Royal College of Physicians’ extraordinary general meeting turns to farce as doctors accuse panel of filibustering and lecturing them after concerns raised about dangers of untrained ‘physician associates’ carrying out doctor roles

The Royal College of Physicians (RCP) has provoked fury among doctors for its handling of an extraordinary general meeting (EGM) called by members to discuss motions against the College’s support for the government’s moves to both expand the use and roles of ‘physician associates’ (PAs) and to have them regulated by the General Medical Council (GMC).

PAs, who do not have medical degrees and receive only two years’ training compared to the seven years and more required to be a doctor, are increasingly being presented in healthcare settings as medical professionals and are even performing unsupervised heart surgery in some hospitals, as well as diagnosing, prescribing and seeing more patients in many general practices than GPs. Privately-owned GP companies are even making GPs redundant in order to replace them with cheaper PAs. Several patients have died, including at least two confirmed by coroner’s inquests, after misdiagnosis and inappropriate treatment by PAs.

The meeting, called to debate several motions around patient safety by enough members to trigger an EGM under the RCP’s rules, quickly descended into anger and farce. Doctor and professor Trisha Greenhalgh summed up in a series of her own and reposted Twitter/X posts indicating that the RCP panel was attacking those who raised concerns as irresponsible and damaging and were shutting down debate, even to the extent of ‘filibustering’, or talking at length to run out time:

More “headlines” without any actual RESULTS from the six questions. pic.twitter.com/SB5H6uAnW2

— Trisha Greenhalgh (@trishgreenhalgh) March 14, 2024

Here’s more. The category “neutral or positive” allows them to over-egg what they are spinning as a positive finding. Assumes that lack of experience with PAs *causes* a negative view. This would be a FAIL in any undergraduate essay on survey analysis. Correlation ≠ causation. pic.twitter.com/ZNPniLRLNM

— Trisha Greenhalgh (@trishgreenhalgh) March 14, 2024

Members attending online reported being unable to connect or losing their connection partway through:

This is fun pic.twitter.com/B4DKbbXgw7

— Trisha Greenhalgh (@trishgreenhalgh) March 13, 2024

Although opportunity to ask about financial conflicts of interest were not addressed, according to attendees, information emerging subsequently seems to indicate that the RCP does indeed have a financial interest extending to ‘millions of pounds’ in at least one aspect of the continuation and expanded use of PAs, as one disgusted doctor and NHS campaigner, Dr Rachel Clarke, pointed out:

Greenhalgh commented on the financial conflict of interest – and pointed out that the RCP’s president had just written an article about there being a role for PAs in healthcare for the British Medical Journal (BMJ) in which she did not point out the conflict, despite each BMJ article ending with a statement of potential conflicts of interest:

Even as of the time of writing, the end of the BMJ article still states that RCP president Sarah Clarke has not declared any competing interests:

So disgusted was Dr Rachel Clarke with the ‘lack of respect’ she witnessed at the meeting that, having originally been thrilled to be scheduled to appear as a keynote speaker at the RCP’s annual conference later this year, she has now withdrawn and has published an open letter about her reasons:

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.

Labour and Tories combine in Lords to defeat attempt to protect your right to see a doctor

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.

At least two people have already died avoidably because of misdiagnosis by PAs. Emily Chesterton, 30, who didn’t realise she wasn’t seeing a doctor, was treated for a calf strain when she had a deep vein thrombosis that led to a lethal embolism. Ben Peters, 25, was sent home from A&E with a ‘panic attack’ that was really a serious heart condition. A doctor’s Twitter/X thread includes details of others said to have died because of issues around PAs.

The RCP was contacted for comment.

Update: the RCP has now said:

In organising the EGM, we wanted to ensure that a broad spectrum of views could be heard and addressed. There was a high volume of questions and we made clear it would be unlikely that all could be answered. However, every effort was made to facilitate an inclusive and constructive discussion where fellows, whether they were in the room, watching remotely, or contributing through randomly selected pre-submitted questions and comments, had the opportunity to express their view. 

While as host to the Faculty of PAs (FPA) there will be a range of issues for the RCP to consider once the EGM ballot results are known, our core mission is excellent patient care. We agreed to host the FPA exactly because we wanted doctors to have oversight of the development of the profession. There is a workforce crisis in the NHS and when employed appropriately we believe PAs can be useful supplementary members of the multidisciplinary team.  As a valued member of the RCP community we are saddened that Dr Clarke has made the decision to withdraw from the upcoming conference. However, we understand and recognise her strength of feeling on this issue and will be writing to her directly to respond to the concerns raised in her open letter.

SKWAWKBOX needs your help. The site is provided free of charge but depends on the support of its readers to be viable. If you’d like to help it keep revealing the news as it is and not what the Establishment wants you to hear – and can afford to without hardship – please click here to arrange a one-off or modest monthly donation via PayPal or here to set up a monthly donation via GoCardless (SKWAWKBOX will contact you to confirm the GoCardless amount). Thanks for your solidarity so SKWAWKBOX can keep doing its job.

If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.