How did the RCP get into a mess over physician associates?

In March 2024 the Royal College of Physicians was forced to hold an extraordinary general meeting (EGM), only the third in its more than 500 year history.1 The issue that prompted it was physician associates (PAs), specifically their regulation, scope of practice, and expansion across the health service.

The meeting was ill tempered and fraught, with participants describing it as “really aggressive” and an “unmitigated disaster.”2 Such was the concern about the meeting’s conduct and the level of hostility in the room that the RCP was forced to admit it had failed its membership and ordered an independent review to establish what had gone wrong.3 That review, carried out by the health think tank the King’s Fund and published in September,2 found a “pervasive lack of trust and confidence” in the RCP’s governance and that its governing council had been operating ineffectively.

After the EGM the college saw several high level resignations: its former president Sarah Clarke,4 registrar Cathryn Edwards,5 former deputy registrar Jamie Read,6 and, after the King’s Fund review, the chair of the board of trustees, David Croisdale-Appleby.7

In 2015 the college had established the Faculty of Physician Associates (FPA), in conjunction with Health Education England (as it was then called) and other medical royal colleges (box 1). Several members of the FPA’s board also resigned en masse after the EGM, including its president and vice president.8 The FPA will close at the end of this year, although the RCP will continue to oversee the annual PA exam.