GENERAL COMMENTS

This is a well described and designed qualitative study in a very important area of primary care. I have a few comments and suggestions for clarification:

The issue of computerisation is mentioned in the sampling strategy and never really picked up. Very few practices did not use computerised records, mostly single handed practices: were their experiences very different from the others? Do we know whether this is roughly representative of GPs in Ireland as a whole? Would computerisation be needed to achieve the desirable connections between primary and secondary care?

I would also recommend to unpick the issues behind being GPs describing themselves as 'lucky' as they had good access to services, or a dedicated member of staff. Would this link to the patchy 'postcode lottery' nature of the services, or a recognition that individual dedication of members of staff is very important but can't be guaranteed? When this theme is discussed on p 14, the part played by luck etc. is rooted in the context of the Irish health system, but it is not clear how. I would also guess that it is a culturally appropriate form of discussing scarcity of resources?

Risk of saturation: this is slightly confusing as saturation is an important term in qualitative research and has a different meaning there. I would clarify this in the title eg. risk of general practices becoming 'saturated' , and also expand a bit more on the participants' experiences: which other services are moved into the community, and how was this received?

The 'limitations' paragraph on p 14 discusses using more than one interviewer and coder and makes a good case for doing this. I would however formally label this section as 'limitations' and briefly discuss other possible limitations: it does not include a patient voice (and is there research on the patient experience of diabetes care in Ireland?), and the data you get may be influenced by the characteristics of GPs volunteering to be interviewed. This is normal in qualitative studies but I would look at the demographics of GPs that agreed/ did not agree to be interviewed.

I have found the following errors/ typos and include them here FYI:
Page 4, para 3: the introduction OF integrated diabetes care
Page 4, para 4: health systems such as the England and Denmark: do you mean such as in the UK, or England and Wales?
Page 5, para 1: barriers and facilitatior to optimal management and attitudes TO quality improvement
Page 7, para 3: divided opinions about the most APPROPRIATE form of remuneration
Page 14, para 3: highlighted in 1982 [this needs a reference]