Successful UK initiative highlights inequity of investments between sectors

The rapidly rising prevalence of diabetes in the United Kingdom demands an effective response from healthcare services.1 British general practitioners were among the first doctors in primary care worldwide to manage many aspects of diabetes care in their own practices,2 and by the millennium were providing systematic diabetes care.3 Primary care based interventions are cost effective—countries with strong primary healthcare systems have lower healthcare costs and healthier populations.4 The 2003 general medical services contract signalled the government's determination to invest in evidence based interventions in primary care and to encourage further expansion of chronic disease management, including diabetes care, into general practice.5 The contract introduced a quality and outcomes framework, designed to monitor the quality of the delivery of primary care.

In this week's BMJ Campbell and colleagues report that general practitioners were already improving effective care for three of the diseases covered by the framework.6 One of these was …