The questions most frequently asked about quality assurance are whether well-established practices already form adequate safeguards of quality of medical care or whether moreformal mechanisms are necessary and if so what form they should take. The Nuffield Provincial Hospitals Trust published in 1976 A Question of Quality ? Roads to Assurance in Medical Care.' I was invited by the trustees to follow up this series of essays by ascertaining in an informal and personal way the extent and range of current activities. It was agreed that my initial approach should be to the presidents of the royal colleges and certain other national bodies and through them to individuals known to be interested. It is the factual part of this inquiry and my own thoughts on the subject that I can include in this review.