Will the next president of the Royal College of Physicians bring the change its members want?

Since last year the Royal College of Physicians (RCP) of London has been under pressure to make appreciable changes to its operations.

An emergency general meeting in March 2024 was followed by a shaming external review last September, which identified a range of collective failures in leadership. The college told its members it had learnt lessons and promised to make a fresh start.1

That fresh start will be given a face next month, when a new president will begin their four year term. The president leads the senior officers of the college and is chair of its council and a member of the board of trustees. The eight candidates for the role (see box) were announced in February.

Over the next few weeks the college will publish full personal statements and video pitches. Fellows of the college (who are nominated for fellowship by existing fellows) will be able to cast their votes from 17 March, with polls closing on 14 April. The new president will take up the post as soon as possible after that date.

Between them, the candidates offer a mix of specialties and experience. Of eight candidates, there is just one woman.

The winner is sure to be key in helping to transform the leadership and reputation of the college. The BMJ has spoken to several members and fellows about the qualities they would like to see in the chosen candidate.

RCP fellow David Oliver, who successfully stood for president three years ago but was unable to take up the role, says members want to see visible professional leadership—someone who will speak up for all doctors, especially on the matters that the majority of members think are the most important.

“Younger doctors are unhappy about their career prospects and they want solutions,” he says. “A lot of people are looking for someone who is prepared to challenge orthodoxy and the establishment, and less likely to just go along with things for the sake of being ‘in the big tent.’

“People feel that the royal colleges have been colluding with the government’s agenda or, at best, have been asleep at the wheel. They haven’t challenged the lack of training opportunities and the rollout of physician associates (PAs)—things that younger doctors see as big existential threats.

“Anyone who’s on their side should also be interested in those matters and the college should be far more vocal about them.”

Phil Smith, an honorary consultant gastroenterologist in Liverpool who sat on the college’s trainee committee from 2012 to 2016, agrees. “We need someone we can trust, who is going to represent the membership, who has got integrity, and who will speak truth to power as opposed to being so frightened about losing their place at the table that they achieve nothing.

“​​Some former presidents have been so worried about keeping their place at the table—keeping the health secretary happy—that they completely lost sight of the fact that they had no influence at the table. They enabled the current mess that the RCP is in.”

That mess relates primarily to the college’s handling of members’ concerns about PAs—specifically their regulation, scope of practice, and expansion across the health service.

On 13 March 2024 the college held an extraordinary general meeting (EGM) to discuss the matter.2 Members and fellows later expressed concern that, at the meeting, the college had presented data from a members’ survey about PAs in a biased way.3

Matt Kneale, former chair of Doctors’ Association UK and emergency care doctor, who led the support for the EGM, says, “As a future specialty trainee, I’ve seen how the RCP’s credibility crisis stems from training shortages and poorly planned PA expansion—failures that erode trust.” He wants to see someone in post who is “capable of bridging frontline realities with reform” and who can offer decisive leadership. “Half measures risk lasting harm,” he adds.

Fallout from the EGM led to a review by the King’s Fund,4 which exposed a “pervasive lack of trust and confidence” in the college. The college acknowledged that the report made “sobering reading” and accepted its findings and recommendations in full. It said its entire leadership team was committed to reflecting, changing, and making a fresh start.

That fresh start was cut short last month by the revelation that a major ‘data processing error’ had affected the membership of the Royal Colleges of Physicians of the United Kingdom examination results for 283 doctors who took the second written component of the exam in September 2023.5

Some 61 candidates who were originally told that they had failed the exam have now been informed that they had passed, and 222 candidates who were initially told they had passed have now been told that they had failed and will need to resit.

The exam is administered by the Federation of the Royal Colleges of Physicians of the UK, representing the colleges in London, Edinburgh, and Glasgow.

Another frustration is the RCP’s apparent failure to deliver change, even after it has been promised. Last September it pledged to deliver constitutional and governance modernisation over the coming months. At its annual general meeting on 10 September acting president Mumtaz Patel acknowledged the need for a “more honest and open relationship” with members and “one that welcomes constructive challenge rather than avoiding it.”6

Lack of transparency continues to frustrate members, however.

Partha Kar has been a council member since 2023 but he now feels “pretty disillusioned” and will consider if he will stay on the council if things don’t change. “I haven’t seen the winds of change sweeping through and they need to,” he says. “Even now there is a lack of transparency around what’s being submitted to the Leng review [into medical associates].

“In spite of all attempts to change it, members still can’t vote in this incredibly critical election—you still have fellows making calls for the next generation of doctors when most of them can’t vote. We just need a fresh start.”

Robert Laurenson, a GP and former co-chair of the BMA’s resident doctors committee, says that resident doctors would like a president in the mould of a trusted critical friend. “A president of a royal college needs clear principles and values that are regularly communicated to all stakeholders, including their own members,” he says.

“There’s been a lot of reputational damage and a lot of damage to trust in the RCP after the EGM, so it’s going to require a leader who’s prepared to explain to its members what is in the college’s control, what’s in their influence, and what’s not. And from there, build a platform for re-establishing trust and gaining the kind of respect required of a president from all the relevant stakeholders.”

Any incoming president is likely to be in post when a government commissioned, independent review of medical associates (including PAs) is published.7 The review is led by Gillian Leng, president of the Royal Society of Medicine and former chief executive of the National Institute for Health and Care Excellence. It is seeking evidence from patients, employers in the NHS, professional bodies, and academics. Its announcement was welcomed by the college.8

The college also welcomed the announcement in February of an NHS England review of all postgraduate medical training.9 NHS England said the review will cover placement options, the flexibility of training, difficulties with rotas, control and autonomy in training, and the balance between developing specialist knowledge and gaining a broad range of skills.

Laurenson says, “The president will have many competing interests and stakeholders to deal with, whether that’s the board of the RCP, its council, the Academy of Medical Royal Colleges, government ministers, the NHS, patient groups, or other think tanks and charities. To be able to set new policy and then deliver on that to increase standards they will need to command the respect of stakeholders. You can only do that from a position of being a true critical friend, where there’s mutual respect and where it is okay to agree to disagree.”

Oliver agrees: “You’ve got to be able to go into those meetings with Health Education England, NHS England, and the Department of Health and Social Care and be credible and influential. If you push it too far, you’ll get disenfranchised, but if you keep it too timid, you’ll get nowhere.”

The presidency is a “punishingly busy job,” Oliver says, and one that requires an extensive set of skills over and above good media handling and lobbying. “A lot of the job is about leading a big membership organisation and registered charity, with all the responsibilities that entails. You’ve got 40 000 plus members and buildings in London and Liverpool, plus investment portfolios. You’ve got several hundred employees, public accounts, an annual report, committees, and are part of the federation that manages exams.”

One obvious feature of the presidential candidates is the lack of women. Scarlett McNally, president of Medical Women’s Federation, expected more female candidates given that more than 50% of the UK’s doctors are women. “Medical leadership needs to change,” she says. “Some behaviours, cultures, or processes exclude people, often inadvertently. Each person’s contribution should be respected and processes need improving. Diverse leadership is needed to get the best healthcare in the UK.”

Certainly, the mood music among members is that the timing is right for a substantial change following a slew of senior leadership departures. Last year president Sarah Clarke,10 registrar Cathryn Edwards,11 and chair of the board of trustees, David Croisdale-Appleby,12 resigned. Next month its longstanding chief executive Ian Bullock will also leave.

“Everybody in the organisation knows that the churn happened because the college had been getting things wrong,” says Oliver.

“The college needs back to basics reform,” says a doctor who did not wish to be identified. “The college needs to be restructured from the ground up. It needs to get its finances in order, and it needs to be serious about training and training standards. The UK is haemorrhaging resident doctors overseas, and that should be its core business right now. We need a president who can make sure that is its focus.”