The Fed has been awarded a contract to manage the demand management process in ELR. We are developing performance monitoring reports by Locality that allow comparison between practices and identify priority areas for action. Locality Meetings will be used on a quarterly basis for an open and informed discussion of these performance reports and areas where practice could be changed to stimulate improved performance and achieve a reduction in the demand placed on secondary care services. By continuing to review a consistent data set on a routine quarterly basis, we will establish a ‘rhythm of accountability’ that will promote ongoing and sustained performance improvement..