What do you consider to be the key issues for quality improvements in the NHS quality-improvement program as it goes forward? What do you consider to be the strengths and weaknesses of the effort to improve the development of QOF indicators over the next couple of years? The program appears to be using QALY metrics to justify the choices of future quality and outcome indicators. What are the strengths and weaknesses of such an approach to valuing quality? Some researchers have expressed doubts about the improvement effectiveness of indicators in the high 90% range. What is your evaluation of this concern and what alternatives do recommend? Most U.S. P4P efforts do not allow for exclusion of significant number patients. What the pro and cons of this approach and the one used by NHS? NHS is a single payer system. How does this affect its design of the QOF system and its efforts to implement it? How do the much more complex U.S. payment systems affect its utilization of the P4P systems? The NHS QOF effort is obviously full of very specific point systems for evaluation. What are the strengths and weaknesses of such quantification of decision rules in a healthcare environment?