Abstract
The United Kingdom's pay-for-performance system, the Quality and Outcomes Framework, continues to evolve. Since its inception in 2004, the Quality and Outcomes Framework has provided a strong focus on evidence-based performance targets that remains a dominant theme. Strengthening of the evidence base has resulted in the appearance of several new clinical indicators. Increasingly, change has been driven by explicit public health goals with targets incentivized according to their potential for mortality reduction. In 2011, a new policy direction became apparent. New indicators accounting for almost 10% of the Quality and Outcomes Framework will be determined by achievement of targets reflecting the efficient use of health service resources.