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Doctors criticise Royal College’s ‘disgraceful’ handling of PA debate

Doctors criticise Royal College’s ‘disgraceful’ handling of PA debate

The Royal College of Physicians has faced ‘outcry’ from its members due to its ‘disgraceful’ handling of a debate on the role of physician associates (PAs).

Two doctors have resigned from their positions on RCP journal advisory boards due to concerns about the college’s ‘trajectory’, and a college officer has ‘stepped down’.

The president of the RCP was also asked by the BMJ to update the ‘competing interests’ statement on an opinion piece published last week in favour of PAs to reflect that the college benefits financially from their introduction through its running of the Faculty of Physician Associates.

At an extraordinary general meeting (EGM) attended by 100 doctors last week, the RCP presented data from a membership survey which had gathered views on the role clarity and supervision of PAs, as well as any impact on doctors’ training. 

The main criticism around the survey is that the college did not present the full data and shared the results by grouping together ‘neutral’ and ‘positive’ responses to the impact of PAs. 

One example was that, of those respondents who had worked with PAs, ‘66% were neutral or positive regarding PAs working as part of the MDT’. 

After pressure from its members, which the college described as ‘huge strength of feeling’, the leadership team published the survey results in full on Monday. 

The full survey results revealed that of the members who felt able to comment, 61% say that having a PA on the team impacts negatively on their own training opportunities. 

For SAS doctors, locally employed doctors, and GPs, of those who felt able to comment, 72% believed PAs ‘limit’ the training of doctor colleagues in their teams. 

RCP fellow Professor Trish Greenhalgh, who is also a GP and academic in primary care at the University of Oxford, said senior officers ‘presented a flawed and distorted version of the findings’. 

In a thread of posts on X, Professor Greenhalgh said: ‘So, what did the survey actually find? NOT, as implied at the meeting, that MRCP’s are “positive” about PAs, and the more contact they have with them, the more positive they are.’

Professor Greenhalgh added: ‘The mismatch between the raw data and the version of the data presented at the EGM is substantial. It raises the possibility (though it does not at this stage prove the case) that there could have been deliberate data fraud by senior officers of the RCP.

‘These survey findings are deeply troubling at a time when the leadership and governance of the Royal College of Physicians of London is being widely questioned. College has said a review of governance is needed.’

She also pointed out that ‘after an outcry’, the senior officer who presented the survey results at the EGM has resigned.

The RCP confirmed to Pulse that deputy registrar Professor Jamie Read ‘stepped down last week with immediate effect’ to pursue a new senior leadership position. 

RCP councillor Professor Partha Kar, who is a diabetes consultant and diabetes co-lead at NHS England, has written a letter to his fellow councillors saying that what had transpired is ‘nothing short of disgraceful’. 

He said: ‘This is an issue of probity, honesty and integrity: all of which should trigger serious introspection from all those involved – not to mention consideration of their positions, for bringing the College into serious disrepute.’

Alongside this, the BMJ opinion piece now includes a statement saying: ‘The RCP hosts the Faculty of Physician Associates and receives membership and examination fees from physician associates.

‘The college therefore risks a financial loss from a limit in the rollout of PAs and is unable to quantify or be more explicit about what the form or extent of any loss might be until the nature of a limit is better understood.’

Since the EGM last week and ensuing outcry, consultant physician Dr Tom Oates confirmed he has resigned from the editorial board of the RCP’s Future Health Journal due to ‘significant concerns about the trajectory of the College’s culture’.

Professor Martin McKee, a professor of public health, also confirmed that he has resigned from the advisory board of the RCP’s Clinical Medicine journal, ‘for the same reason’. 

In contrast to the RCP’s handling of the PA survey results and debate, GP Dr Selvaseelan Selvarajah, who is a council member of the Royal College of GPs, said his college was ‘very open and transparent’. 

Earlier this month, the RCGP held a debate on physician associates and added to its ‘red lines’ following a voting process. Council members asserted that the GMC is the wrong body to take on the role of PA regulation. 

Dr Selvarajah said the college gave members ‘ample time’ to debate and it was an ‘exemplary way of involving everyone’.

He added: ‘The problem with the RCP is it looks like they didn’t share the full data on their membership’s views, and there was a diverse range of views from doctors who are very supportive of PAs to doctors who are more critical of the rollout and want it paused until all the safety issues and regulation are in place. 

‘So it looks like those diverse views weren’t incorporated and that’s what’s probably led to the debacle. It’s not the ideal way of doing it.’ 

When publishing the full survey results, the Royal College of Physicians said it is undertaking a ‘major governance refresh’, but this is not in direct response to recent criticism from members.

A spokesperson told Pulse: ‘This constitutional refresh was underway well before the EGM. Members of RCP Council are reviewing College governance and updating, where appropriate, as part of a wider piece of work to modernise college processes.’

The college’s statement on Monday said: ‘The RCP aspires to be the voice of medicine in the UK and across the world. 

‘Globally, our 40,000 fellows and members are clinical leaders upholding the highest standards of patient care and medical education across 30 specialties. Our primary commitment is to our fellows and members, especially our early career stage colleagues, who must be our priority.’



Please note, only GPs are permitted to add comments to articles

David Church 20 March, 2024 1:26 pm

oh dear. It looks like someone saw a chance to profit from more exam charges, but did not think to consult with their own trainees, nor the other Royal Colleges who’se toes they must have seen they would be stepping on (RCGP is responsible for qualifications for GP clinicians), and did not properly consider who would be regulating the people the RCP would be giving out qualifications to ! And they had planned for a very secure income stream from this venture, without thinking it might be challenged, especially if there was manipulation of statistics going on somewhere. As a result, a lot of reputational damage to this august body’s reputation, as well as stress for PAs and AAs in the fallout.

Decorum Est 20 March, 2024 4:57 pm

A simpler and more realistic explanation, is that many institutions (and their officers) have jumped on the bandwagon of running expensive, compulsory, unevidenced exams/Appraisals, so as to acquire institutional/personal benefits (income, kudos etc).
The benefit to society in general has not even been zilch, it has been negative.

Centreground Centreground 21 March, 2024 11:04 am

RCGP/RCP/ICB Board GPs(formerly CCGs) /LMC GPs/ PCN CDs- these board GP/doctor positions have been and are simply routes for a proportion of GPs (not all and the latter are far outnumbered) to obtain inside information on contracts/financial information /instability of other practices suitable for takeover or for some other self-serving purpose of a visit to the palace etc. and not to serve the wider NHS.
Some obtain information via these routes and then use this information to set up companies based on information obtained via these routes rather than making this more available to the population where relevant /or colleagues in general where appropriate until already in progress these projects for themselves.
It is this self-centred approach which leads to the difficulties the BMA is now facing in bringing the profession together to vote on co-ordinated action (as well as the problems receiving voting links) as these GP types have infiltrated leadership positions for decades and are embedded via closed networks. These relatively small groups often act in groups but carry great influence often harmful for their colleagues as seen in PCNs with countless young GP careers ruined or temporarily on hold.
Do others recognise this phenomenon?
Simply the wrong individuals have positioned themselves or been allowed to do so in leadership roles at cost to their colleagues and the wider NHS for far too long and this internal destructive conflict needs recognition and resolution.