To flourish, practice accreditation must meet challenges. It needs to manage uncertainty over its effectiveness and cost effectiveness, to address concerns that it erodes professional autonomy, and to promote and elucidate the conditions under which it is appropriate. Lessons from Australia and New Zealand help to focus these challenges. The lessons include the need to reward quality practices, loosen professional control over accreditation, trade some consistency of standards for validity, develop standards that acknowledge cultural diversity, and be transparent. Another lesson is to separate quality control from quality improvement within a coordinated systems based framework, with practices being helped to pay for accreditation and quality improvement. Such assistance is important because, in the presence of unintended variations in practice service delivery, all practices should have to show that they meet or exceed minimum standards while aiming for excellence.