Textbox 1 Care group approach and diabetes protocol

The care group approach supports stakeholders at several levels. People with type 2 diabetes are offered a protocol comprising 3-monthly consultations at the practice location by the GP or nurse practitioner. During these consultations, the GP or nurse practitioner monitors diabetes-related health indicators and provides lifestyle coaching [9]. Generally, one annual consultation, specifically focused on monitoring of biomedical health indicators, is delivered by the GP. The additional three consultations, which are typically delivered by nurse practitioners, are primarily dedicated to lifestyle counselling and self-management support. Participation is free of charge for individuals and all consultations are reimbursed by health insurance companies.

For practices, care group support includes i) the availability of a team of specialised nurses who provide coaching with regard to the implementation of protocols, ii) task delegation from GPs to nurse practitioners, iii) an electronic system providing up-to-date monitoring information on the diabetes population; and iv) professional education.

In addition, care groups negotiate with health insurance companies on behalf of participating practices regarding the content of the structured care protocols, annual quality targets and reimbursements. Although quality targets and reimbursements vary depending on local agreements between care groups and insurance companies, annual quality registrations of all care groups are monitored on a national level. More specifically, all care groups are asked to provide data on the number of people with at least one registration of a predefined set of diabetes health indicators including HbA1c, systolic blood pressure, LDL and lifestyle-related variables. More details on care group support, roles and responsibilities in the practice team are presented in Additional file 1, Table 1.