Examples of indicators that went wrong

Indicator	Problem
Patient survey reports of whether patients could get appointments	Insufficient survey numbers and a poorly constructed formula linking survey scores to payment resulted in substantial random variation in payments (introduced in 2008, dropped in 2011)
Using a validated instrument (PHQ9) to assess the severity of depression within 28 days of a new diagnosis, repeating the assessment 2-12 weeks following diagnosis	Poor alignment with professional beliefs prompted substantial criticism about lack of supporting evidence (although other indicators with similar levels of evidence that GPs did believe in were not criticised in the same way). It was also easily “gamed” by GPs using free text description of the patient’s problem rather than coding “depression” in electronic records (introduced in 2006, dropped in 2013)
Practices should develop a register of patients with obesity	Practices could effectively claim payments by including a register with one obese patient. The indicator does not encourage regular weighing to create a more comprehensive obesity register or any strategy for tackling the problems of obesity (introduced in 2006, still current)
Opportunistic screening of elderly and at-risk patients for dementia (technically an “enhanced service” rather than part of QOF)	Little professional support, substantial concern about harms resulting from false positive results, lack of services for specialist diagnosis and management (introduced in 2014, dropped in 2015)