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Revalidation can’t all be piled on the individuals and the registration bodies are not the right ones to lead it. For the bulk of doctors (and nurses, and therapists – all clinical roles) a big part of the answer is that their employers should do this and be held to account for doing it well through a licensing system on institutions and all other organisations which deliver healthcare. For clinical contractors, meaning the bulk of GPs – who are self employed don’t forget – there is no substitute for a peer review process. The people who know best about good and poor medical performance are the local GPs in the CCG. I believe that they should deal with assessment, remediation and rooting out failure as part of the CCG’s own reputation management and clinical governance processes. And they should be held to account by the Commissioning Board for doing this well. No matter where it happens, the process has to have a strong and meaningful patient (customer) input. That’s the challenge we need to put to the new revalidation system. Let’s hope the evidence shows that it can deliver what we all hope for it.