QOF is the system of hoops, carrots and sticks by which we get paid nowadays.
We only know about the "smoking status" of 70% of our patients. if we knew another 200 patients' smoking status we would qualify for another £290 (shared between 7 don't forget) this year. (Never call us penny pinching - we're trying to get one diabetic's blood sugar controlled for - wait for it - £3. 3 measly quid. Every penny counts don't you know). Someone suggested getting a receptionist to call all our patients to find out if they smoked. But...
if we can tell another 31 of our known smokers to stop we qualify for another £3000 this year. Receptionists are not allowed to tell people to stop smoking - that has to be done by a healthcare professional (such as the receptionist we have just trained as a healthcare assistant). Therefore if they phone around and discover another couple of hundred smokers we'll need to tell over 110 of them to stop smoking in order to qualify for the £3000.
In other words it's far better not to know. Ignorance is not only bliss; it's £2710.