Stricter assessment of doctors proposed

The Medical Council has proposed that doctors should have to be certified as competent every five years under the terms of a radical restructuring of Irish legislation allowing them to practise in the Republic.

In a discussion paper submitted to the Minister for Health yesterday, the council said: "It is no longer acceptable for bad doctors to be identified and sanctioned following an incident. Our responsibility as a self-regulating profession must be to do our utmost to ensure that patients do not come to harm in the first place."

The body, which is responsible for protecting the public interest when dealing with members of the medical profession, also has proposed that doctors with health problems should not be subject to an adversarial system which deals with their fitness to practise. Both proposals would require extensive updating of the 1978 Medical Practitioners Act.

The international trend is towards proactive assurance of doctors' competence, the council president, Prof Gerry Bury, said. The urgent need for ongoing assurance was underlined by the recent experience of the General Medical Council in Britain of professional misconduct in Bristol, which raised disturbing questions about the extent to which the profession monitors its activities. This related to unacceptably high death rates among children who had undergone heart surgery.

The public should have continuing confidence in the abilities of doctors, Prof Bury said. Irish doctors had been "extraordinarily assiduous" in maintaining their competency, but it was a voluntary effort, and this had not been uniform. The council was proposing a competency assurance system on a partnership basis with the profession and Department of Health primarily.

Current Irish legislation "appears not to require doctors to perform any continuing professional development following completion of training", the paper noted. Many specialities, however, have been active in exceeding the Act's requirements with in-built continuing medical education (CME) and reviews by their peers.

Doctors on a specialist register, in effect all fully-trained doctors, including GPs, would require five-yearly recertification, the council suggested. It envisages the use of educational and audit procedures, to assure the public that, once training is completed, doctors continue to maintain their skills.

While doctors may be willing to consider some form of reaccreditation, formal examinations were unlikely to be acceptable or appropriate, it said. Doctors should exceed a points threshold, with most points allocated for CME and continuing professional development, including courses, self-education and attendance at routine teaching sessions. Up to 20 per cent of points would be allocated on the basis of peer review of competence; likewise for a performance review.

Failure to accrue the relevant points would result in a warning and an agreed remedial plan. Failure to implement this would result in a loss of specialist registration. The inevitable implication was every doctor working in independent practice would be required to be on the specialist register. The peer review would involve examination of facilities, protocols and case management.

A practice audit, for example, would require analysis of outpatient attendance by physicians to examine follow-up or discharge procedures.