The aim of this article is to illuminate participants' access, utilization and perceptions of primary health care (PHC) services in two cities in England, including factors that militate against or enhance utilization of PHC services for African Caribbean people residing in England. Hypertension remains a major health issue amongst immigrant and UK born African Caribbean people. Current policy agendas are concerned with a reduction in cardiovascular disease and with addressing social exclusion, ameliorating health inequalities, and ensuring that individuals from black and minority ethnic groups receive fair and equitable access, care and treatment. The research conducted in two English cities investigates the meaning and consequences of hypertension and perceptions of PHC services. The research explored the decision making processes that lead to the presentation of individuals in PHC in England for early diagnosis and treatment. This qualitative study draws heavily on the focused ethnography methodological approach. Multiple methods were employed including two focus groups interviews, 21 semi-structured interviews and five vignette-based interviews. Participants numbered 36 in total. Data were analysed with the aid of Atlas/ti. using established principles for analysing ethnographic data. The findings map out the factors influencing early presentation for diagnosis in PHC and perspectives are gained on the quality of the participant/general practitioner (GP) relationship, as perceived by the participants. Participants' satisfaction and dissatisfaction with PHC services are also evidenced. It is relatively common in English communities of African Caribbean origin to use private PHC services. Motivations for this are evidenced, including historical antecedents. Participants used non-concordance (ie, non-compliance with prescribed medications) and traditional Caribbean herbal remedies as strategies of empowerment.