Views & Reviews From the Frontline

Hold the carrots

BMJ 2008; 337 doi: (Published 11 November 2008) Cite this as: BMJ 2008;337:a2511
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    In less politically correct days behavioural therapy was called “sticks and carrots.” Now carrots are called “incentives.” Financial incentives, such as the quality and outcomes framework (QOF) system of payments, are widely used in medicine to deliver change. But even well intentioned financial incentives have many unintended and far reaching effects that can distort health care. The traditional strength of the NHS has been the absence of incentives: staff do not expect kickbacks, and the only gift is genuine, impartial advice.

    Now general practitioners are being …

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