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clinical care without having to demonstrate that they are achieving acceptable standards. Several factors are contributing to a dilution of this implicit trust and to increasing demands for explicit evidence about the performance of the medical profession. Some of these factors represent social trends; for example, the de-professionalization of society, demands for greater accountability of public services, and the expectation that information about health care should be as available as information in others areas of modern life. Other factors relate specifically to health care; for example, public concern at high profile examples of failure of self-policing;1 increasing evidence of wide variations in quality, often around a mediocre team;2 the ready availability of data; and advances in our ability to measure quality.3 Public disclosure of comparative performance data has been a prominent and controversial policy in the United States of America (USA) for more than a decade.4,5 Information is now freely available about the performance of health plans, hospitals, and individual doctors. The data are usually published as mean scores on specific quality indicators relating to such disparate areas as patient satisfaction, immunization rates, and post-operative mortality. There has been considerable debate about the content of the data, the process of disclosure, and the associated merits and risk.6,7 Despite the resources expended on public disclosure, there has been remarkably little rigorous evaluation of either the positive or negative impact of the information. Even the most fundamental question concerning the relative merits of making performance data public and using the same information for the purpose of internal audit remains unanswered. The limited evidence that is available suggests that doctors in the USA are distrustful of the information, fail to make use of it, and go out of their way to discredit both the scientific basis of the data and any conclusions that might be drawn from them.8 Neither individual consumers nor purchasers make significant use of the information that is currently available, though there is some evidence that it is starting to have a greater impact on their decisionmaking process.7 Organizational providers, such as hospitals, seem to be most sensitive to the information, and there is some evidence that publishing comparative data about performance can play a significant part in improving clinical outcomes.9 In the United Kingdom (UK), an emphasis on professional accountability for maintaining and improving quality and public reporting of the results is a central feature of the present government’s health policy.10,11 The political spotlight has, for a long time, been focused on secondary care owing to its associated high costs, public profile, and the ready availability of quality indicators designed to measure hospital practice. General practitioners (GPs) would, however, be naïve to think they will escape attention. Indeed, the primary care orientation of health policy in the UK will inevitably shift the political focus from the GP’s role as a purchaser of specialist care to his or her role as a provider of generalist care. An explicit assessment of the quality of care requires the creation of valid and reliable quality indicators.12 This is inevitably a partial activity that will not reflect the complex and integrated nature of generalist practice and may promote a more biomedical orientation to quality assessment than many GPs would wish to see. Most of the primary care indicators in use by health authorities in the UK at present have uncertain scientific properties and have been chosen principally because of the ready availability of routine data. However, the validity and utility of established and new indicators are being tested at the National Primary Care Research and Development Centre,13 and this work is influenced in part by research being carried out in other countries, such as the USA.14 As GPs struggle to establish the systems to support clinical governance in primary care groups, they may be forgiven for wanting to ignore public disclosure. However, the public reporting of performance is likely to become a central component of clinical governance and, assuming that it is introduced properly and funded adequately, holds several potential benefits for the primary health care team and their patients. Public reporting of valid and reliable quality indicators will help to focus attention on specific problem areas and will encourage debate on variations between practices and over time. Using audit data for internal purposes has also helped to achieve this purpose, but the impact of clinical audit has been disappointing given the level of investment.15 There is some evidence that making performance information public heightens the sensitivity of health professionals to the results and increases the chances of action being taken.6 In addition, public disclosure of performance data can help patients to make informed choices or have informed debates with their GP, and a greater degree of openness might have a positive effect on the relationship between doctors and their patients. Making performance information public may also help to highlight serious deficiencies in quality or resource problems resulting in poor quality of care. There are also some significant risks associated with public disclosure. It would be a mistake to underestimate the culture change required by GPs as they move from a predominantly reactive and data-deficient style of practice to one characterized by explicit accountability based on their own and their colleagues’ measured performance. If this change is perceived as a threat to professional autonomy, it may result in a loss of morale at yet another time of great change in British general practice. Public recognition of deficiencies in the quality of care may result in patients losing trust in their GP, with incalculable consequences for other aspects of the doctor-patient relationship. Misleading information may damage a GP’s reputation, and the detailed technical data contained in public reports of performance are easily misinterpreted by the general public, the media, health managers, and health professionals themselves. Additional unintended consequences of public disclosure have been described, including deliberate manipulation or ‘massaging’ of the data and an inappropriate focus on what is being measured, to the detriment of other areas of activity.16 A greater degree of openness and increased accountability for the quality of care provided in general practice is inevitable, as it is in all areas of health care. It is in the interests of GPs and their patients to ensure that this happens in a rational and sensitive way to maximize the potential gains and reduce the associated risks. To accomplish this, GPs need to contribute to the debate from the start and work with their primary care groups, academics, health services managers, and patient representatives. Failure to do so will result in the quality of general practice being judged by those with little understanding of its nature or purpose.