Royal medical colleges `just cosy clubs'

THE ROYAL medical colleges are "toothless tigers" and "cosy clubs", claiming to safeguard the public while in reality promoting the interests of their own members, says the president of the Royal College of Psychiatrists.

Robert Kendell warns the colleges they must take action to respond to a succession of scandals that have shaken public confidence in the medical profession.

Writing in the Psychiatric Bulletin, Professor Kendell says that while in the past the position of the colleges has been "unassailable", recent events have exposed their limitations.

He says a series of scandals - including breast and cervical screening problems,alcoholic surgeons who were allowed to continuing operating and the "awful saga" of cardiac surgery in Bristol - revealed that all too often colleagues were aware of problems but did nothing to stop incompetent practitioners. "It has become clear ... that the colleges lack the power and perhaps the stomach to discipline those senior members of their fraternity who are no longer functioning competently," he writes.

He said that none of the scandals had so far involved psychiatry but that was probably because the nature of psychiatric practice does not lend itself to easy detection of incompetence and patients' lives are not put at immediate risk.

While the colleges see themselves as the guardians of standards, in reality once a doctor is a member or a fellow all the college can do is issue guidelines that doctors do not have to follow.

"The fact is at present all the medical colleges are toothless tigers," the professor says. "Neither consultants nor their employers need pay any attention to the colleges' statements about clinical standards or minimum staffing levels if they do not want to. Even the ultimate and rarely used sanction of expulsion ... is little more than a symbolic gesture."

Professor Kendell says the colleges face a "stark choice" and "time is not on our side". The first choice is to retreat into postgraduate training and abandon pretensions to guarding standards, in which case their prestige and influence would rapidly wane.

The other way would be to nail their colours to the mast over clinical standards. But in doing that "they would be committing themselves to criticising and indirectly imposing sanctions upon their own members and fellows" and risk alienating those they criticise.

However, Professor Kendell adds that while in the past the colleges have had it both ways, as "cosy clubs" and guardians of standards, this is no longer possible. "The colleges have to decide explicitly and publicly whether when a conflict arises they exist to further the interests of patients or doctors," he concludes.