The storm that blew the Royal College of Physicians off course

A storm blew through the Royal College of Physicians of London (RCP) this year. A disastrous extraordinary general meeting, only the third in the college’s 500 year history, led to the resignations of the president, deputy registrar, and chair of the board of trustees. The college was ripped asunder. At the heart of the crisis was money and the college’s position on physician associates (doi:10.1136/bmj.q2729).1

A King’s Fund review commissioned by the college identified a “lack of trust and confidence” in governance (doi:10.1136/bmj.q1983).2 The college will cease to host the Faculty of Physician Associates, from which it benefits financially, at the end of this year. But its support of NHS, General Medical Council (GMC), and government plans on physician associates placed it in direct opposition to its members and fellows. This was a sobering reminder to membership organisations that steer their hubristic agendas away from the position of their members.

This year’s extraordinary general meeting was an exquisite shambles. Reluctantly forced into holding the meeting, the RCP attempted to stonewall and bluff its way through the protests. Doctors, when roused for good or for ill, should never be taken for fools. The RCP, faced by adversaries who were both literate and numerate, obfuscated like a government minister on a bad news day and selectively reported its own survey (doi:10.1136/bmj.q769).3 The college mistook the storm for a breeze—and a particularly light one at that. The conduct of the meeting was a historic mistake.

Partha Kar, BMJ columnist and RCP council member, believes that the physician associate issue merely “exposed a lot of underlying issues” about the workings of the college. Louella Vaughan, another council member, believes that the crisis is one of identity. What is the college for—a membership organisation about doctoring or a “modern charity” delivering public benefit? These issues should play out in the coming weeks as the college elects a new president. The same question, about purpose, challenges every medical organisation.

But the distinction between better doctoring and delivering public benefit isn’t so clear cut. If the college throws itself behind The BMJ’s new commission on the future of academic medicine (doi:10.1136/bmj.q2508),4 recognises and helps to tackle medical misogyny (doi:10.1136/bmj.q2780),5 promotes treatment of heart failure that allows for frailty (doi:10.1136/bmj-2023-078188),6 embraces advances in management of psoriatic arthritis (doi:10.1136/bmj-2024-081860),7 and debates the future of cancer vaccines (doi:10.1136/bmj.q2294)8 or the urgent response to widening inequities in uptake of childhood vaccines (doi:10.1136/bmj-2024-079550),9 it will be encouraging better doctoring for public benefit. The point, therefore, may be that better doctoring delivers public benefit but that neglecting better doctoring to focus on public benefit risks failing on both.

The government has recognised the turmoil and toxicity surrounding physician associates by commissioning a review (doi:10.1136/bmj.q2585).10 In the interim, the GMC’s consultation on regulation of physician associates has resulted in only minor changes that won’t assuage its critics, given that the changes fail to reflect the degree of dissent found in its consultation (doi:10.1136/bmj.q2757).11 Iqbal Singh argues that the GMC is at least making some progress on equality, diversity, and inclusion, after his independent review with Martin Forde (doi:10.1136/bmj.q2694).1213 But this will count for nothing in the face of the storm that’s likely to engulf the GMC over physician associates. The RCP didn’t listen, took its power for granted, and was hit hard. The GMC is sailing in the same choppy waters.