Failure to follow up abnormal test results is an important patient safety issue and requires urgent attention. In a recent study we analysed quality improvement data from 123 Aboriginal and Torres Strait Islander primary health care centres (6523 patient records) for chronic illness care. There was wide variation between health services in the documented follow-up actions for patients diagnosed with coronary heart disease or type 2 diabetes with an abnormal blood pressure (range 0–100%) and some health services showing no record of delivering follow-up. Improving follow up of abnormal results requires action and strategies that are multifaceted and implemented at health centre, community, patient and policy levels.