This could suggest that the high level of points attributed to GPs for mental health services successfully rendered encourages patient selection and the deliberate exclusion of more difficult cases from the data. Concerns have also been expressed that GPs are directing attention away from activity not rewarded by the QOF, and as such care delivery quality is declining in some areas (Cashin et al., The recommendation by the Primary Care QOF Indicator Advisory Committee on behalf of NICE was that these indicators be withdrawn, and that a consideration process for new indicators was considered. At present these indicators remained in the QOF framework for 2011/12, although the points value of all of the indicators was reduced.