The Health and Social Care Bill for England has now reached the House of Lords. With the proposed demise of deaneries, questions still remain about how medical training will be carried out in the future. Niall Dickson, chief executive of the General Medical Council, explains how the council hopes to maintain professional standards whatever the outcome, and what changes to postgraduate education are on the horizon. Also this week, James Chalmers takes us through the steps in treating a non-responding presumed lower respiratory tract infection.