The challenge for Primary Care in delivering high quality care in the management of renal disease lie mainly at opposite ends of the patient pathway. Prevention and early detection requires a systematic approach to disease register development, call and recall systems and data collection. End of life care in Primary Care has been enhanced greatly by the adoption of tools such as the Gold Standards Framework and the Liverpool Care Pathway for the dying. Much has been learned by practices in delivering the Quality Outcomes Framework of the new General Medical Services contract and can be built upon in delivering the NSF for Renal Services. The speaker has been involved in the development of a national whole system performance improvement tool for diabetes (DiabetesE) and is currently working on a similar tool for Renal Services.