The National Service Framework for Coronary Heart Disease (CHD) stated that individuals at greatest risk of CHD should be identified. This category included those with diagnosed peripheral vascular disease. Despite this, the condition was not included in the Quality and Outcomes Framework of the new General Medical Services contract. This article looks at the strong evidence to include peripheral arterial disease in the next update of the GMS contract, which is expected in April 2006. It also looks at what is being done to identify such patients, and their relative risk compared to other subpopulations at risk of atherothrombosis. The setting up of an international register – the REACH registry is also discussed.