Physicians must now openly demonstrate their competence and ability to perform their role as consultants. Measures have been developed which allow early identification of problems and provide procedures to examine in detail where and when problems arise. A number of organisations will be involved and efforts must be made to co-ordinate the various initiatives. One note of caution, however. Assuming that regular peer review is accepted, that CHI carry out a four-year cycle of visits to every trust in the land, that all visitors in such procedures have to be trained to do the job, that the visitors must be engaged in active clinical practice, that at home appraisal audit and assessment are in progress, the question inevitably arises as to where all the personnel will come from and what happens to clinical work in our under-doctored country? Change certainly stimulates excitement about the future.