Thursday, March 22, 2018

Rajya Sabha Committee recommendations on NMC Bill: Salient points

·         Total strength of the Commission be increased from 25 members to 29 members

·         6 members should be ex officio members

·         9 should be elected by registered medical practitioners from amongst themselves

·         10 members should be from amongst the nominees of the States and Union Territories to be appointed on rotational basis in the Medical Advisory Council for a term of two years

·         3 members appointed from amongst person having special knowledge and professional experience (management, law, medical ethics, health research, patient rights advocacy, science and technology and economics)

·         Ex officio Member Secretary of the Commission should assist the Commission as its Secretary and shall not be a Member of the Commission.

·         President of the Under-Graduate Medical Education Board; President of the Post-Graduate Medical Education Board; President of the Medical Assessment and Rating Board; DGHS, DGICMR and one person to represent the Ministry of the Central Government dealing with Health and Family Welfare, not below the rank of Secretary/Additional Secretary to the Government of India, to be nominated by that Ministry.

·         The Chairperson shall be a medical professional of outstanding ability, proven administrative capacity and integrity, possessing a recognized postgraduate degree in any discipline of medical sciences and having experience of not less than twenty years in the field of medical sciences, out of which at least ten years shall be as a leader in the area of medical education.

·         NITI Aayog has been instrumental in drafting the NMC Bill and hence its own presence in the Search Committee for appointment of Chairperson and Members of the Commission tantamounts to conflict of interest.

·         Search Committee: Cabinet Secretary –Chairperson; 3 experts, possessing outstanding qualifications and experience of not less than twenty-five years in the field of medical education, public health education and health research, to be nominated by the Central Government —Members; 2 experts, from amongst  the  part-time  Members  referred  to,  in clause (c) of sub-section (4) of section 4, to be nominated by the Central Government in such a manner as may be prescribed — Members; 1 person, possessing outstanding qualifications and experience of not less than twenty-five years in the field of management or law or economics or science and technology, to be nominated by the Central Government —Member; Secretary to the Government of India in charge of the Ministry of Health and Family Welfare, to be the Member Secretary for the Search Committee. The Member Secretary will not have any voting rights.

·         Clause 6(6) authorizes the Chairperson or Member of the NMC for accepting any employment in any capacity including as a consultant or expert in any private medical institution after the gap of one year, consequent to his demitting office: the cooling off period of one year may be extended to two years

·         The Secretary should be a person of proven administrative capacity and integrity, possessing a degree in any discipline of medical sciences, and having not less than fifteen years of experience in the administration of medical education and healthcare sectors.

·         Secretariat of the Commission shall be headed by a Secretary who shall be the Secretary to the Commission and not a member of the Commission, to be appointed by the Central Government. Accordingly, consequential changes, if any, may be made in all the clauses to replace the word ‘Member Secretary’ with the word ‘Secretary’.

·         Appellate jurisdiction over the decisions taken by the Commission: Constitution of a Medical Appellate Tribunal comprising of a Chairperson, who should be a sitting or retired Judge of the Supreme Court or a Chief Justice of a High Court, and two other Members, to have an appellate jurisdiction over the decisions taken by the Commission. One of the Members should have a special knowledge and experience in the medical profession/medical education and the other member with an experience in the field of health administration at the level of Secretary to Government of India.

·         All States in the country have a well-defined process to regulate fees charged by the private medical colleges as per their separate State Acts under the existing fee regulatory mechanism and the same should not be diluted.

·         To remove discrepancies it may be ensured that the fee charged by all such unregulated private medical colleges, the deemed universities and the deemed-to-be universities should be regulated at least for 50% of their seats.

·         The quorum of meetings of the Medical Advisory Council should be fifty percent of the Members of the Council.

·         The Council should meet at least twice a year at such time and place as may be decided by the Chairman.

·         The designated authority of the Central Government, shall conduct the common counseling for All India seats and the designated authority of the State Government shall conduct the common counseling for the seats at the State Level.

·         Autonomy to universities/medical institutions as per the provisions of their respective Acts, to which such medical institutions are affiliated, should also be given along with the permission to conduct the common counseling.

·         This permission should, however, be for the vacant seats remaining after the National & State level counseling and should be done on merit basis from the candidates who have qualified NEET, so as no vacant seats remain. Similar changes may be made in clause 15 (5) so that no seats remain vacant for Post Graduates also.

·         The Licentiate examination be integrated with the final year MBBS examination and be conducted at the State Level. The final MBBS examination should be of a common pattern within a particular State, initially due to the logistical constraints, and could be extended across the country as the system streamlines.

·         The final year MBBS exam should be designed in such a way that it takes into consideration not only the cognitive domain but also the assessment of skills by having practical problems/case study types of questions as a major component, with a strong tilt towards primary healthcare requirements.

·         The theoretical examination should be a common short-question based examination for all final professional students at a level commensurate with the current final professional theory examination. The examiners for conducting the practical examinations should be external and to be decided through a lottery from an empanelled list of examiners.

·         The PG NEET for admission to PG courses may continue as of now as an interim management till a mechanism is evolved within three to five years for the conduct of a common final year MBBS examination which has an adequate structure, so that subjectivity in the theoretical examination is replaced by common problem/case study based MCQ type examination.

·         The common final year MBBS examination may be conducted within a particular State by any State University/State Health University or any other suitable agency.

·        The strength of all the autonomous Boards should be enhanced to five instead of three i.e. a President and four members.

·         One member in each of the autonomous boards should be an elected member from amongst the nine elected members as recommended by the Committee in the clause 4(4)(c) in context of composition of the NMC.

·         All the members in the Under Graduate Medical Education Board, the Post Graduate Medical Education Board and the Medical Assessment and Rating Board including their President should be from a discipline of medical sciences from any University and having experience of not less than fifteen years in such field, out of which at least seven years shall be as a leader in the area of medical education, public health, community medicine or health research, except the elected member.

·         The President of the Ethics and Medical Registration Board (EMRB) should be a retired Judge of a High Court so as to meet the said objective.

·         Two members of the EMRB would remain the same as prescribed in clause 17 of the Bill.

·         Out of the remaining two members, one member should be having an experience in the field of law/academics/eminent educationist, of not less than fifteen years and another one member should be an elected member from amongst the nine elected members as recommended by the Committee in the clause 4(4)(c) in context of composition of the NMC.

·         The EMRB shall be independent of the NMC and to avoid any conflict of interest, the Committee recommends that its President should not be a member of the NMC so as to maintain its autonomy and independent character.

·         Clause 24(1)(c) may be amended as follows:- “develop competency based dynamic curriculum for addressing the needs of primary health services, community medicine and family medicine to ensure healthcare in such areas, in accordance with provisions of the regulations made under this Act”.

·         The following new sub-clause may be inserted in clause 25(1): ‘mandate that Institutions that are running post-graduate courses in medical and surgical specialties pediatrics, obstetrics and gynecology shall be required to establish and run post-graduate courses in family medicine as per the regulations prescribed by the Commission’.

·         With reference to Clause 25 (1) & 25(2), suitable provisions may be made to ensure that the shortage of Post Graduate Doctors, Specialists and Faculty is addressed on an emergent basis within the country without compromising the quality as per globally accepted best practices with innovations in clinical teaching methodology.

·         Tor determining the procedure for assessing and rating the medical institutions for their compliance under clause 26(1)(a), the words ‘as the case may be’ to be replaced by ‘using an outcome-based model of regulation that focuses on the outcomes of training rather than the infrastructure, staffing and processes’ in line 39 of the page 11 of the Bill.

·         All three provisos of Clause 26(f) may be done away with and an alternative provision be made for warning, subsequent reasonable monetary penalty followed by adequate time to address the deficiencies and in case the lacunae still remains a provision for de-recognition for a certain period, subject to adequate check and balances to ensure that there is no misuse of discretionary powers be made.

·         The MARB needs to include parameters that capture the qualitative changes that have been brought about by medical institutions. These parameters may include (i) rating of the MARB for medical education; (ii) accreditation of the hospital facilities by NABH/NABL; (iii) contribution in the field of public health in the region where the college is located; (iv) research publications in reputed journals; (v) contribution as a regional training centre, etc.

·         The EMRB board may keep an Aadhar linked database of all medical graduates in the country including their employment status so that an authentic data base of the availability of this important human resource is made and they can be given a choice to opt for rural posting wherever there is a deficit in the country.

·         A process of registration leading to the creation of a common data base of all human resource working in the healthcare sector including the para-medical staff, nurses etc. may be explored and maintained by EMRB.

·         To encourage setting up of new medical institutions of higher standard, those medical professional who have been instrumental in setting up of medical colleges from the scratch, may be given due weightage. Consequently, the Committee, in this regard, strongly recommends for re-drafting of Clause 28(1) of the Bill so as to provide adequate opportunity to the State Government in the decision making process with regard to establishment of the new medical colleges.

·         To incorporate the words ‘of unquestionable integrity having experience of medical profession’ after ‘any other expert’ as mentioned in line 16-17 of page 13 of the Bill.

·         A hundred member panel of experts to be selected as assessors by NMC keeping in view the large size of the country. The deputation of assessors out of these hundred experts would be done by MARB through a process of lottery/draw for carrying out the inspection of medical colleges.

·         The State Governments concerned shall undertake the required assessment and rating under clause 29(a) to (d), prior to the submission of a new proposal for setting up of a medical college to MARB.

·         A mechanism wherein adequate hospital facilities at the commencement of a medical college is mandatory. Hospitals with adequate facilities and providing clinical services for at least three years may only apply for the establishment of a new medical college resulting in better trained doctors with adequate clinical exposure.

·         Clause 32(1) the words any person who qualifies the National Licentiate Examination, as mentioned in line 45 (page 14 of the Bill) may be substituted by the words any person who qualifies the final year MBBS examination.

·         To delete the first proviso of Clause 33(1)(d) of the Bill.
A foreign citizen, who is enrolled in his country as a medical practitioner in accordance with the law, may be permitted to practice medicine and surgery subsequent to qualifying the screening test meant for foreign medical graduates.

·         Highly qualified and renowned medical professionals from countries that are accredited by the National Medical Commission may be permitted to obtain temporary registration in India without going through the screening process.

·         Persons, who contravene any of the provisions regarding bar to practice, shall be penalised with harsher punishment.

·         Insertions of penal provisions under appropriate Sections of the Code of Criminal Procedure, 1973. The Clause may accordingly be re-drafted to incorporate those provisions

·         The discretion of NMC should be subject to qualifying the screening test (FMGE) meant for foreign medical graduates.

·         The Diplomate of National Board, granted by the National Board of Examinations, in broad specialty course and super-specialty course shall be equal in all respects to the post-graduate qualification and the super-specialty qualification, respectively, as granted under this Act with the exception in teaching in medical colleges as they do not take DNB education in a medical college.

·         With the coming into force of this Act, all the post-graduate education programmes being conducted by the National Board of Examinations will be brought under the purview of the Commission for award of common degrees.

·         Any medical qualification granted by the medical institution outside India shall be recognised medical qualifications for the purpose of this Act subject to qualifying the screening test (FMGE) meant for foreign medical graduates.

·         The Central Government may give only such policy directions, as it may deem necessary, to State Government for carrying out all or any of the provisions of this Act.

·         The State Governments may implement measures to enhance the capacity of the existing healthcare professionals including AYUSH practitioners, B.Sc (Nursing), BDS, B.Pharma etc to address their State specific primary healthcare issues in the rural areas.

·         Adequate budgetary resources may also be provided to meet the said objective.

·         Healthcare professionals who are practicing without the requisite qualifications anywhere in the country may attract penal provisions.

·         Consequential changes may be made in all the Clauses of the Bill, wherever applicable.

·         Instead of termination of their services, the employees of Group B, C and D category of the council may be suitably absorbed on compassionate grounds in any Department of the Government.

·         The Preamble to the Bill may be amended as follows after due legislative vetting:- ‘to provide for a medical education system that improves access to quality and affordable medical education, ensures availability of adequate and high quality medical professionals in all parts of the country; that promotes equitable and universal healthcare that encourages Community Health Perspective and makes services of Medical Professionals accessible to all the citizens; that promote national health goals; that encourages medical professionals to adopt latest medical research in their work and to contribute to research; that has an objective periodic and transparent assessment of medical institutions and facilitates maintenance of a medial register for India and enforces high ethical standards in all aspects of medical services; that is flexible to adapt to changing needs and has an effective grievance redressal mechanism and for matters connected therewith or incidental thereto’.

·         Adding a separate provision in the Bill stating as under: ‘Notwithstanding anything contained in any law, the provisions of this Act and subsequent rules & regulations made therein shall be uniformly applicable upon all medical institutions in the country without any distinction, unless specifically mentioned in the Act’.

·         All consequential changes to be carried out in the relevant clauses of the Bill keeping in view the Committee’s observations and recommendations contained in the report.

·         All the Members of the National Medical Commission be required to mandatorily declare their professional and commercial involvements and should also declare their personal assets along with assets of their dependents on the website of NMC as and when they assume office and at the end of their tenure.

·         Formulation of regulatory/licensing/accreditation norms for all paramedical and allied health care professions like physiotherapy, optometry, etc. so as to regulate such professionals and their scope of practice in various clinical settings.

·         A minimum compulsory period of working within the Country be prescribed before such Doctors can be allowed to serve outside the Country.

·         Consideration of a compulsory one year rural posting for all doctors graduating out of medical schools in the country subject to the condition that the requisite infrastructure facilities in terms of supporting staff, decent remuneration, necessary medical equipment and appropriate security are made available so that their training can be appropriately utilized for dealing with shortage of doctors in rural/remote areas of the country.

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