Aims. To compare different packages of care across care providers in Scotland on foot-related outcomes. Methods. A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Proportional hazards were used for time-to-event univariate and multivariate analyses, adjusting for case-mix characteristics and care processes. Results were expressed in terms of hazard ratios with 95% confidence intervals. Results. 2,243 (32.7%) subjects had a major amputation or death. Exposure to all nine care processes at all ages (
HR
=
0.63
; 95% CI: 0.58-0.69;
p
<
.001
) and higher foot care attendance in people aged >70 years (
HR
=
0.88
; 0.78-0.99;
p
=
.03
) were associated with longer major amputation-free survival.
Waiting
time
≥
12
weeks between ulceration and clinic attendance was associated with worse outcomes (
HR
=
1.59
; 1.37-1.84;
p
<
.001
). In
people
>
70
years, minor amputations were associated with improved major amputation-free survival (
HR
=
0.69
; 0.52-0.92;
p
=
.01
). Conclusions. Strict adherence to a standardised package of general diabetes care before foot ulceration, timely foot care after ulceration, and specific treatment pathways were associated with longer major amputation-free survival among a large cohort of people with type 2 diabetes in Scotland, with a larger impact on older age groups.