With Sir Kenneth Calman off to pastures new in October, as vice-chancellor of Durham University, the smart money is on Liam Donaldson to succeed him as chief medical officer for England.
Professor Donaldson, regional director and public health director at the NHS Executive Northern and Yorkshire regional office, is tipped by most public health experts to take the job in what many see as the last move of his career.
But not all believe he would be the ideal candidate. Strongly in his favour as front runner is the fact that he is 'well in' with health secretary Frank Dobson and health minister Alan Milburn, whose constituency is in the region.
He is believed to be the architect of clinical governance and has just had four health action zones created in his region. He has clinical and managerial experience, an academic background and 'a track record at the highest level'.
But many feel he has groomed himself too well for the job and are cynical about his decision to retain the director of public health role as well as being regional director. 'This is most unusual, ' says one observer.
'I have no qualms about his credibility and qualifications but I do have concerns about his fronting role, ' adds one source. 'The job demands a good communicator. He comes across as rather remote.'
Widely tipped as the second favourite is Sheila Adam, deputy director of the health services directorate at the NHS Executive and a former regional public health director.
She has many impressive qualities 'which she has displayed in every place in her career', says one observer. 'She has managed to combine an obvious commitment to public health with the ability to work deeply within the system.
'She has social and political skills, and would have the most chance of making the DoH and Executive more of a public health outfit than it has ever been.'
Dr Adam would combine the authority and commitment last seen in the CMO many believe had most impact, Sir George Godber, says another.
'Sheila Adam would fit the profile well. Appointing a woman to the post would be very New Labourish and she is on-side with the agendas. She also has a broader, more holistic perspective.'
Dr Adam also works 'extraordinarily well' with NHS chief executive Alan Langlands. 'She thinks laterally, beyond clinical boundaries, has experience of working across lots of agencies and good politics.'
Though these are not the only names whispered on the grapevine, others are thought to face longer odds should they decide to put their names forward (see box).
Candidates for such a job tend to provoke strong opinions. Though happy to offer them, not one of the many public health experts contacted by the Journal was willing to be quoted by name.
But how important is the job anyway?
'It ought to be increasing in importance because of the government's agenda, ' says one expert. 'One of the puzzles is why Ken Calman wants to leave at this time.'
Others agree. 'It should be a very important job but it is very difficult to do because of the political dimension.
You are almost damned if you do, and damned if you don't, whatever you do, ' says another expert.
One public health professional cites the difficulty Sir Kenneth is likely to have experienced over the BSE crisis.
'Sir Kenneth Calman is very interested in risk and has written extensively on it, ' he says. 'He feels the public should be educated about the levels of risk so that they can take objective action.
'I bet he would have been hopping mad with the government's decision to ban beef on the bone, where the risk to the public health is miniscule. But that is a political decision and the CMO has got to stand up and say how sensible it is.
'You need someone in the job who is very politically sophisticated and who knows their way around the system, someone who can stand up to the system and ensure that professional advice is taken.'
There is consensus that the CMO's role needs to be broader, working across government and ensuring the public health aspect of every department's work is high on the agenda.
At the moment the role is 'hanging around at the margins', having been 'pushed out considerably', some feel.
The general view is that Sir Kenneth neither jumped nor was pushed.
'He was looking for another job because he would have to leave the CMO post in three years' time, when he is 60, and he wants to go on working longer than that. The Durham job came up at the right time.'
The job could still be offered to an outsider - there is a history of academics and researchers being appointed as CMO.
But, whatever the outcome, most would like ministers to be 'a bit braver and a bit more radical' in their appointment. 'It needs someone who can build up the reputation of the post - and someone who can stir things up.'
Longer odds - other possible candidates
Graham Winyard, director of the health services directorate at the NHS Executive; has not had the profile many would wish.
Diana Walford, former assistant principal medical officer at the DoH and now director of the Public Health Laboratory Service; seen as 'too narrow in her experience' and a conservative choice.
John Ashton, North West regional director of public health; well respected but, says one observer, a 'slightly eccentric' choice.
Jeremy Metters, deputy chief medical officer at the DoH; seen as probably too old.
Michael Adler, AIDS expert and medical academic; thought to be a long shot; married to health minister Baroness Jay.
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