Intensive care medicine: Is this the time to unify our professional organisations?

We stand at a pivotal moment for the future of intensive care medicine in the UK. Throughout the pandemic, our specialty rose to the challenge, demonstrating its critical role in national healthcare. However, the crisis also exposed longstanding issues, particularly the inadequate capacity of intensive care services. ¹ Now, as our specialty continues to grow in confidence, we are considering the formation of a new independent College of Intensive Care Medicine with the aim of better advocating for both our specialty and the patients we serve.

As the immediate past chairs of the resident doctor committees at the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS), we have spent the past years fostering integration and collaboration between the two bodies. In this article, we reflect on the question; is now the right time to explore the potential unification of our professional organisations?

A single, unified, louder voice

Intensive care medicine is a relatively small specialty, and while our professional circles may feel broad, we share the space with 23 other Royal Colleges and Faculties, many of which are larger and more influential. When engaging with national decision-makers, such as the departments of health and the four-nation health systems, as well as statutory education bodies and the General Medical Council (GMC), a unified voice would carry greater weight than several smaller ones working independently.

A notable example of this is the Royal College of Emergency Medicine, which successfully merged with its association in 2008. This consolidation has helped it become a strong advocate for emergency care in the UK. Considering the growing challenges facing the NHS, including the underrepresentation of ICU bed capacity and staffing concerns highlighted in reports like the Darzi Review ² and the NHS Long-Term Plan, ³ a more unified structure could help elevate the profile of intensive care medicine and ensure it receives the attention it needs.

There are, of course, alternative models to consider. For instance, the Royal College of Anaesthetists and the Association of Anaesthetists have maintained separate identities and now developed an effective and collaborative relationship. Some organisations outside the traditional college model can also engage more freely on certain issues. However, many Royal Colleges have increasingly embraced advocacy, recognising the value of directly addressing public concerns and contentious issues.

Enhancing collaboration and reducing duplication

One of the strongest arguments for unification is the significant duplication of efforts across these and other organisations. Though both organisations have worked together successfully on some guidelines, there is no need for the duplication of a wide range of work on the same topics. There is even less need for unnecessary competition and rivalry between organisations when we should all be working together. Many members contribute voluntarily to both organisations, and a more coordinated approach could help direct their time and expertise more effectively. As the expectation grows for doctors to be renumerated for their contributions to education, examination, and standard setting, streamlining these efforts would reduce inefficiencies and allow our collective energy to be better directed.

Financial burden

For many intensivists, professional organisations can sometimes feel distant from their day-to-day work. However, the financial burden of maintaining multiple memberships is very tangible. In addition to the organisations discussed here, many intensivists also belong to subspeciality-specific and European bodies. In the current economic climate, sustaining several smaller national organisations may become increasingly challenging. Even well-established Royal Colleges have faced financial pressures, ⁴ as seen with the Royal College of Anaesthetists selling their historic home. A more unified structure could potentially offer a more sustainable financial model, allowing for greater efficiency and stability.

Strengths and synergy

Each organisation brings valuable strengths to the table. FICM has a statutory responsibility from the GMC for managing education and training and plays a key role in representing intensive care at the Academy of Medical Royal Colleges. ICS has built a strong national conference and a well-regarded research journal. There is also an important conversation to be had with the Scottish, Welsh, and Northern Ireland Intensive Care Societies, each of which has developed a strong profile and meaningful representation within their respective nations and devolved governments. A more unified structure could help preserve these unique strengths while fostering greater collaboration and a unified voice across the UK that represents the diversity of our profession.

Conclusion

The organisations have had varying degrees of historical integration. Previous merger attempts were hindered by challenges in establishing a governance structure that fairly represented both leadership teams, concerns over financial viability for one or both organisations and the complexities of navigating the new intensive care landscape as relatively young entities. However, now that both organisations are more established and financially stable, the most significant obstacles appear to have been overcome. As intensive care medicine continues to evolve, it is worth considering whether in the current landscape a unified professional body could offer a stronger, more effective voice for our specialty and our patients. Moving forward, we ask for an open and constructive dialogue towards a shared future vision of intensive care medicine in the UK.