Since April 2004, the performance of general practitioners has been measured and remunerated against a limited, although increasing, number of easily measurable clinical activities. This initiative is unique worldwide and is attracting considerable international interest. It therefore behoves us to think critically about what we are doing.

General practitioners have responded by systematically recording the listed activities, apparently performing well above expectation, and the whole exercise has been hailed as a success for quality of care. Despite evidence that these sorts of incentives improve the quality of documentation while having a much more limited effect on underlying standards of care,1 there have undoubtedly been useful achievements. Of these, probably the most substantial are improvements in diabetic control and innovations in computer prompting systems. However, the system is in danger of missing the point of both quality and general practice.