As a GP, it seems to me that I have been waiting for a significant chunk of my active medical career for revalidation to finally happen, and I am not that fresh off the starting blocks.

However, it seems it is finally upon us - well, at least the Department of Health report Medical Revalidation Principles and Next Steps, published in July, suggests piloting should start in January 2009, with implementation following in April 2009.

That said, the report cautions that the timetable is "indicative and will require further refinement". So perhaps best not to hold our breath just yet?

I am, however, content with this and happy to wait. After all, the debacle of Modernising Medical Careers and the Medical Training Application Service has shown us that such tasks are complex and need careful planning. Success can easily elude even those with the best intentions.


But as a medical director at a primary care trust, I am also content because I am not sure the systems, structures, insight and commitment needed to support revalidation are in place in the majority of PCTs. There are a number of worrying signs - for example, I do not have to cast my mind back that far to recall that a number of PCTs quickly tried to withdraw funding from GP appraisal once it was no longer a monitored key target.

Similarly, while I work for an enlightened PCT that supports appraisal and has a medical director, many PCTs do not have an MD or anything that approaches it. How can it be that medical directors are an absolute "must-have" in secondary care and yet can be considered a luxury in the primary care environment? The fact that PCTs may not directly employ doctors should be irrelevant to organisations that have performers list powers and an obligation to assure patients of the safety and quality of the independent practitioners they commission.

A recent National Audit Office report noted that implementation of clinical governance structures in the NHS was weakest in primary care, surely demonstrating that the need for medical directors is greatest in PCTs.

Crucial role

PCTs seem to be blind to the need to have medical directors in the primary care environment. I have heard this same blindness echoed in the words of professional executive committee chairs, who say there are no GP quality issues in their PCT (!), and in PCTs' adverts for directors of public health - who are expected, apparently as an afterthought, to fill the role of medical director as well. I have nothing against directors of public health as such, it's just that they have a full-time job already. Being a medical director is also a full-time job with very different skill and knowledge requirements.

Unfortunately, this blindness goes higher than just PCTs. Even the DH document Trust, Assurance and Safety makes the rather mealy-mouthed assertion that PCTs must have "responsible officers". It says these officers should be medically qualified but seems nervous of calling them medical directors. It is hard to understand why the document is so shy of coming out more firmly on the side of quality, when it also highlights the need for these officers to have an appropriate set of competencies and support structures. I am left worrying that the unacceptable compromise of having a joint public health/medical director will be allowed to continue.

All is not lost, though. There are signs of change and a rising awareness of what is really needed. I see increasing numbers of adverts for true medical directors for PCTs, and those of us in harness are shouting loudly to ensure the trend continues. To assure quality and safety in our GP services and a strong and vibrant system for revalidation, this developing medical specialism must be given appropriate support, career development and a future role in PCTs.