As the 500th birthday of the RCP fast approaches deputy CEO Clive Constable asks which of the founding principles are still relevant today, and whether we're still the same organisation as in 1518.
Reaching our 500th anniversary is a significant and rare achievement. We have been celebrating our history this year and rightly so – there is a lot to be proud of. However, it is also an opportunity to look back to what was intended in 1518, and how relevant that still is.
Obviously healthcare, and the world in general, was very different when the college (or as I will call it now: the RCP) received its Charter in 1518 from the 27-year-old Henry VIII, and Thomas Linacre became its first president. Henry was what we now call a Renaissance prince, wishing to ensure the happiness of his subjects. Ensuring modern standards of healthcare (for the time) was one way of doing that. It is clear from the wording of the Charter that he had been lobbied, but that means he was listening. He acknowledged that patients could be misled by false claims to expertise, and he was willing to draw on examples of where things were done better, including overseas.
So, looking for, and following, good practice has been in the RCP’s DNA since the very start. It was deliberately a new type of organisation, bringing together the most educated professionals in their field, not just to regulate their own affairs, but to work together as equals ‘both for their own honour and in the name of the public benefit’.
... good practice has been in the RCP’s DNA since the very start
It was a good start and very well-intentioned but things later changed, as the RCP became more concerned about process and rituals to ensure its survival in politically difficult times, such that the new entry requirements would have excluded Linacre and some of the other founding physicians. The progress of the next few centuries was not always positive, but underlying it was a continuing sense of professionalism and standard-setting that kept the torch alive. This meant that by the time the NHS was coming into being the RCP was able, through its president Lord Moran, to give the necessary and crucial professional support that enabled the government to press on in the face of opposition from other parts of the medical establishment.
The RCP has contributed to the development of medicine in many ways. Some are obvious; others are less so. For an example of the largely unknown, at the end of the Second World War there were only two royal colleges in England, the RCP and the Royal College of Surgeons. Since then the number has grown, along with the recognition of individual specialties, but before then all those with a medical foundation found their home in the RCP. Nowadays that process still continues, with new faculties of the RCP being created from time to time as medicine continues to evolve. The faculties of Forensic and Legal Medicine, and the Faculty of Physician Associates are just two examples, the latter being the first specifically intended to welcome and support practitioners who are not doctors.
Are we still the same organisation as in 1518? The answer is yes, and no
More obvious activities include the development and provision of examinations, and our wide range of work in developing standards and guidelines. Even then, it is not always widely known and appreciated. An excellent example is the National Early Warning Score (NEWS), a tool which improves the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes. At present around 70% of acute trusts in England are using NEWS, and it was developed by the RCP. That is now acknowledged on the NHS website, but probably still not widely known or appreciated.
Are we still the same organisation as in 1518? The answer is yes, and no. In 1555 the membership of the RCP was capped at 40, because the outlook then was different. The concept of having more than 35,000 members, as we have now, would have been unimaginable then – but things have moved on, and it’s just as well. The spirit of 1518 and the intent of the Charter has survived it all, and is now complemented by the RCP500 charter which re-emphasises those original values. We have actively invited physicians to sign up to those values and they have done so willingly and enthusiastically. It’s been quite a journey, and it continues.
Clive Constable is deputy CEO of the RCP, where he also leads the Membership Support and Global Engagement Department.