Typically, a GP will refer a patient to a secondary mental health service if they consider the patient’s problems to be too complex, or too serious, to be handled by themselves and counselling services alone. The QOF for GPs is being used by NICE and the NHS to define other primary care objectives for mental health and to try to influence and shape the outcomes and quality of care through this pay for performance scheme. Of the QOF indicators used by GPs in 2013/14, 10 were in the mental health domain.