Heather’s notes from RCGP Council 18 November 2023

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!

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