No doubt many of the more senior members of ENTUK will be giving careful consideration to their pensions with the media reporting an anticipated retirement surge amongst senior doctors. Discussions on commissioning and provider services continues and it seems that, for now, few people actually now what the future NHS will be like. One thing is for sure, appraisal and revalidation is here to stay. There are further uncertainties amongst many consultants who are finding that they have to justify why they should have adequate SPA time in their job plans. Therefore I hope that you find the CPD aspect of this journal useful with regards to these important issues and for the trainees I hope that the MCQs help with their revision for what will hopefully be the final exam in their long careers.