General Practice is almost an example of how this could work. When the QOF was first introduced employees were in my own and many other practices given a share of the profits which did reward them for the extra effort they had to put in to make the Qof work. General practice is also given a fixed budget which it can use often innovative ways to provide proscribed services. Because the organisation is small it is easy to "tweak" things and implement changes quickly if something is not working well or proving too costly.The partners, who can include other employees apart from the GPs, are paid from the remains of the Budget, after the costs of providing the service are deducted. The partners therefore have an absolute incentive to run the organisation as efficiently as possible.