On 21 February 2007, the government published its white paper Trust, assurance and safety–the regulation of health professionals in the 21st century,1 which sets a framework to assure the safety of patients and quality of care. The paper considers the English chief medical officer Sir Liam Donaldson's review of medical regulation, Good Doctors, Safer Patients2; the Department of Health's report, Regulation of the Non-medical Healthcare Professions3; and subsequent consultations with professionals and lay people.

The main areas covered by the white paper are how to assure the safety of patients in situations where a doctor's performance or conduct pose a risk, the introduction of an effective system of revalidation, and modifications to the role and function of the General Medical Council (GMC).

Patient safety is central to the proposals. At local level the value of attempts to ensure quality in the current National Health Service is recognised. In the current system poor medical performance is dealt with separately by the employer (NHS) and the regulator (GMC). This …