Annex A > Chapter 4 - National Accountabilities and Roles > National regulatory and professional bodies > Royal Colleges
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Royal Colleges
211 There are Royal Colleges for each of the principal hospital-based clinical specialties. They are established by Royal Charter (e.g. the Royal College of Surgeons of England (RCSE) was established in 1800; and the Royal College of Physicians of London [282] (RCP) in 1518).
212 The objectives of each vary, but have a broad similarity in encouraging education and knowledge (`science') in their respective fields. Royal Colleges typically have charitable status. The Inquiry took evidence from the RCSE, the RCP, the RCA, the Royal College of Paediatrics and Child Health (RCPCH) and other Royal Colleges. The first table of comparisons (Table 5) below sets out comparisons between four Royal Colleges of hospital-based clinical specialties in respect of such matters as constitution, membership, fellowship, discipline and funding.
213 There are also Royal Colleges relating to non-hospital-based medical specialties, such as the Royal College of General Practitioners (RCGP). In the second table of comparisons (Table 6), the RCGP is contrasted with the British Paediatric Cardiac Association (BPCA), one of very many other, ad hoc, associations of healthcare specialists. The other specialist associations that have given evidence to the Inquiry include: the British Cardiac Society (BCS), the Paediatric Intensive Care Society (PICS), the Intensive Care Society (ICS), the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCS), the Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) and the Society for Cardiological Science and Technology. The details of the RCGP in the second table of comparisons (Table 6) may also be compared with those of the four hospital-based specialties in the first table of comparisons.
214 There are also Royal Colleges for healthcare professionals other than doctors, such as the Royal College of Nursing of the United Kingdom (RCN) and the Royal College of Midwives (RCM). In practice, the RCN has functions like that of a trade union, in addition to having a Royal Charter. Miss Christine Hancock, General Secretary, RCN, told the Inquiry:
`The RCN is a professional union, responsible for addressing its members' employment and welfare needs, as well as the realisation of their professional goals. In addition, unlike most other accredited trades unions within the health service, it is governed by its Royal Charter to promote the science and art of nursing.' [283]
215 The third table of comparisons (Table 7) sets out the similarities and differences between the RCN and the RCM.
| | College | |||
|---|---|---|---|---|
| | RCSE | RCP | RCA | RCPCH |
| Founded | 1800 | 1518 | 1992 | 23 August 1996 |
| Constitution | Royal Charter granted 1800 | Royal Charter granted 1518, endorsed by statute 1523. RCP's role and responsibilities altered over time, notably due to the founding of the GMC and the Medical Acts of 1858, 1860, 1886 and 1960 | Faculty of Anaesthetists established within RCSE 1948, became College of Anaesthetists in 1988. Royal Charter granted and become Independent Royal College 1992 | RCPCH was formerly the British Paediatric Association (BPA) with no statutory authority or duties. Royal Charter granted 17 October 1996 |
| Charitable status | Yes | Yes | Yes | Yes |
| Headquarters | London | London | London | London |
| Responsible to whom? | Independent | Responsible to the Privy Council | Independent | Independent |
| Responsible for | Surgical specialties | Medical specialties, general internal medicine | Anaesthesia | Full range of general and specialist paediatricians (but not paediatric cardiologists) |
| Aims | Art and science of surgery | To set the standards and to influence the quality of medical practice in hospitals [39] | Education, training, research and promotion of anaesthesia | Art and science of paediatrics, raising standards, education of practitioners and public |
| Number of members | Fellows and members: 6, 000 (UK) and 2, 000 (overseas) | 9, 000 fellows worldwide and 7, 000 active collegiate members | 10, 728 fellows, 962 members and 1, 965 trainees | Just over 5, 000 |
| Sources of funding | Courses (16%), investments (16%), membership subscriptions (15%), rents, charges and sales (11%), examinations (9%), grants (9%), legacies (8%), residential and conference (8%), donations (8%) | Membership subscriptions, examination fees, DoH grants in aid, investments, room hire | Fellows' subscriptions (45%), examination fees (21%), course fees (13%), DoH grants (6%), investment income (6%), other income (9%) [40] | Members' subscriptions, annual meeting, research unit, profits from archives, trading subsidiary, sales of publications, donations, surveillance unit, training grants [41] |
| Basic membership | LRCS (primary qualifying diploma) | Membership is obtained through passing an examination (MRCP(UK)) and payment of a diploma fee | Membership (paying College subscriptions and participating in College activities) voluntary | Ordinary members have passed College membership examination - MRCPCH (parts 1 and 2). Junior members have commenced training but not passed exam. Administers Diploma in Child Health (DCH) |
| Higher membership | MRCS (postgraduate diploma - basic surgical training) | Associate membership; MRCP(UK) qualification [42] | Fellowship: FRCA (following traditional surgical model) | Associate members are paediatricians in non-consultant career grade posts and medical practitioners from other specialties with an interest in child health |
| Fellowship | FRCS (intercollegiate examination toward end of specialist training) | FRCP | See above | Fellows are selected by Council from members on Specialist Register |
| Is membership a requirement for employment? | No, but widely looked for | Membership and Fellowship are not compulsory for employment in relevant posts, though generally recognised | Membership has no legal relationship to the continued practice of the specialty | |
| Training post approval | Role in the Joint Committee on Higher Surgical Training and the Specialist Advisory Committees | Approves senior house officer (SHO) posts and rotations for training. Central to the Joint Committee on Higher Medical Training's approval and supervision of training posts and programmes | Programmes of inspection of hospital posts for approval of training of anaesthetists: `a powerful tool ... through the ultimate sanction of removal of training posts'. [43] Provides an Advisory Appointments Committee assessor on consultant and non-consultant career grade appointment committees | Higher Specialist Training: monitors trainees, publishes syllabus and recommends Certificates of Completion of Specialist Training. General Professional Training: inspecting and approving SHO posts. Advising committees appointing consultant paediatricians |
| Standard-setting | Has published many documents, including `The Surgeon's Duty of Care'. No statutory powers | Ad hoc reports and guidelines are recommendations as to good practice. Some statutory powers: providing representatives on advisory appointment committees; also delegated powers with respect to specialist training from specialist training authority | Sets educational and training standards for entrants and good practice and conduct for continuing members | |
| Current President [44] | Sir Barry Jackson | Prof Sir George Alberti | Dr Peter Hutton (Professor Cedric Prys-Roberts was President from June 1994 for 3 years) | Prof David Hall |
| Discipline of members | `The College's disciplinary powers over members are limited. ... It cannot ... of itself, initiate disciplinary action against individuals in relation to their standards of professional practice' [45] | If member `has been guilty of any great crime or public immorality, or has acted in any respect in a dishonourable or unprofessional manner.' [46] Participation in Joint Cardiology Committee `intermediate procedure' review | Grounds for termination of membership include fraudulent application for membership, criminal conviction, GMC erasure, bankruptcy (not yet used). The Joint Liaison Committee responds to requests for help in dealing with the poor performance of anaesthetists and with system failures | |
| Continuing Professional Development/ Continuing Medical Education (CME) | Involved in Senate of Surgery publications promoting CME | Co-ordinates and monitors for consultant and non-consultant career grade physicians | Likely in future to be a requirement of membership. Wants statutory role in CME linked to revalidation | |
| Historic links to other colleges | RCSE keeps pre-1992 archives of RCA | Historic links with many other Colleges. Before formation of RCPCH, paediatricians were represented on own board within RCP. RCP retained responsibility for paediatric cardiology. Joint CME programme with the Royal Colleges of Physicians of Edinburgh and Glasgow | RCSE keeps pre-1992 archives of RCA. Mutual recognition of Fellowship of College of Anaesthetists and Royal College of Surgeons in Ireland | RCP retained responsibility for paediatric cardiology |
| [39] WIT 0032 0001 Professor Sir George Alberti. The College has, since the period covered by the Inquiry, developed a new statement of purpose - see further WIT 0032 0002 [40] WIT 0065 0117; RCA annual report 1997/98 Professor Strunin [41] WIT 0036 0151; annual report 1997/98 Professor Baum [42] WIT 0032 0003 - 0004 Professor Sir George Alberti [43] WIT 0065 0007 Professor Strunin [44] As at January 2001 [45] WIT 0048 0003 Sir Barry Jackson [46] WIT 0032 0017 Professor Sir George Alberti; chapter 34, bye-law 168 `Of Penalties' [47] WIT 0036 0009 Professor Baum [48] WIT 0036 0010 Professor Baum |
| | College | |
|---|---|---|
| | RCGP | BPCA |
| Founded | 1952 | 1991 |
| Constitution | 1952 (unincorporated association), `Royal' prefix 1967, Royal Charter granted 1972 | 1991. Non-statutory body [49] |
| Charitable status | Yes | A non-profit-making organisation |
| Headquarters | London | No headquarters building |
| Responsible to whom? | Independent | Independent, but affiliated to the British Cardiac Society |
| Responsible for | General practitioners | Paediatric cardiologists and paediatric cardiac surgeons |
| Aims | `To encourage, foster and maintain the highest possible standards in general medical practice' [50] | `To promote the study and care of infants and children with heart diseases ... to promote and distribute study data pertaining to these problems and their prevention; to help those engaged in this work ... to promote communication and co-operation between these workers.' [51] |
| Number of members | 18, 400 | 270 |
| Sources of funding | Annual membership fees, examination fees, sale of publications, grants for specific research and particular projects and activities | Members' subscriptions |
| Basic membership | MRCGP | - |
| Higher membership | - | No higher membership |
| Fellowship | FRCGP | No fellowship |
| Is membership a requirement for employment? | No | |
| Training post approval | `The College plays no direct role in the regulation of entry to the profession nor continued membership of it. The Competent Authority which regulates entry to general practice is the Joint Committee on Postgraduate Training for General Practice (JCPTGP)' [54] | `The Association plays a major role in training but the statutory control of this rests with the Specialist Advisory Committee (SAC) of Paediatric Cardiology of the Joint Committee on Higher Medical Training of the Medical Royal Colleges and of the SAC in Cardiothoracic Surgery of the Joint Committee on Higher Surgical Training of the Royal Colleges of Surgery.' [55] |
| Standard-setting | `In 1993 the Royal College of General Practitioners, in conjunction with the British Paediatric Association, produced guidelines on the paediatric component of vocational training for general practice' [56] | `It has attempted to advance professional standards and good inter-disciplinary practice.' [57] |
| Current President [58] | Dame Lesley Southgate | Dr Michael Godman |
| Discipline of members | `The College has limited regulatory control over its members in the sense of their right to practise. The College's disciplinary powers are generally confined to striking them from the list of members if they fail to renew their subscriptions or when they are struck off the Medical Register by the General Medical Council (GMC)' [59] | `The British Paediatric Cardiac Association at present is not a regulatory body...' [60] |
| Continuing Professional Development/Continuing Medical Education (CME) | Introduction of Accreditation of Professional Development (APD) planned | The BPCA appoints a Council Member to regulate and assess programmes of Continuing Medical Education in Paediatric Cardiology. This responsibility has been devolved to the Association from the Royal Colleges [61] |
| Historic links to other colleges | None | Affiliated to the British Cardiac Society, and thereby to other similarly affiliated associations [62] |
| [50] WIT 0059 0020 Royal Warrant [51] WIT 0047 0014 Dr Godman [52] WIT 0059 0003 Dr Reith [53] WIT 0059 0006 Dr Reith [54] WIT 0059 0003 Dr Reith [55] WIT 0047 0004 Dr Godman [56] WIT 0059 0005 Dr Reith [57] WIT 0047 0003 Dr Godman [58] As at January 2001 [59] WIT 0059 0005 Dr Reith [60] WIT 0047 0004 Dr Godman [61] WIT 0047 0003 Dr Godman [62] WIT 0066 0002 Dr Howard Swanton |
| | College | |
|---|---|---|
| | RCN | Royal College of Midwives [63] |
| Founded | 1916 | 1881: Midwives Institute founded under the patronage of Queen Victoria 1889: Incorporated under the Companies Acts 1942: Name changed to The College of Midwives 1947: Name changed to The Royal College of Midwives 1971: The Royal College of Midwives was included on the Special Register of trade unions established under the Industrial Relations Act 1971 |
| Constitution | Royal Charter granted 1928 | The last modifications to the Memorandum and Articles of Association were made on 20 April 1999 |
| Charitable status | Yes | The College does not have charitable status. A sister college (The Royal College of Midwives Trust) is registered as a charity |
| Headquarters | London | London |
| Responsible to whom? | `The College is accountable to Her Majesty the Queen in Privy Council' [64] | Independent |
| Responsible for | Nurses | Midwives |
| Aims | `To promote the science and art of nursing and the better education and training of nurses and their efficiency in the profession of nursing' [65] and other aims | `To promote and advance the art and science of midwifery, to promote the effectiveness of and protect the interests of midwives' [66] |
| Number of members | 318, 000 | Approximately 35, 000 |
| Sources of funding | Membership subscriptions, gifts [67] | Membership subscriptions: 95% Net income from courses: 2% Dividends and interest: 2% Other: 1% |
| Basic membership | Full membership is open to all nurses on any part of the UKCC Register. In addition there are Newly Qualified, Joint, Career Break and Associate memberships, depending on circumstances | Full membership and Overseas membership are available to practising midwives. Associate, Retired and Honorary memberships are available for those no longer practising, depending on eligibility |
| Higher membership | No higher categories of membership | No higher categories of membership |
| Fellowship | No higher categories of membership | No higher categories of membership |
| Is membership a requirement for employment? | No | Membership is not required or even recommended for practice as a midwife |
| Training post approval | No | The College does not inspect or approve midwifery training posts |
| Standard-setting | `The RCN is a leading player in the development of nursing practice and standards of care.' [68] `The RCN offers its members a wide range of services including: development of nursing practice and standards of care'. [69] `The Dynamic Quality Improvement Programme has focused on developing work, including ... developing specialist guidelines and standards.' [70] `An initial programme of work to develop national standards for particular specialty areas was undertaken during the late 1980s and early 1990s. This resulted in the production of standards for a whole range of specialist subjects' [71] | The College plays only an advisory role to its members and the five statutory bodies (the UKCC and the four National Boards) |
| Current President | Mrs Roswyn Hakesley-Brown (General Secretary: Christine Hancock) [72] | Dame Lorna Muirhead (General Secretary: Karlene Davis) [73] |
| Discipline of members | `The RCN can remove members from membership, although this power has never been used' [74] | The College regulates the conduct of its members only in relation to the Code of Conduct for Council members as directors of the company and trustees of a charity |
| Continuing Professional Development/Continuing Medical Education | `The RCN offers its members a wide range of services including: education and professional development activities' [75] | The RCM currently runs courses, study days, workshops and conferences |
| Historic links to other colleges | `The RCN has a good track record in working with other organisations in order to improve health care.' [76] | Links with other Royal Colleges are informal and depend upon mutual co-operation |
| [63] Information in WIT 0576 0001; letter from Louise Silverton, Deputy General Secretary, Royal College of Midwives to Inquiry, dated 6 October 2000 [64] WIT 0042 0003 Miss Hancock [65] WIT 0042 0004 Miss Hancock [66] WIT 0576 0016; Memorandum of Association of The Royal College of Midwives [67] WIT 0042 0004 Miss Hancock [68] WIT 0042 0003 Miss Hancock [69] WIT 0042 0003 Miss Hancock [70] WIT 0042 0005 Miss Hancock [71] WIT 0042 0005 Miss Hancock [72] As at January 2001 [73] As at January 2001 [74] WIT 0042 0003 Miss Hancock [75] WIT 0042 0003 Miss Hancock [76] WIT 0042 0025 Miss Hancock |
216 As `independent' bodies, the Royal Colleges are not accountable to anyone other than their own members for achieving their respective objectives, save to the extent that some are responsible to the Privy Council (see Tables above). Much evidence was received as to the role of the Royal Colleges in the maintenance of standards, both in relation to clinical practice and to professional education.
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Footnotes
[282] There are other Royal Colleges of Physicians, including the Royal College of Physicians of Edinburgh and the Royal College of Physicians of Glasgow
[283] WIT 0042 0004 Miss Hancock