rationing
Leading medics publicly accuse RCP of misleading docs about non-doctor ‘associates’
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:
- 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
- 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.
- 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.
- Apparent failure to respond to patient safety concerns raised by Fellows of the RCP with Senior Officers during 2023.
- 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.
- 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.
- 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.
- Apparent failure to acknowledge that PAs in substantial numbers are and were working in place of doctors on medical rotas in hospitals.
- 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.
- 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.
- Apparent failure to adequately monitor and analyse the performance of PAs in clinical practice to determine patient safety, performance, clinical outcomes and cost effectiveness.
- 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.
- Apparent failure of the Senior Officers to fully declare their Conflicts of Interest.
- Apparent failure of the Senior Officers to adequately determine the Conflicts of Interest of the FPA leadership team.
- Apparent failure of the Senior Officers and CEO to act in accordance with the RCP Code of Conduct.
- 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 FRCP23rd 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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Video: EGM leak reveals RCP ‘refusing to answer patient safety questions’ and more
Clips from 2-hour leaked extraordinary general meeting appear to show Royal College of Physicians avoiding scrutiny – but making damning admission of financial conflict of interests in government’s expansion of ‘non-doctor-doctor’ roles
A leaked video of the entire ‘extraordinary general meeting’ (EGM) of the Royal College of Physicians (RCP), called by doctors to try to force a slow-down in the roll-out of the government’s expansion of the use of non-medically-trained staff in ‘doctor’ roles, has revealed comments and obfuscation that have led medical professionals to call for the resignation of senior RCP officers. One has already resigned.
A number of patients have already died avoidably because of errors by ‘physician associates’ (PA), who have only two years’ training compared the seven-plus years completed by doctors. A Doctors’ Association UK survey has found ‘deeply disturbing’ abuse of the PA role in NHS trusts.
Keele University cardiology Professor Mamas A Mamas wrote of the leaked video:
The ‘PlatinumPizza’ Twitter/X account has posted a number of excerpts from the EGM video highlighting what it feels are the most noteworthy evasions and obfuscations. The first two reveal that, while the RCP claims that PAs must complete national exams, a freedom of information request revealed that this can be bypassed – and that the RCP, which criticised a far more comprehensive survey by the British Medical Association (BMA) as biased, in fact skews the results of its own small survey to present a falsely positive outlook:
Next, Dr Read tries to present the results of the survey. It's important to remember that Dr Read has since resigned from his post following the EGM.
Somehow, they've managed to mess-up even a basic Likert scale survey and clustered the neutrals with the positives! pic.twitter.com/G2DRpdegBx— platinumpizza
(@Xeon4f145d96s1) March 17, 2024
Doctors participating in the EGM also raised the issue of the fact that PAs are paid more than the junior doctors who often have to supervise them (and can be held to blame if a PA screws up) – but the RCP said it was ‘not a union’ and not interested in getting involved in pay issues:
Next, slightly sped-up, @DrOKaneAgain eviscerates the survey and its results. An insinuation about the BMA survey being "biased" and "leading" is raised. This comes after the RCP tries to pawn off its results by aggregating positive with neutral, as @doctor_oxford shared with us. pic.twitter.com/MefdfOmxT4
— platinumpizza
Next, the first of two posts about the RCP’s prioritisation of its finances above what nine out of ten doctors feels is a grave threat to patient safety:
Back to it, this clip talks about the fiscal and fiduciary responsibilities the RCP have. Although not shown in this particular clip (I'll include it in the thread later), mentions of millions in reparations/ law-suits/ class actions is made. pic.twitter.com/OYLBQtN5VO
— platinumpizza
And then the second, which shows the RCP’s treasurer admitting/warning that the RCP could stand to lose millions if the PA expansion is halted or even slowed down – and the RCP apparently disagreeing with the RCP of a short while below about being a ‘union’, at least when it comes to ensuring PAs have jobs:
I know you are all waiting to hear the millions the RCP might be forced to pay up…so this clip is just that!
Will someone think about the pensions?! pic.twitter.com/s8JD70ooXs— platinumpizza
And, adding farce to the ‘contempt’ of which doctors accused the RCP after the meeting, the panel refuses to say what additional benefit a PA brings to a ‘multi-disciplinary team’ that is not already present in the mix – rounded off by a clip of a doctor warning of the dangers of pressing ahead with the whole damaging system:
And lastly, in what can only be described as an epic season finale, @DrAsifQasim drops an absolute banger.
"i am deeply concerned we will take a patient safety hit if we do not act" pic.twitter.com/LaqIozrAEV— platinumpizza
And in a clip not included in the thread but created by Skwawkbox, one of the movers of the motion for the expansion to be slowed down until it can be shown to be safe for patients explains why it is so important for voting members of the RCP to support it, despite the RCP management’s recommendation to reject it and plough on:
Other discussions during the meeting included the panel failing to explain how it was going to ‘hold the government to account’ for the safe functioning of the system, as it had claimed it would – and treating the mere inclusion of any extra doctors in the government’s ‘long-term workforce plan’ as an achievement by the RCP.
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.
Watch the full RCP meeting here.
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Doctors’ Association survey finds ‘deeply disturbing’ misuse of govt’s non-doctor roles
Danger to patients and conflicts of interest as government continues to push for expanded use of ‘associate’ roles – with help from the Royal College of Physicians
A survey by the Doctors’ Association UK (DAUK) has revealed ‘deeply disturbing’ ‘scope creep’ in which – as warned by the British Medical Association (BMA) and others – ‘physician associates’ (PAs), who are not qualified as physicians, are being used and acting as doctors.
A statement by the group warns that PA are not only overstepping the boundaries in which they are meant to operate, but also being used by NHS trusts and health companies to fill positions that require fully-qualified doctors:
PAs are overstepping boundaries, putting patient safety at risk, and impacting doctors’ training. This is shocking in itself, but made far worse by recent events at the Royal College of Physicians… Doctors at Torbay report PAs being used as “middle grades” – clear scope creep.
According to a doctor recruitment agency:
Doctors in speciality training programmes are known as Middle Grade doctors. Junior Middle Grade doctors are trainees who have completed their foundation training and are now in the early years of their speciality training. They are: ST1/ST2: ST stands for Specialty Training.
According to survey responses from doctors at Torbay and South Devon NHS Trust, as well as being used as ‘middle grade’ doctors and putting patients at risk by acting outside their competencies, PAs:
- work without adequate supervision
- consent inappropriately
- participate in unsafe clinical activity
- treated severe infective colitis with antibiotics and steroids simultaneously
According to NHS Scotland, steroids “shouldn’t be used if you have an ongoing widespread infection. This is because they could make it more severe.”
The DAUK also linked the survey results to this week’s fiasco at the Royal College of Physicians (RCP), where attendees of an extraordinary general meeting (EGM) regarding concerns about PAs linked the behaviour of the RCP’s panel, which was accused of ‘contempt’, shutting down discussion and even filibustering, to the RCP’s financial conflict of interest in the millions of pounds it reportedly makes from administering PA examinations.
The RCP is hiding their full survey data from FRCP and Council until after the EGM vote. This lack of transparency is unacceptable…
The RCP Registrar, who sets RCP professional standards, works at this Trust. (Important note: there is no indication she was involved in this case [of steroid/antibiotic administration].)
Doctors at Torbay report PAs being used as “middle grades” – clear scope creep. Yet the Registrar, whose job is to “create consensus” & uphold standards, has been involved in withholding critical data that potentially sways the EGM vote. This is not leadership.
The Registrar’s own job description emphasises “accountability for clinical and professional affairs” and “…setting and maintaining professional standards.” How can the Registrar fulfil these duties, ensuring patient safety and upholding standards, when those very standards are being violated in their own Trust? This is an untenable conflict of interest.
In our view, the Registrar has failed in their core responsibility for transparency and integrity of RCP decision-making. We call for their resignation to restore trust in the RCP. The RCP’s position on PAs is currently compromised.
The statement concludes with a call on all voting members of the RCP to vote to support all the motions tabled at the EGM calling for a rethink on the issue of PAs:
Lastly, we are asking that Fellows vote in favour of all five motions as presented, to ensure that a safe revaluation of the PA role can be conducted to ensure patient safety and to ensure continued viable training of the medical profession moving forward.
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.
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.
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Royal College of GPs deletes article exposing lack of supervision of ‘PA’ not-doctors
RCGP has been equivocal about government’s changes to use of ‘associates’ without medical training to treat patients
The Royal College of GPs has deleted an article that detailed the extent of the lack of supervision by fully-qualified doctors over the actions and decisions of the ‘physician associate’ (PA) roles – who have only two years’ training – whose use the government is expanding.
The use of PAs, which is considered by ninety percent of 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.
Now, as Pulse magazine has revealed, the RCGP has deleted a case study that revealed a shocking lack and laxity in the supervision of a PA:
According to the now-deleted case study, held a ‘minimum’ of 27 10-minute appointments each day and asked the on-call doctor to review patients for an ‘urgent opinion’ only ‘once every two to three months’…
…After screenshots circulated on social media, the RCGP removed the case study at the PA’s request…
…The case study previously said: ‘[The PA] has three, ten-minute appointment slots in a row, and at the end of those slots has a ten-minute break for administration and including having prescriptions signed by a GP.’
It said supervision is ‘shared’ between GPs working at the practice, and that for ‘non-urgent concerns’ there is a ‘ten minute debrief with an on-call doctor’ which takes place every two to three weeks.
Matt Kneale, co-chair of the Doctors’ Association UK which along with the British Medical Association is opposing the changes, said:
Much of the concern from doctors in recent months has built up from a lack of transparency from Royal Colleges about where they stand on physician associates.
While we are grateful that the RCGP has removed what can, at best, be described as unprofessional practice, we maintain that the College needs to sit down with wider stakeholders on the concerns around PA roles and scope more generally.
The RCGP has voiced ‘concerns’ about the new system, but has not formally opposed it, despite the outrage of doctors and the increasing examples of companies hiring PAs instead of doctors and even making doctors redundant to switch to PAs.
The government’s expansion and renaming of these roles, along with backdoor to regulate them via the General Medical Council (GMC), which regulates doctors – is part of what experts call ‘scope creep’: physician’s assistants and anaesthetist’s assistants, as they were originally called, are valuable roles in carefully limited settings, but NHS England, the government body appointed to run (and run down) the NHS has been using them way beyond their original scope, for example even to perform some types of brain surgery and expecting them to ‘learn on the job’.
The government used a ‘statutory instrument’ 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 debate. Green peer Natalie Bennett has tabled a motion in the House of Lords in an attempt to kill the instrument, but without support from the notional ‘opposition’, it is unlikely to succeed.
During the Statutory Instrument debate, Tory former Health Secretary Therese Coffey gushed about the potential for using three associates to anaesthetise patients during operations, with just a single consultant anaesthetist monitoring remotely as an ‘efficiency’.
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.
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.