In the past decade there has been sustained international interest in measuring quality of care. In the United Kingdom, quality indicators with financial incentives to reward good care were introduced as a result of increasing awareness of variable quality in primary care, the technical feasibility of introducing evidence based indicators within information technology systems, and a resolve by political negotiators to use improved quality to secure additional investment in primary care.1 Similar but less comprehensive initiatives have been introduced in the United States, Europe, Australia, and New Zealand. However, as this series has shown, the use of quality measures has also created controversy. Our view is that using incentives to improve quality of care has been beneficial. We look at what needs to be done to ensure those benefits remain in the future.