The current epidemic in Type 2 diabetes is largely being driven by an ageing population and by obesity 
. The trend for more services to be delivered in primary care is UK government policy and is a cornerstone of modernising the NHS 
. Most people with Type 2 diabetes no longer routinely attend hospital specialist clinics and receive their diabetes care from their primary care practice teams.
There have been a number of studies exploring the provision of primary care for patients with diabetes. These have largely focussed on the structure of care suggesting that whilst the organisational infrastructure for delivering care to patients with diabetes is in place 
, there is still variation in performance and room for improvement in the quality of care 
. Some of the variation in care has been shown to be associated with factors such as practice size and socioeconomic deprivation 
but features such as dedicated clinic provision, staff numbers and training were not associated with compliance of process or outcome of care 
Policy support for diabetes care has been provided by the National Service Framework (NSF) 
, National Institute for Health and Clinical Excellence (NICE) guidelines 
and the implementation of the Quality and Outcomes Framework (QOF; http://www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/the-quality-and-outcomes-framework
accessed 2012 July 9th) which provides incentives for practice performance. Analysis of the QOF data suggests that whilst the care of patients with diabetes has improved, it is difficult to understand how much of this has been due to QOF 
. Glycaemic control may have improved as a consequence of QOF but not in patients with type 2 diabetes and high HbA1c levels, and more stringent QOF thresholds might be needed in order to produce further improvement 
All of these studies rely on either routinely available data or physician report. Several of the key behaviours required in diabetes care are not well recorded in routine clinical sources (such as primary care records) and their most reliable data source may be patients themselves. There are no comprehensive published data on the processes of care delivery for patients with diabetes cared for in primary care.
As one part of a larger study 
we have previously reported the organisational structure and intermediate outcomes of diabetes care across 99 UK primary care practices (74 in England, 13 in Scotland, four in Wales, and eight in Northern Ireland). The study was designed to better understand the quality of care patients with diabetes received through the performance of six key behaviours. These behaviours covered prescribing to control blood pressure and HbA1c (in patients with poor control), three advising behaviours (for weight management, self-management and general education) and one examining behaviour (foot examination). Practice attributes and a range of individually reported clinician measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months and a number of proxy measures of behaviour (including patient report) were collected at 12 months.
Our analysis of this data found that whilst QOF scores were generally high (with mean practice level percentage achievement rates of over 90% for 12 of the 15 clinical indicators), the mean percentage achievement rates for tight blood pressure control and tight HbA1c control were lower (80% and 68% respectively). Forty-nine practices had one or more clinicians trained to diploma level in diabetes care. Seventy-one practices had a dedicated diabetes clinic. Access to specialist support was variable. Most practices could access a diabetes nurse specialist (53 via secondary care, 28 via primary care) but GPs with a specialist interest in diabetes were rare (not available to 79 practices). Only 23 had access to a diabetes centre in secondary care and 44 practices reported having access to a specialist diabetologist. Forty-two practices did not have access to a dietician and 37 did not have access to a podiatrist.
Against this background of infrastructure and performance this paper presents further findings on the provision and receipt of care for patients with diabetes, as reported by healthcare professionals and patients. Specifically, we aimed to investigate the care of patients with Type 2 diabetes from the perspective of patients and health professionals, and to assess the extent to which the care that primary care clinicians report providing is associated with the care that people with Type 2 diabetes report receiving.