In the linked study (doi:10.1136/bmj.a2030), Ashworth and colleagues report on the relation between the quality and outcomes framework and health inequalities in general practice in the United Kingdom by assessing the effects of social deprivation on levels of blood pressure monitoring and control.1 Tackling health inequalities has been a consistent part of the political rhetoric in the UK for more than a decade, with primary care seen as a key player in improving life expectancy in areas with the worst health record and highest deprivation.2

Perhaps the most substantive government intervention in primary care in recent years has been the renegotiation of the general practitioner contract in 2003, which included—at its heart—a system of financial incentives for delivering quality care. This pay for performance scheme—the quality and outcomes framework—now links achievement on 129 indicators covering clinical domains; organisational domains; and additional services domains, such as contraception and patients’ experience, to the practice’s income. The framework was originally designed …