Aprofound loss of public, and to a lesser extent professional, confidence has cast a dark shadow over medical regulation and the General Medical Council for the past few years. After the Shipman inquiry's fifth report,1 revalidation was suspended pending a review by the chief medical officer, Sir Liam Donaldson. The review, Good Doctors, Safer Patients,2 published last week, will be followed by consultation, but the direction is set. As expected, the review places the protection of patients as paramount, but within an appropriate regulatory framework that is practical, non-punitive, and at the international leading edge.

The intellectual case for two levels of revalidation—relicensure for all doctors to remain on the register and recertification for all on specialist and general practice registers—is compelling. Relicensure will be against national standards and implemented through appraisal, 360 degree feedback, and local processes that include lay input.

However, more than 60 000 doctors in unsupervised practice will also need to gain recertification regularly through …