GPs in the uk have 2 options in dealing with the massive numbers of patients that come to see us having had someone check their blood pressure and find a mildly raised reading.

Option 1. We can diligently check the BP many times, discuss lifestyle changes in detail, and arrange regular follow up, at which we will have to go through the whole discussion again about treating or not treating with drugs. When one of these patients has a stroke we will be blamed.

Option 2. We can start the patient on drugs, and treat the BP according to a protocol, probably delegating the job to a nurse. If the patient has a stroke, we are not blamed. If the patient gets side effects that is the drug's fault not ours. We will also be paid more because our "Prevalence" of hypertension will be high, and it will be easy to hit our QOF targets for bp control.

Just in case we might be tempted to stick to our principles and ignore the QOF bribe, there is another consideration. If we fail to hit our QOF targets, not only will we lose money but our NHS choices score will go down. The CQC and our patients will regard us as a bit suspect and wonder what else we are bad at.

Until the QOF starts to pay attention to Cochrane reviews and other relevant evidence it will be very difficult for GPs to change the practice of overtreating mild hypertension.

Competing interests: I am a GP whose income is dependent on the QOF