Open letter to Royal College of Physicians officers cites false claims, failure to declare conflicts of interest and disregard for patient safety

Twenty-nine Fellows of the Royal College of Physicians (RCP) have accused the RCP’s leading officers of misleading doctors and hiding conflicts of interest in an attempt to persuade them and other RCP Fellows into voting down a key motion, tabled at last week’s RCP Extraordinary General Meeting (EGM), calling for a slow-down in the expansion of ‘physician associate’ (PA) roles pushed by the government, which ninety percent of doctors believe are endangering patients.

Last week, Skwawkbox covered the extraordinary scenes at, and outraged reaction to, the EGM and the conduct of the RCP panel as it refused to engage with doctors’ questions and misleadingly presented statistics to inflate support for the way in which the government is (ab)using PA roles, which do not have a medical degree, to replace fully-trained doctors – and to excuse the RCP’s continued support for the government’s programme. The RCP was exposed as having a huge financial interest in the programme.

The Fellows, senior doctors and medical professors, sent their letter to the RCP expressing concern at the ‘terrible harm’ the RCP leadership has done to the College’s reputation and detailing the issues with the way the EGM was run and data were presented by the RCP panel in the debate – and the way in which the College mishandled the need to come clean after the issues were exposed, failing to let doctors know before the close of the vote on the five motions that they had been misled. The motions, including the fifth one that the RCP board had urged doctors to reject, passed overwhelmingly:

STATEMENT OF CONCERN

The events of the last week have done terrible harm to the reputation of the College and the trust that its members and the wider public have in the leadership of the organisation.

Prior to the extraordinary general meeting (EGM) on 13th March 2024 to discuss issues around Physician Associates (PAs), members of the College who are not eligible to vote on the motions were surveyed. Their views were important to inform Fellows voting on the EGM motions about the impact of PAs on patient care and doctors’ training. It has become apparent that the Senior Officers of the College presented selected survey data at the EGM on 13th March, that in our opinion was manipulated in a way that can only have been intended to mislead fellows of the college.

Of note, the Deputy Registrar who presented the survey data, but who we understand did not prepare the slides, resigned from their post immediately after the EGM.

Following the EGM, multiple formal written requests were made to the CEO and Senior Officers to release the survey data. The CEO and Senior Officers refused for 5 days to release the survey results, only doing so after sustained public and direct pressure and multiple written requests. PRCP also cited the same misleading, manipulated survey data in an email to Members and Fellows of the College after the EGM.

The survey results were published on the RCP website at 9am on Monday 18th March, but no attempts were made during the voting period which ended on 20th March, to directly inform members or Fellows of the College that the data presented at the EGM were misleading, although PRCP emailed members on related matters.

During this time, Fellows voted on the 5 motions presented at the EGM, and they were doing so informed in part by the misleading information presented to them at that meeting.

The 5 motions presented at the EGM have been approved by a substantial majority of the Fellows of the College including Motion 5, which the Senior Officers had advised Fellows to vote against, despite the patient safety concerns raised in relation to PA scope and practice.

Discussions at the EGM and events leading up to and following the meeting raise serious concerns about the conduct, governance, and performance of the RCP, especially in relation to patient safety.

These concerns include but are not limited to a number of issues over several years:

1. Apparent failure of the RCP to adequately monitor the role and scope of PAs since the College agreed to house the Faculty of PAs (FPA) in 2015
2. Apparent failure to communicate clear parameters and scope for PAs from 2015 to March 2024, including failure to clearly communicate that PAs are not doctors and PAs must not replace doctors.
3. Apparent failure to respond to the concerns of the RCP Training Committee in relation to PAs raised in 2015 and subsequently with regard to loss of training opportunities for doctors and patient safety.
4. Apparent failure to respond to patient safety concerns raised by Fellows of the RCP with Senior Officers during 2023.
5. Providing false assurance from 2015 onwards to Members and Fellows of RCP and the wider public that PAs were safely working in their intended scope of practice.
6. Apparent failure to acknowledge that PAs in substantial numbers are and were working outside the intended scope despite being provided with evidence that this was the case.
7. Apparent failure to acknowledge that PAs are and were working in place of doctors in General Practice, and that PA locum agencies were facilitating this using NHS ARSS funding despite being provided with evidence that this was the case.
8. Apparent failure to acknowledge that PAs in substantial numbers are and were working in place of doctors on medical rotas in hospitals.
9. Apparent failure to act on evidence ]Provided by DAUK and the BMA that PAs are and were systematically replacing doctors in General Practice and hospitals.
10. Apparent failure to work collaboratively with NHS England, the FPA and GMC to ensure that PA Schools educate and communicate with PAs in line with their agreed scope, including but not limited to the principle that PAs are not doctors and must not replace doctors.
11. Apparent failure to adequately monitor and analyse the performance of PAs in clinical practice to determine patient safety, performance, clinical outcomes and cost effectiveness.
12. Apparent failure of Senior Officers to act on patient safety concerns raised by Members and Fellows and the wideir public because of the potential financial impact on the College.
13. Apparent failure of the Senior Officers to fully declare their Conflicts of Interest.
14. Apparent failure of the Senior Officers to adequately determine the Conflicts of Interest of the FPA leadership team.
15. Apparent failure of the Senior Officers and CEO to act in accordance with the RCP Code of Conduct.
16. Apparent failure of the Senior Officers to act in accordance with GMC Good Medical Practice.

This non-exhaustive list highlights that the Senior Officers and CEO have failed on multiple accounts to adhere to the RCP Code of Conduct.

Whilst, given the time pressures, there must be an immediate action plan to ensure that PAs are working within their scope of practice and not in place of doctors, there is a parallel urgent need for an independent review of the Senior Officers with a particular focus on governance and probity.

Dr Asif Qasim FRCP
Professor Alexander Ford FRCP
Professor Charlotte Bolton FRCP
Professor Trisha Greenhalgh OBE FRCP
Professor Martin McKee CBE FRCP
Dr Dagan Lonsdale FRCP
Professor Shah Ebrahim FRCP
Dr Taryn Youngstein FRCP
Professor Nick Hopkinson FRCP
Dr Vinoda Sharma FRCP
Dr Barry Monk FRCP
Dr John Stephens FRCP
Dr Arjun Ghosh FRCP
Dr Scot Garg FRCP
Dr Shrilla Banerjee FRCP
Professor Liz Lightstone FRCP
Professor Mamas Mamas FRCP
Professor Raanan Gillon FRCP
Dr David Nicholl FRCP
Dr Animesh Singh FRCP
Professor Jim Nolan FRCP
Dr Philip Pearson FRCP
Dr David Cohen FRCP
Professor Shahrad Taheri FRCP
Dr Rajiv Sankaranarayanan FRCP
Dr Nasser Khan FRCP
Dr Kevin O’Kane FRCP
Dr Zoe Wyrko FRCP
Dr Muhammad Ahsan FRCP

23rd March 2024

The use of PAs, which is considered by nine out of ten doctors to be dangerous to patients and confuses many patients, who do not realise that they have not been seen and treated by a fully-qualified medic, is being pushed by the government as a way of ‘downskilling’ the NHS, reducing costs and allowing increased profits for private providers, under the guise of the so-called ‘NHS Workforce Plan’ as part of the ‘Integrated Care Systems’ (ICS) project.

ICS, formerly called ‘Accountable Care Organisations’ (ACOs) after the US system it copied, were renamed after awareness began to spread that ACOs were a system for withholding care from patients and that care providers were incentivised to cut care because they receive a share of the ‘savings’. The system remained the same, but the rebranding disguised the reality.

The government used a ‘statutory instrument’ (SI) to pass these changes, avoiding proper parliamentary scrutiny, but both the Tories and Keir Starmer’s Labour support these and other measures to cheapen the NHS for private involvement and only independent MP Claudia Webbe spoke against them during the brief SI debate. Green peer Natalie Bennett’s motion in the House of Lords to attempt to kill the instrument was defeated by the Tories with the help of Labour peers.

Some of the signatories, such as Keele University Professor Mamas A Mamas, have added a demand for a full investigation into the actions of the RCP leadership – and ‘urgent action’ to prevent the government’s push for physician associates to operate beyond safe boundaries:

Despite the government’s attempt to keep this cost-cutting, care-degrading manoeuvre below the radar, it is rapidly becoming a major public issue – yet both Labour and the Tories are committed to continuing it, despite the avoidable deaths among patients that it has already caused.

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