In 2008, people with diabetes living in Greenwich had some of the poorest outcomes in the country as measured through Quality Outcomes Framework (QOF) achievement rates. Only 53.7% of patients with diabetes had an HbA 1c <7.5% (DM20), which was in the bottom 1% of PCTs. 76.7% of patients with diabetes had a cholesterol level of <5 mmol/L (DM17), which was also in the bottom 1% of PCTs. 76.9% of patients with diabetes had a blood pressure of <145/85 mmHg (DM12), which was in the bottom 14% of PCTs. As a result, a new initiative was launched to develop a more systematic approach to secondary prevention in primary care. As part of this initiative NHS Greenwich joined a partnership with MSD (UK subsidiary of Merck) to deliver improvements using the established EVIDENCE into PRACTICETM programme, which provided assisted, structured cardio-metabolic risk management and supported sharing of best practice and continuing professional development. This programme ‘aims to ensure that people with diabetes and those at increased cardio-metabolic risk receive optimal care through the effective implementation of national policy and guidelines, particularly NICE Type 2 Diabetes Guidelines’ (NICE 2009, see contacts and resources).The programme was designed to improve health outcomes of people with diabetes through the implementation of national and/or local guidelines. An additional aim is to ensure that the practices are self sustaining in the future.