This report sets out findings from a four-year evaluation of the Health Foundation's Engaging with Quality in Primary Care programme (EwQPC). Nine teams from across the country were funded to design, implement and evaluate quality improvement projects. These projects would engage primary care clinicians in making measurable and sustainable improvements in the quality of clinical care. There was considerable variation across the projects in terms of the clinical fields covered, and the number of practices and professional groups involved. The extent of change sought also varied, from relatively small, incremental changes to existing systems, to more radical restructuring of organisations and systems.