Secondly, targets that are applied nationwide, without attention to the individual needs of different communities, risk disadvantaging practices that serve areas of deprivation, for example, where targets often take superhuman efforts to achieve and divert attention from more important problems.A suggestion is that some of the QOF structure should be replaced by a system in which individual practices negotiate development plans with health boards that are specific to the needs of the area that they serve, and progress is charted in regular follow...