A 'crisis meeting' has been called over the Academy of Medical Royal Colleges' future amid infighting between member organisations.
The meeting was scheduled yesterday to discuss how far the colleges are prepared to allow the academy to speak for them collectively.
The academy and colleges were criticised in the Tooke inquiry on Modernising Medical Careers for showing insufficient leadership.
A senior Department of Health source has said the colleges' disengagement from Lord Darzi's review had left them "in danger of becoming like the [City] livery companies".
While smaller colleges are concerned their voice may be lost in any boosted role for their academy, some bigger colleges feel they can better represent themselves. One source commented it leaves the academy with a role "like herding cats".
A source close to the discussion said the "worst case" outcome from the meeting could be that the Royal College of GPs split from the academy - just as the DH was pushing for more integration between primary and secondary care.
The RCGP has distinguished itself by its close engagement with the next stage review. It is the only college mentioned in the report's main text.
RCGP chair Steve Field denied the college wanted a split, but said it should be speaking louder for itself.
Citing the review's proposals on integrated care, he said: "We are doing more with the other royal colleges than ever before." But he added: "We have to be far more assertive as leaders and over the standards of patient care. It's about time we stood up and said there are variations in care and as a college we shouldn't tolerate that."
Last week the Commons health select committee grilled academy vice chair Adrian Newland over his organisation's role. Asked why the academy and royal colleges had not addressed unacceptable variation in clinical practices Professor Newland said: "We don't have the managerial role on the ground."
The colleges could outline good practice but they could not enforce it, he added.
Independent MP Richard Taylor told HSJ that Professor Newland's response was "disappointing".
"I would have thought that an organisation that brings together all the colleges would be able to exert some kind of leadership," he said.