The Need for Change
Under the old Medical Practitioners Act 1978, whilst the Medical Council assumed responsibility for standards in education and training in general, there was no mandatory system for ensuring that doctors participated in continuous professional development or any other clinical maintenance schemes. The majority of doctors did participate in such schemes on a voluntary basis and individual specialty organisations were proactive in co-ordinating involvement of their members in these schemes. However, as participation was entirely voluntary there was no penalty for non-participation.
The new Medical Practitioner’s Act (“2007 Act”) replaced the old statutory regime and it is now the duty of the Medical Council to satisfy itself in relation to the ongoing competence of its registered medical practitioners practising in Ireland. Prior to the introduction of the new statutory provisions under the 2007 Act, continuing education development for doctors was not something which could be ensured. Whilst the Medical Council’s Guide to Ethical Conduct and Behaviour stipulated that doctors should be engaged in the maintenance of competence, there was arguably no facility to effectively ensure that doctors complied with this ethical obligation. The introduction of the 2007 Act brought about the beginning of the end of self-regulation in some respects which provides, under Part 11, for Mandatory Professional Competence Schemes.
The Medical Council’s most recent edition of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners, published in 2009, also outlines the continuing necessity for the maintenance of competence throughout a professional career by taking part in the Professional Competence Schemes established by the Medical Council. Part 11 of the 2007 Act came into law on 1 May 2010 and provides for the establishment of such schemes and places the ethical obligation of maintaining professional competence on a statutory footing.
The Scope of the Schemes
These schemes apply to all practitioners whose names are on the General and Specialist divisions of the Medical Register. Even those practitioners working on a part-time basis must partake fully in continuing professional development and provide evidence of such participation. At present these schemes may not apply to trainees provided they are enrolled in a formal training programme supervised by a Postgraduate Training Body. The Act also places an obligation on the employers of registered medical practitioners to facilitate the maintenance of competence and the involvement of its employees in Professional Competence Schemes.
Requirements in More Detail
The schemes envisage more than simply continuing professional development. They consist of a multi-faceted initiative involving “Clinical Audit” and “Multi-Source Feedback”, in addition to professional development. The schemes are, however, in their infancy and the Council is still working closely with postgraduate organisations and advisory groups in an effort to coordinate the introduction of the three main elements of the schemes. At this time the Medical Council explains that the schemes will consist of the following:
- Practitioners are required to participate in 50 hours of Continuing Professional Development (“CPD”) per year (250 over a 5 year period) as prescribed and overseen by their individual speciality training body. A wide range of activities can go toward the fulfilment of the 50 hour quota, including all educational activities that are sponsored by Postgraduate Training Bodies. The Medical Council also advise that the content of CPD courses undertaken by practitioners will be tailored to their particular specialties.
- The Clinical Audit aspect of the schemes aims to assess, evaluate and improve the care of patients in a systematic way. In short, the idea is that doctors will be measured against a prescribed ideal standard, in an effort to identify and address clinical deficiencies in a doctor’s practice. For example, analysing patient and departmental outcomes and comparing them to national figures can be an effective method of enhancing the quality of clinical services.
- Multi-Source Feedback, on the other hand, involves the procurement of information about medical practitioners from various sources, such as colleagues, nurses, trainees, managers and patients. The introduction of a peer review model is an effective way of assessing a doctors’ performance and has been successfully implemented on the international front. No formal Council rules on Multi-Source Feedback have been implemented and, as such, it is not yet technically mandatory. At the time of writing, the Council advises that practitioners should at least aim to participate in the requisite 50 hours of CPD, in addition to a minimum of one clinical audit.
Should a practitioner fail to cooperate with the requirements under the 2007 Act to participate in Professional Competence Schemes, the Medical Council will have discretion to examine the reasons behind the non-compliance. If extenuating circumstances justify the failure, the Council may dismiss the issue with a warning. The Medical Council advises that medical practitioners who feel they will not be able to complete their requisite CPD hours should contact the Medical Council. However, where there is no justifiable basis for the failure to participate, that doctor could find him/herself subject to a complaint by the Medical Council. The obligation placed both on the Medical Council and practitioners in this regard is a serious one and must be treated as such. The primary responsibility for fulfilling clinical maintenance ultimately rests with the practitioner and, despite the embryonic nature of the schemes, doctors would be advised to be proactive in pursuing a range of suitable CPD activities.
The introduction of this legal obligation helps to create a transparent process which clearly catalogues the involvement of medical practitioners in the maintenance of their professional competence. It should also help to ensure that registered medical practitioners do not fall below an acceptable standard which will, in turn, fulfil the Medical Council’s statutory obligation to protect the public.