RCP members vote to limit physician associate roles amid calls for president to resign

Anger from members

Palliative care doctor Rachel Clarke said the result shows “the severity of the disconnect between RCP leadership and the members and fellows that those leaders purport to represent.” She told The BMJ, “The college has failed to read the room from the outset, grossly underestimating both the strength of members’ concerns around PAs and our incredulity at college conduct during the EGM.”

Clarke had been so upset by the EGM that she has decided no longer to be a keynote speaker at this year’s RCP annual conference. “Even now, the college has failed to apologise for misrepresenting data from the members’ survey, referring only to ‘confusion’ around how they chose to present the data, rather than what actually occurred—namely a deliberate attempt to cover up members’ negative views of PAs by conflating ‘neutral’ and ‘positive’ responses,” she said.

“This is a probity matter—a clear attempt to gerrymander a democratic vote. If a drug company rather than a royal college had misrepresented data in this way, it would be nothing less than a scandal. I can only imagine the interest the General Medical Council would be taking if it were an individual doctor at fault.”

Clarke said she could not see how Sarah Clarke could remain as president of RCP. “The data misrepresentation alone is disastrous—but the PA project she is spearheading has now been proven to be radically at odds with the views of members. She does not represent us, and neither, I believe, does the college currently meet the high standards of professionalism and probity the public rightly expects from all doctors.”

Trish Greenhalgh, professor of general practice at the Nuffield Department of Primary Care Health Sciences at the University of Oxford, said, “I have been shocked at the unfolding of what I interpret to be serious breaches of governance at the heart of the college, and with the degree to which senior officers have shown themselves to be out of touch with the clinical professionals they are in post to serve.”

She told The BMJ, “I remain concerned that the partial and distorted presentation of data at the EGM may have been a deliberate attempt to deceive. I understand there is to be an independent inquiry and I hope this will be the start of a transformation for the better in college leadership.”

Mamas Mamas, interventional cardiologist at Keele University, wrote on X, “Despite the best efforts of senior leaders of RCP to define what we were allowed to vote on, sabotage the open debate at EGM, and misrepresent data, the fellows of the royal college have spoken and highlighted their views on the unregulated mess of PAs in the NHS. The current leadership has lost the support of their members and in view of this overwhelming mandate should resign.”2

Partha Kar, consultant in diabetes and endocrinology at Portsmouth Hospitals NHS Trust, welcomed the fact that the fellowship had resoundingly passed all five motions. Kar said, “It is time now for senior leadership to reflect on the result, listen to their members, and work on matters regarding PAs, especially around safety, presence on rotas, and development of scope. A pause is the right thing for many reasons—most importantly to take stock of this healthcare intervention and review it in light of patient safety flags.”

There are around 3000 PAs currently working in the UK. NHS England’s long term workforce plan aims for an expansion in numbers over the next decade.

RCP president Sarah Clarke recently wrote an opinion piece for The BMJ arguing there is a role for PAs in the NHS. She was asked by The BMJ to update her competing interests statement so that it now states that RCP hosts the Faculty of Physician Associates and receives membership and examination fees from PAs. The college therefore risks a financial loss from a limit in the rollout of PAs.3

The BMA recently published guidance stating that PAs should be barred from diagnosing or from claiming to be “one of the medical team” without stating their job title.4

The Royal College of General Practitioners recently shifted its position on PAs after members of its UK council passed a motion stating that “another regulatory body would be more appropriate to take this crucial work forward to regulate PAs.”5

In October last year members of the Royal College of Anaesthetists voted through six resolutions proposed by grassroots campaigners who opposed the expansion of anaesthesia associates, in an extraordinary general meeting.6

On 21 March, the British Association of Oral and Maxillofacial Surgery released a position statement saying their council unanimously agrees that there is no role for PAs in the practice of oral and maxillofacial surgery.7