Area-wide diabetes care: the Manchester experience with primary health care teams 1991-1997.

Diabetes 2000 has evolved over 6 years from a practice-based audit to a cross-sector, multidisciplinary, multi-agency project. Its prime aim is to improve the care of people with diabetes in Manchester. There are 93 out of 111 practices and all four Trusts now involved. The prevalence of diabetes known to the project is 1.46% (among 418,000 people). Eighteen practices have never participated at any level. There are 6088 people on the now outdated DOS database, another 2000-5000 people are thought to be missing. The audit has shown limited improvements in care over the years. Despite only modest quantitative success there is now in place a mechanism for implementing Department of Health recommendations for a good diabetes service, namely, a city-wide register, management and referral guidelines across primary and secondary care, the start of an integrated care programme and, above all, goodwill on behalf of all participating providers.