Many quality indicators I like much in this proposal. Firstly, it specifies a large number of specific quality indicators in multiple domains of care and links these to a method of implementation that is likely to achieve real change in performance. Since a sizeable financial incentive is involved there is every reason to expect that general practitioners will change their behaviour in order to try to meet these targets, just as they improved their delivery of cervical smears and childhood immunisations in response to financial incentives. The broad number of quality indicators is also a strength. Much concern exists in the United States that initiatives to improve quality containing only a few indicators promote a situation in which providers concentrate on only those indicators to the exclusion of other aspects of care. The large number of indicators in multiple domains of care in the new proposal will help minimise, but not eliminate, this likelihood. From my American perspective, another admirable attribute of this proposal is that it was developed by the government that pays for the care working together with the providers to reach agreement on the important aspects of care to perform and be paid for. This is in contradistinction to the approach in the United States, where the providers of care are usually left out of the equation.