interventions in primary care. This is important to understand, as these interventions are effective and cost-saving for smoking cessation (Maciosek et al., 2017; U. S. Preventive Services Task Force et al., 2021); effective and cost-effective for reducing hazardous drinking (Purshouse et al., 2013; U. S. Preventive Services Task Force et al., 2018); effective and cost-effective for weight loss in obesity (Aveyard et al., 2016; Retat et al., 2019); and effective and may be cost-effective for physical inactivity (Gc et al., 2018; U. S. Preventive Services Task Force et al., 2022).

It is plausible that inequalities may exist in the effect of the pandemic on preventive interventions in primary care. Tobacco addiction and obesity are increasingly related to poverty. In the UK there is a 17% and 8% higher prevalence of overweight and obesity in the most deprived compared to the least deprived areas for women and men respectively (NHS Digital, 2020). Similarly, 17% of adults in the most deprived areas smoke compared to 9% in the least deprived, and adults from the most deprived areas have the highest incidence and annual presentation of alcohol dependence (Office for National Statistics, 2019; Thompson et al., 2017). Providing support for these, and other, behavioural risk factors can be a key component of addressing health inequalities.

Our primary aim was to quantify the rate of preventive interventions delivered (advice or referral for the four main behavioural risk factors: smoking, obesity, excess alcohol and physical inactivity) delivered before and after the start of the COVID-19 pandemic March 2020. Our secondary aim was to understand whether vulnerable groups were differentially affected.