Category: RCGP

Another enjoyable Council meeting – my third as a Nationally Elected Council Member! This was probably the least eventful of the Council meetings I’ve attended, but I still have plenty to update you on.

Firstly, an apology: I realise I have been a little bit less responsive than usual of late. It probably isn’t wise for me to go into details at this stage, but essentially I have had a very unpleasant experience recently. I am being well supported by the police – and the BMA, who have been absolutely wonderful. My husband, and my parents, are being hugely supportive too. Please be kind if I am not quite my usual self for a while, or if I don’t respond immediately (or at all) when you contact me. I continue to do my best to represent you.

The Chair’s welcome – some highlights

• Senior figures at the College are acutely aware of the GP jobs crisis and are lobbying stakeholders at every opportunity. Kamila suggested that Council members might wish to send her details of medical unemployment in their local area. If you have a story to share, please email me (heather.ryan@nhs.net) and I can collate your concerns and forward them to Kamila.
• King Charles has been confirmed as the Royal Patron of RCGP, but don’t get too excited – he is Patron of around 700 organisations, so I don’t think he’ll be dropping into Council any time soon! However, I was pleased to hear that he is, reportedly, very positive about GPs.
• Council Members’ declaration of interest forms will be published shortly and will be visible to the entire College membership. There are no current plans to redact special category data, but any Council member with concerns can contact Kamila to discuss further.

C43 – Preventive Medicine

This paper asked Council to support the adoption of “preventive medicine” as RCGP’s clinical policy priority for the next three years. Essentially, the paper proposes that the College should lobby for GPs to take a more prominent role in promoting a population-level approach to proactive care, rather than reactively waiting for patients to become ill then treating them. The paper advocates a focus on lifestyle modification to delay or prevent the onset of disease.

 The paper received a broadly positive reception, though several Council members argued that the College is likely to have a far greater impact if it lobbies for strategic political changes to address socioeconomic determinants of health, rather than focusing on lifestyle advice given by individual GPs to individual patients.

Although there was much in this paper I agreed with, whenever somebody talks about things that GPs are best placed to do, my inner sceptic always wonders what additional resource will be made available to us to facilitate that – or, if no funding is available, what GPs should stop doing to give them capacity to pick up this new work. I also had concerns about the risk of overdiagnosis. I spoke to the paper as follows:

Heather Ryan, Nationally Elected Member. Thank you for bringing this paper, Michael – I thought it was really thought-provoking. However I worry a little about how this will be received by the wider membership. This paper suggests that College should call for greater resourcing of General Practice, on the grounds that preventative work could be funded by this. I think we can only ask members to do more work if we get significant additional resource. At the moment, many of our members are struggling to meet the needs of patients who are already unwell, and if offered more funding, many would argue that it should be used to deal with patients presenting with illnesses. What work should we stop doing in order to make time for more preventive work? GP surgeries are pushed to the brink already – without significant additional funding and staffing, I cannot see how our members can make time to do yet more work, and I think they will feel we are out of touch if we say they should.

I was relieved to see the repeated references to “evidence-based” in this document, given that some aspects of primary prevention and early intervention are less well-evidenced than others. I do think it is vital that the College focus on high-value interventions, rather than interventions of dubious clinical impact. I raised an eyebrow at the mention of “aiming to slow down or eliminate the onset of conditions” – this is not always of clinical value, as some conditions have a long latent period, or may never cause clinically relevant disease. Has the overdiagnosis group had any input into this policy? If not, can this be added to the ‘internal activity’ planned for this policy? (As a declaration of interest, I subscribe to the overdiagnosis group mailing list.)

I note the British Society of Lifestyle Medicine is listed as a key stakeholder – although much of the BSLM’s approach is commendably evidence-based, some isn’t, such as their promotion of the UPF hypothesis, which most academic nutritionists agree is grossly oversimplified and not supported by the existing evidence. (As another declaration of interest, I sit on an advisory board for Nestle, but that does mean that I know what I am talking about.) I would respectfully ask that you engage with BSLM with caution and ensure that any policies that the College makes are supported by evidence rather than ideology.

C46 – Responding to the climate emergency

In many ways, papers C43 and C46 were diametrically opposed: while C43 seemed to be predicated on the assumption that more medicine is a good thing, C46 had a refreshing focus on the benefits of deprescribing. 

The background to this paper is that the climate emergency is one of RCGP’s four strategic priorities for 2023-2026, and this topic was first discussed at the November 2023 Council meeting, when the Officers received robust feedback to the effect that encouraging GPs to look after the planet might be perceived as inflammatory when they don’t currently have the resources to look after themselves, let alone their patients. At that meeting I suggested that the College should focus on promoting “win-win” initiatives which save practices time and/or money as well as helping the environment. 

It is a testament to the Officer team that they took this feedback on board and presented a fantastic, pragmatic paper this time around. Despite this, when we discussed the current paper at our Faculty Board meeting on Wednesday, further concerns were raised about the need for sensitive messaging about GP workload. I articulated those concerns today:

This is a fantastic paper, Victoria, thank you, and it is a great testament to your leadership that you have clearly taken heed of the feedback you got when this was last discussed at November Council. I was thrilled to see the focus on reducing overprescribing and prioritising high-value care. I was also pleased to see how pragmatic many of the suggestions are – many suggestions would also reduce either cost or GP workload, for example the suggestion that electronic prescribing should be rolled out in those areas of the UK that do not yet have it. I was shocked by the statistic in the paper that approximately 15% of hospital admissions in over-65s are caused by the adverse effects of medication, and I think that makes the case beautifully that too much medicine can be bad for patients as well as the planet.

I would just like to sound a note of caution about how this policy is communicated to our members. I’m a Nationally Elected Member, but I attend Faculty Board. When we discussed this paper at Faculty Board, it was suggested by others that debate about climate change risks alienating members and making us seem out of touch, given the more immediate crises facing General Practice. As I say, I think this is a very clever paper because most of the suggestions would reduce cost or workload or both – I think we just need to be careful about the messaging.

Other Council members articulated similar concerns about how GPs might respond to any suggestion that College cares more about the green agenda than it does about its members. The Officers’ closing remarks made it clear that, although Council was broadly supportive of this paper, they had heard and understood those concerns and would ensure that the excellent ideas in this paper are communicated sensitively to our membership.

Verbal update from the Chair on the PA policy statement and consultation

This was a fast-moving and complex discussion, so forgive me if any errors have crept into this account; if so, let me know and I will of course correct them.

If you’re politically active enough to be reading a blog about an RCGP Council meeting, you have no doubt already seen the results of the RCGP member consultation about Physician Associates in General Practice, following which the College called for a halt to the recruitment of PAs into Primary Care for the time being. There was widespread praise for our bold stance, and although a couple of Council members expressed a desire for a more conciliatory stance towards Physician Associates, the vast majority of Council members wholeheartedly endorsed the College’s current position.

The next step is that the Officers will engage with external stakeholders, including patient groups and indeed PAs themselves. They will also, of course, consult with College members. A further paper will be brought to Council in September 2024 concerning the scope of practice, induction, and supervision of PAs working in General Practice.

Some other notes:

• There was some discussion about who will regulate PAs. Since March 2024 Council, RCGP’s position is that an organisation other than the GMC should have this responsibility. This remains the College’s position. The Officer team indicated that, unfortunately, the most likely outcome is that the GMC will indeed be the regulator, despite the College’s concerns. However, other Council members pointed out that there is a potential legal challenge to the GMC as regulator of PAs – at least one organisation intends to launch a legal challenge. Watch this space!
• The Royal College of Physicians has reportedly indicated that they will no longer take responsibility for writing papers about PAs working in specialties other than their own.
• The College continues to campaign for urgent action to grow the GP workforce, including advocating that ARRS funding should be opened up to GPs. Current rumours suggest that the rules may at some point change such that ARRS funding can be used to employ GPs if those GPs are being employed to supervise ARRS staff. (My personal view is that the neatest solution would be to abolish ARRS and pour that money into core GP funding, but it seems that would be far too simple for the politicians!)
• One Council member very kindly thanked me by name for my role in pushing for the PA member consultation. That same person made a very interesting suggestion – that the College should repeat the PA member consultation after the RCGP scope of practice document has been released, to see if the guidance is being followed and if PAs are working more safely as a result. I think this is a fab idea – after all, in clinical practice we would re-audit as part of the audit cycle! If PAs aren’t working safely even once the guidance has been released, I think that would add weight to the idea that the PA role is ill-suited to General Practice…
• Various members, including me, called for a halt to the utilisation and/or training of PAs in General Practice full stop. One member argued very articulately that most patients have “no idea” about the PA role and do not understand how little training and knowledge PAs have. I thought that was an excellent point. If patients don’t understand the PA role, how can they give informed consent to be treated by one?
• In contrast, one Council member argued that we should not “get on our high horses about patient safety” because GPs make mistakes too. Personally, I disagree – if even professionals with at least 10 years of training (5 years of medical school and 5 years of postgraduate training) make mistakes, surely allowing people with just 2 years of training to see complex patients is a recipe for disaster?
• One Council member pointed out the inherent confusion created by referring to GP trainees as “Associates in Training”. How can we expect patients to understand that Physician Associates are not doctors if we call our own trainee doctors Associates? The Officers reassured us that this is already being addressed within the College, and our trainee colleagues will increasingly be referred to as GP Registrars rather than AiTs. This is very welcome news.
• In light of events at RCP, various commentators on social media have asked how likely Kamila is to be subject to a vote of no confidence. I don’t think that is going to happen, for two reasons. Firstly, procedurally, as far as I can tell from having read the Byelaws of RCGP, there is no mechanism by which “ordinary members” (i.e. non-Council members) can call for a vote of no confidence in an Officer. If I understand the rules correctly, a vote of no confidence cannot be triggered unless ten or more Council members request one. More than half of Council members need to vote in favour of the no confidence motion in order for it to succeed. It was clear during the meeting that Kamila has the confidence of a majority of RCGP Council, so I cannot imagine that a vote of no confidence would succeed at the present time even if it was brought.

I spoke on the PA discussion as follows:

Heather Ryan, nationally elected member. I am glad that the College has demonstrated leadership on this issue, and has showed real courage in taking on the political establishment in defence of patients. We have set a fantastic example to the other Medical Royal Colleges. However, in the 48 hours since our statement was released, I have been contacted by members asking why, given the damning findings of the consultation, we have not gone further. Given that we have called for a halt to the recruitment of new Physician Associates due to safety concerns, is the next step to think the unthinkable and call for the phasing out of all Physician Associates in Primary Care, given the inherent unsuitability of the PA role for the GP setting? And should the College call for a pause on the training of Physician Associate students full stop, given uncertainty on the future of the role? I am disappointed to hear you say just now that you do not plan to call for GPs to stop training PAs in primary care.

One RCGP member approached me while the survey was live to express their view that there was pro-PA bias in the survey design; they felt that the questions were asked from the starting point that PAs have a role to play in General Practice. This member felt that they had to heavily utilise the free-text boxes in order to express their view that PAs have no place at all in Primary Care. Who designed the survey and was the possibility of bias considered? You mentioned a Task and Finish group – who was on it and how were they chosen?

In terms of transparency, it is commendable that we have published a full report into the consultation findings, but many members have asked me for more detail about what the free text responses said – I understand that individual responses may need to be redacted for confidentiality reasons, but can we please publish more thematic analysis of the free text comments?

I agree that it is vital that this debate remains civil, but I do not feel we should be weaponising rhetoric about kindness in order to stifle debate about patient safety.

The response to my points was as follows:

• Thematic analysis of the free-text comments on the survey will be published soon.
• Some people have said that the survey was framed in an anti-PA way, and some feel it was pro-PA.
• The Task & Finish group was assembled by invitation.
• Although a few Council members have argued that RCGP should have gone further, there are no current plans to do so – the next step is to await the scope of practice document. However, in the meantime, we were reminded that it is up to individual GP practices whether they hire PAs. That is a good point – perhaps, as a profession, we just need to collectively stop employing PAs? But due to the way that General Practice is currently being funded in part via ARRS, that may not be as simple as it sounds.

C49 – Member motion

This was a motion advocating that the GP trainee representatives on Council should be able to vote at RCGP General Meetings, which currently they cannot. There was overwhelming support for this motion and it passed. However, due to the need for this to be officially approved by the Privy Council, it will apparently take 2-3 years to come into effect.

C50 – Governance Review Update

The paper itself is a bit dry (and I say this as a governance enthusiast!), but we were treated to a slideshow which explained the issues very well. We were told that this would be made more widely available, so watch this space. Essentially the issue is that our current structure is unwieldy, and it is sometimes unclear who is ultimately responsible for decision-making. There will be an all-member workshop on 11th September to discuss the Governance Review in more detail. I have to say how impressed I am by the reflection that is taking place within the College following the concerns raised at November’s AGM.

Conclusion

I think I’ve covered everything! If you have any questions or comments, please get in touch; as a Nationally Elected Council Member, my job is to represent the views of my electorate! If you’d be interested in attending a Council meeting as an observer, please let me know and I can put you in touch with the relevant people at the College. If you’re in Merseyside and Cheshire, I can arrange for you to observe a local Faculty Board meeting too! Have a lovely summer and stay in touch 🌞

Wow! What a momentous day! You’ve no doubt already seen the news on Twitter: RCGP Council has voted to revise its position on Physician Associates! It was actually a fairly packed agenda, and we discussed a couple of other very interesting papers as well. I’ll run through it in order…

Physician Associates

The Council paper had been kept confidential until after the vote, but I am told it will shortly be uploaded to the members’ section of the website, so if you’re a member you will hopefully soon be able to find it on the Council page on MyRCGP. 

Mindful that Physician Associates would be on the March Council agenda, and cognisant that this is a topic which has aroused strong feelings in many of our members, I felt that as a Nationally Elected Member of Council I should consult my electorate to inform my position. In January I created my own informal survey of RCGP members – if you haven’t seen it, my results are presented here. This proved to be tremendously useful, as it meant I could represent your views with confidence and authority, and the results seemed to be taken seriously within the Council chamber. (One Council member came up to me in the ladies’ loos to congratulate me on doing it!) I am so grateful to the 457 RCGP members who spent time filling out my survey. You have all helped to drive change within our College. Thank you!

Due to the intense (and appropriate) scrutiny of the management of conflicts of interests, Council members had to submit a written declaration of their interests in advance of the meeting, and then separately had to re-state relevant interests before speaking.

I spoke to the motion as follows:

I’m Heather Ryan, nationally elected member. When I joined my former partnership, there was a PA at the surgery, who left fairly shortly afterwards, and I didn’t have much involvement with them. I occasionally let PA students sit in with me in the Secure Unit. I’m a private GP and we don’t employ PAs. My husband was a Nationally Elected Council Member when Council voted on PAs last time.

As a Nationally Elected Member of Council, I was keen to ensure I was representing my electorate on this contentious issue. So I undertook my own survey of RCGP members, advertising on social media platforms. I got 457 responses, all of whom self-declared they were members of the College. Respondents were asked how well they felt that RCGP was currently representing their views on PAs, on a scale from 1 (not at all) to 5 (very well). The majority – 72.9% – felt that RCGP was not representing their views at all, and a further 69 respondents (15.1%) gave a less strong but still negative response. Only 5 of those 457 doctors felt that RCGP is currently representing their views on PAs very well.

So, our members are not happy. What can we do better?

95.2% of the doctors who responded to my survey felt that RCGP should undertake a formal consultation of its members’ views on PAs. Most respondents felt that RCGP’s position should be that any incorporation of PAs into Primary Care should not be at the detriment of GP trainees’ learning opportunities, and, sadly, several respondents gave me examples of how their own GP training had already been affected.

The view of my members is that GMC regulation of PAs will add to the confusion amongst patients and clinicians, so in vote 4 I will vote for option B despite the caveat that it is likely to delay the registration of PAs. It is better that we get it right, than that we get it wrong quickly*.

Council, at this critical time for our profession, we must ensure that we take our members with us in any decisions we make. For that reason, I beg you to please vote yes to the questions put to us today, and in particular, vote yes to a public consultation.

* My questionnaire didn’t ask about this specifically, but colleagues made their feelings clear via other channels!

Most Council members spoke, and those who didn’t speak nevertheless had to declare their conflicts of interest before we voted.

The outcome of our vote was, as summarised in the RCGP press release, that RCGP’s position on PAs is now as follows:

• RCGP opposes GMC regulation of PAs
• GPs must be able to choose if they supervise PAs
• The training of GPs must be prioritised over training of PAs
• PAs must be considered additional members of the team – not substitutes for GPs
• PAs do not replace GPs 
• RCGP will undertake a formal consultation of its members’ views on PAs, including scope of practice and supervision

Most of the credit for today’s victory goes to the incredible Victoria Tzortziou-Brown, RCGP Vice Chair for External Affairs, who showed great leadership and courage in bringing this paper to Council in its current form.

Approval of Standing Orders

Fair play to the RCGP officer team: after the excitement of November’s AGM and Council meeting, I was really impressed by how they approached the revision of the Standing Orders. The concerns I raised about the process for bringing motions to Council were incorporated into the next draft of the Standing Orders; and then the Hon Sec hosted a webinar for Council members in which the proposed changes were discussed, following which further amendments were made. As a result, I was happy to support the new Standing Orders, and I spoke to commend the Officers for the way in which they had engaged Council members with the process.

There was also some discussion about how declarations of interest will be managed going forwards. In principle it was agreed that Council members’ declarations of interest should be made available to the wider RCGP membership, though there are some practical and governance questions about how this can be implemented, so it’s unclear exactly what form this will take or how quickly it will happen.

Health inequalities

This was a great paper which prompted a lot of thoughtful discussion. It was humbling to be reminded of the depth and variety of expertise we have on Council. Points raised included culturally competent care for patients with learning disability; and how GP surgeries should not make showing photo ID or proof of address a condition of registration, as this risks excluding the very patients who most need healthcare.

I spoke to make the following points:

• I am pleased to see the call for targeted recruitment and retention schemes to support maintaining GP numbers in deprived areas
• In North West England we have several successful ‘deprivation’-focused GP training posts, plus local initiatives to ensure GP trainees gain some experience of working with disadvantaged communities – such as arranging for trainees to spend time with a homelessness outreach worker, and a scheme I have until recently facilitated in the mental health unit in which I work, where GPST3 trainees would spend an afternoon with me
• I am pleased to see that the paper discusses the difficulty that some patient groups can have in booking an appointment. Interestingly the paper doesn’t talk much about the challenges that older people can face when contacting their GP surgery. I do my private work in a very affluent area, yet many of the patients who consult me are wealthy, educated older patients who report that they have really struggled to access their NHS GP because they cannot, or do not want to, use eConsult. The word “elderly” only appeared once in this paper, and I would ask that the needs of older adults, who are at risk of digital exclusion regardless of their socioeconomic status, are not forgotten.

GP retention

Council ended on a high note with an excellent paper which summarised the College’s recent policy work on GP retention. I was particularly pleased to see that RCGP is calling for all international medical graduates qualifying as GPs to have the right to apply for indefinite leave to remain in the UK. Such a scheme would address the ludicrous situation we currently have, in which newly-qualified GPs risk deportation if they can’t find a job quickly enough after they complete their training.

One Council member spoke very well about how one of the groups with the worst retention rate is female GPs aged between 30 and 45, and factors which may be contributing to this, including the cost and difficulty of arranging childcare; recent changes to the retained GP scheme; and the reduction in availability of locum work.

I said the following:

I think this is a great paper – thank you for bringing it, Kamila. I was particularly pleased to see the mention of flexible working and I would echo [other member’s] comments. I was a GP partner when I had my eldest child, and I found it really difficult to stay in a substantive GP role because core contracted hours are 8am to 6.30pm and in the remote ex-mining area I lived in, nurseries and childminders didn’t offer long enough opening hours. I was fortunate that my husband, also a GP, picked up the slack – but he once had to take our 8-month-old on an emergency home visit to a nursing home. Given that childcare options are often worse in deprived areas such as the one I worked in, support for flexible working may well help mitigate the impact of the inverse care law. 

As a GP educator in Sefton, where a high proportion of our GP trainees are international medical graduates, I was also pleased to see the suggestions put forward about how we might tackle the visa trap which sees excellent newly-qualified GPs threatened with deportation if they can’t find a job quickly enough.

That said, when we discussed this paper at our Faculty Board meeting on Wednesday, one of our members drily said, “if you want to retain GPs, you need somewhere for them to work”. I think this superb paper would be even better if it were clearer about the fact that we will not be able to retain GPs unless General Practice as a whole is funded adequately, because at the moment, our very profession is fighting for its survival.

One GP also contacted me to point out that the Performers’ List puts barriers in the way of retention, especially for doctors in low volume or niche roles. I would urge RCGP to consider its position regarding the Performers’ List.

Conclusion

I remain, as ever, your humble and obedient servant: as a Nationally Elected Council Member, I am here to represent you, so please do keep your feedback and suggestions coming! The outcome of today’s Physician Associate paper feels like a big step forward, but our work isn’t over; keep your eyes peeled for the member consultation!

Today was my first meeting as a Nationally Elected Council Member at RCGP. Thank you so much for electing me; I know it sounds trite, but it is such a tremendous privilege that you trust me to represent your views. 

The day started with the Annual General Meeting – probably the longest and best-attended RCGP AGM in living memory – and then progressed to the Council meeting. Because the AGM took longer than expected, there was a great deal of time pressure during the Council meeting. One item is therefore going to be carried over to the next meeting. At one point, it was suggested that Council members’ speeches be compressed to one minute apiece – as opposed to the usual two minutes – but after one item it became evident that this wasn’t conducive to high-quality debate, and speeches reverted to a two-minute limit.

Before I start discussing individual items, I need to explain the terms under which I write this blog. Although Council members are free to talk and Tweet about non-confidential items, the actual Council papers are not allowed to be released to non-members, and I cannot write about confidential or particularly sensitive items.

Council members can report the gist of the debate, but a variant of the Chatham House rule is used: we can’t quote named individuals without their permission. As a Council member I also have to adhere to the principle of collective responsibility, and if I don’t, I can be sanctioned; so, although I will be reporting what I said when I spoke about each item, and I can report how I voted, I will not be openly critical of decisions that Council has reached. My opportunity to influence the outcome is by speaking and voting in the Council chamber, rather than by undermining democratically-made decisions afterwards.

The Annual General Meeting

The lead-up to the AGM was eventful. A week or so before the meeting, concerns started to circulate about the content of some proposed changes to the College byelaws. Many of us were concerned that the wording of the proposed changes would undermine Council’s decision-making power in relation to the term and election of members of Trustee Board. This may sound trivial, but Trustee Board is tremendously important and makes many of the key decisions which materially affect members, so I feared that proposals which would weaken the ability of Council to hold Trustee Board to account could ultimately undermine Council members’ ability to represent their constituents. Concerns were also raised about proposals to raise the ceiling for membership fee increases to £750 per year. Concerns were raised about these proposals, including by high-profile GPs like Margaret McCartney.

Less than three days before the AGM, those who had registered to attend online received emails containing updated papers. Many Council members, including myself, had not registered for online attendance, and so didn’t receive this update, although it was also available on the RCGP’s web page about the AGM. I only found out about it because a friend mentioned it.

Happily, most of the contentious byelaw changes had been removed, and a very helpful document was released explaining some of the changes. I Tweeted about this at the time.

So, the AGM promised to be eventful, and it didn’t disappoint! It was very well-attended, with around 60 members online, as well as the significant number who attended in person. My husband dialled in from home and spoke; it felt odd to be facing him across the virtual Council chamber! The main discussion centred around the proposed resolutions near the end of the agenda. The new version of resolution 5, which proposed only a modest increase in themembers’  fee ceiling, was passed.

Resolution 6, which centred around changes to bylaws governing Trustee Board, was not passed, with 67 members voting to move to next business without approving it, and only 22 in favour of continuing to discuss it (most or all of whom would presumably have voted for it). I will paste the text of what I said in the Council chamber, which seemed to capture the mood of many of my colleagues as well (one thanked me over coffee for my “statesmanlike intervention” in the debate!).

I’m delighted to see that many of the more contentious proposals, such as the proposals that, either deliberately or due to poor wording, risked weakening the power of Council over Trustee Board elections, have been removed. That is a great credit to the leadership team of our College and I am grateful. I am grateful for the hard work of our Honorary Secretary, the Trustee Board, and the Governance Committee, and I do not doubt that they acted in good faith.

However, I remain concerned by the way in which the proposals were originally made, and by the way this has played out over the past week. The proposed changes were in my view really very significant, and had the potential to significantly weaken Council’s relationship with the Trustee Board. The fact that these changes were quietly tabled on the AGM agenda, without any prior discussion with Faculties or at Council, has led to a great deal of ill feeling and distrust amongst our membership. The way that the papers were originally laid out did not make clear the magnitude of the changes being proposed.

The fact that the AGM papers were then changed less than 3 days before the AGM, while commendable in one sense, further added to the sense that the decision-making processes of the Trustee Board are sometimes opaque even to Council members.

I would also respectfully suggest that the process by which these changes were brought to the AGM in this way should be treated by the College as a significant event.

Resolution 9 had been withdrawn by the Honorary Secretary before the meeting because of feedback from members and Faculties that they would like more time to discuss the proposal.

Resolution 10 proposed to change the arrangements by which Council members can oust Officers in whom they have no confidence. Although this bylaw change seemed broadly sensible overall, some members, myself included, were unhappy with the stipulation that, in order for a vote of no confidence to succeed, two-thirds of Council members present at the meeting would need to support it. I put it to the Officers that, if 65% of the Council chamber had no confidence in one of them, they would no longer be able to execute their duties with authority, and they would no doubt resign anyway. To require a simple majority would make more sense. On reflection, the Officers decided to withdraw Resolution 10 and indicated that they would likely bring it back to a future meeting in a modified form.

Council

After a quick break – sadly only coffee and pastries, though I think a few of us would have welcomed a stiff drink – the Council meeting began. The following issues were discussed:

Proposed changes to the Council Standing Orders

This item was withdrawn by the Chair in light of the fact that many of the proposed resolutions in the AGM had not passed. The plan is to bring it back to a future Council meeting. However, I spoke to put my concerns on record. Essentially, the proposed changes would have allowed the Chair of Council and Hon Sec ultimate right of veto over proposed motions to Council. I expressed concern that this would  take power away from Faculties and Council members; this proposal would concentrate too much power in the hands of these two Officers and weakens Council. Concerningly, there was nothing about how a Council representative might be able to appeal such a veto. 

This is a subject close to my heart because I have been trying for several months to bring a Faculty motion to Council, and have had it declined, seemingly with no right of appeal, even though my own Faculty had proposed it and another Faculty had seconded it.

The Chair kindly suggested that I should email her to further discuss my concerns. I must say that I am very impressed so far by how accessible Kamila is to Council members and how willing she is to help.

The Simulated Consultation Assessment

Unsurprisingly, the recent technical outage, which led to multiple candidates being unable to complete part or all of their exam, was a hot topic. Many Council members recounted horror stories which their constituents had shared with them. We are acutely aware that some of the affected candidates risk having their CCT date delayed through no fault of their own. I called for the Officers to find solutions which would allow trainees to get their results as soon as possible. Many trainees managed to complete most but not all stations – can results be extrapolated from the stations they completed? For those who completed few or no stations, can an urgent resit be arranged? I also asked about arrangements for trainees who did eventually manage to log in and sit the exam, but with hours of stress and failed logins beforehand.

The gist of it is as follows:

• The disruption to the exam was due to an external IT provider outage in Europe.
• The RCGP leadership team and the exams team understand how badly trainees’ lives have been affected and are very keen to find solutions.
• The GMC has the final say on which solutions are acceptable, because the SCA is a licensing exam. RCGP explored the possibility of offering an urgent resit for affected candidates; this was vetoed by the GMC as, with so few candidates sitting the resit, the GMC were not confident that the pass mark would be statistically sound, and so the GMC framed this as a potential threat to patient safety.
• The RCGP is therefore urgently exploring other potential solutions, but needs the input of other stakeholders – the GMC, and a psychometrician. Modelling is required to understand whether results can be reasonably extrapolated, in the case of trainees who completed most but not all stations; and also to understand what impact on marks there may be for trainees who struggled to log in but did eventually manage to sit the exam. There will hopefully be an update in the next few days.
• Officers are also considering financial arrangements. For example, many on social media have asked if candidates will be refunded their exam fee as well as being offered a free repeat sitting; this has not yet been decided and it may be several days before a decision is reached.
• In summary, RCGP is taking the situation very seriously, but is constrained by the GMC and its rules around licensing exams.

Gaza

Many members spoke about the conflict in the Middle East. There is a petition currently circulating which calls on Council to call for a ceasefire and to make other statements about the conflict. It was explained to us that the College is a charity, and so is bound very strictly by Charity Commission rules which state that charities can only campaign on political issues when to do so would advance the charity’s objectives. If these rules are broken, the Trustees of the charity are personally liable. However, the Officers recognised the strength of feeling on the subject, and plan to explore next steps outside of this meeting..

Paper C4 – Developing our policy activity for priority 4 of the strategy: Respond to the climate emergency

The RCGP’s Strategic Plan for 2023-2026 consists of four priorities, one of which is to respond to the climate emergency. The purpose of this paper was to explore how we might achieve this as a College. Unfortunately this was at the point in the meeting in which we had been told to speak for no longer than a minute, so I didn’t manage to say everything I had hoped to. In essence, I said:

I welcome this paper and I am grateful to Victoria and everyone on the policy team for bringing this to Council.

As a GP in a secure mental health unit, I recently did a quality improvement project around switching patients from MDIs to DPIs. This was a very easy sell and I was able to get good engagement from colleagues, because the project had other benefits for our patients – DPIs being easier to use and better tolerated by many of our patients, which will hopefully reduce workload in the long term.

Given the workload and workforce crisis, and the political sensitivities around RCGP being seen to ask NHS GPs to take on yet another thing, I would strongly advocate that the College focus on “win-win” initiatives which save practices time and/or money as well as helping the environment. The focus on avoiding overdiagnosis is very welcome in this context.

I enjoyed hearing others’ contributions. I was particularly shocked to learn that electronic prescribing has not yet been rolled out across all of the devolved nations. This is a great example of a change which would reduce GP workload while also being more green.

Paper C13 – MVP update – Supporting our AHP colleagues

This paper had been the subject of fierce online debate in the days preceding Council, as the RestoreGP Twitter account had leaked excerpts of the paper which suggested that RCGP was exploring the feasibility of extending Fellowship to AHPs. I found this a deeply unpalatable suggestion and planned to speak against it. I was relieved, then, when the Honorary Secretary, Michael Mulholland, opened the discussion by explaining that the reference to Fellowship in the paper was a typo and there had never been any plans for this to happen.

Once that contentious proposal was taken off the table, Council was broadly positive about this paper. Potential outcomes include a “Primary Care Summit” at which stakeholders can further discuss what collaboration might look like; and exploring the possibility of some kind of practice-level affiliation with RCGP.

I spoke to this motion as follows:

I think we need to tread incredibly carefully to avoid alienating our core membership. We are the Royal College of General Practitioners and I believe we must stay true to our charitable objective, which is “To encourage, foster and maintain the highest possible standards in general medical practice”. The paper talks about language, and I strongly believe that we should use the language General Practice – not Primary Care, which is much broader.

I’m relieved to hear that there is no proposal to give AHPs Fellowship – the backlash online shows that this was perceived as very inflammatory and would alienate many GP members. As we take this initiative forward, we need to take great care in how we communicate with our members to ensure we take members with us on this. I second [another member’s] suggestion that RCGP needs to explain this was a typo and apologise for the upset caused.

I was pleased to hear about the proposal for practice-level membership. As a GP who co-owns a private practice, I ask that the needs of private GP surgeries are not forgotten when you develop your practice membership.

Conclusion

I hope this blog has given you a useful insight into the decision-making processes at the College, and how I am trying to represent you. If you’ve got any questions or would like to chat, get in touch!