The prevalence of chronic disease is rising and many health systems are now seeking to improve the way they respond to the needs of patients with chronic illnesses. The King's Fund and the Commonwealth Fund of New York sponsored a seminar bringing together leading policy-makers, clinicians and academics from England and the USA to share experiences. The seminar looked at the policy context in each country for chronic disease management, identified facilitators and barriers to success and explored methods for evaluating chronic disease management programmes. This report from the seminar includes six case studies of chronic disease improvement programmes. [Introduction]