Ethnic Disparities in Blood Pressure Management in Patients With Hypertension After the Introduction of Pay for Performance

I want to congratulate the authors and participating general practices of this study. You used the databases of a cluster of 16 UK general practices to examine ethnic disparities.

I found it refreshing in two respects. Firstly you used amalgamated data to examine social issues. The social dimension is increasingly forgotten in the study of my discipline - general practice. Yet it is half of my work, since we GPs act at the interface between the science of diseases and the science of human relations. Please do more.

Secondly I was struck by the research and development potential of your approach, since all 16 practices in the same geographic area took part in the study. From a research perspective, collaborations of this kind help to overcome the bias introduced when researching within isolated practices - each practice has its own micro-culture and patients choose to attend a particular practice for many different reasons. From a development perspective this participation provides an opportunity to facilitate change. Action learning groups, including practitioners and managers from the participating practices and other experts including patients, could ask what the data means to them. From this they could pilot changes and at a later stage measure what happens. This activity could reveal important new research questions about ethnic disparities. In the UK, clustering of practices is becoming increasingly common, through new organisations such as polyclinics, practice based commissioning and academic health science centres. I hope this study will encourage widespread leadership of this kind of research and development in the future.

Competing interests:   None declared