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This article is written by Jannat, a student of Chandigarh University, Mohali. The article evaluates the National Medical Commission Bill 2019.

Introduction

“It will go down in the past as the most revolutionary stride taken to refine and for the betterment of medical education in India.” -Union Health Minister Harsh Vardhan.

The National Medical Commission (NMC) Bill, 2019 was introduced and passed by the lower house i.e (Lok Sabha), and has been introduced in the upper house i.e (Rajya Sabha). The Bill focuses on the abrogation of the existing Indian Medical Council Act, 1956, and replacing the Medical Council of India (MCI) with a contemporary body — the National Medical Commission.

Scope and significance

  1. The National Medical Commission Bill, 2019 is a bill to provide for a medical education system that enhances access to quality and economical medical education, certains the availability of adequate and superior medical professionals in all segments of the country.
  2. This bill encourages equitable and universal healthcare that advances community health standpoint and makes services of medical professionals accessible to all citizens.
  3. It promotes national health aims, encourages medical professionals to adopt the latest medical research in their work, and helps and contributes towards research. 
  4. It has an objective periodic and crystalline assessment of medical organizations and eases maintenance of a medical register for India and administers high ethical standards in all characteristics of the medical system.
  5. This bill is supple to adjust to substituting needs and has effective grievance redressal procedures and for matters linked therewith or incidental thereto.

The current position of medical education and practice in India

The Medical Council of India (MCI) is responsible for regulating medical education and practice. For several years, various issues have been there which are related to the functioning of the MCI like regulatory role, composition, allegations of corruption, and lack of accountability. It has failed to raise the abysmal low doctor-population ratio. It has also failed to rationalize the setting up of Medical Colleges in the country as per regional needs and this has led to geographic maldistribution of technical education resulting in a concentration of institutes in some states while absent in others. MCI could not produce a competent basic doctor. It has put excessive focus on medical education at the cost of another mandate of upholding the ethical practice. It is an elected body. Its members are elected by medical practitioners themselves, that is the regulator is elected by the regulated.

The National Medical Commission attempts to tackle two major aspects- Quality and Quantity i.e. Corruption in medical education and scarcity of medical professionals.

Composition of members 

According to the bill, there will be 25 members in the National Medical Commission and at least 17 of them must be medical practitioners. They will be appointed by the central government on the recommendation of a committee. The commission will include a chairperson, who must be a senior medical practitioner and should have academic experience of at least 20 years, 10 ex-officio members and 14 members will be temporary.

The ex officio members will include:

  1. Presidents of the undergraduate and postgraduate medical education boards, 
  2. The director-general of the Indian Council of Medical Research, and 
  3. A director of one of the AIIMS institutes, among others.

Part-time members, on the other hand, will include:

  1. Experts from the field of management, law, medical ethics, etc.  
  2. Nominees of states and union territories.

Compared to the present 70 percent figure of elected representatives in the Medical Council of India (MCI), only 20 percent of members of the NMC will be elected representatives.

Under the Medical Council of India, decisions were not binding on state medical councils, under the national medical commission to the contrary, the ethics board of the commission can exercise jurisdiction over state medical councils on compliance related to ethical issues. Furthermore, while action against the MCI president can only be taken in the direction of a court, the NMC Bill gives the central government the authority to remove the chairperson or any other member of the commission.

Regulatory bodies under National Medical Commission

Under the supervision of NMC, the Bill will set up four autonomous boards. Each board will comprise a President and four other members out of which two members will be hired temporarily and they will be appointed by the central government on the recommendation of a search committee. These bodies are:

  1. The Under-Graduate Medical Education Board (UGMEB) 

Construes undergraduate academic requirements, training, examinations, faculty credentials, medical college facilities and acknowledges the skills of medical professionals.

2. The Post-Graduate Medical Education Board (PGMEB)

Establishes requirements for postgraduate and superspeciality education, training, examinations, faculty guidelines, and facilities in medical schools, as well as acknowledges academic qualifications.

3. The Ethics and Medical Registration Board

This Board will maintain a National Register of all licensed medical practitioners in the country. This board will keep a record of doctors and licensed community healthcare providers. Only those who are registered under this board will be allowed to practice. The board will also keep a check on the professional and medical conduct of the practitioners.

4. The Medical Assessment and Rating Board

This board will have the authority to grant permission for the establishment of new medical colleges, starting new PG courses. It can also increase the number of seats in medical colleges. If an institution fails to keep up with the standard laid by the UGMEB and the PGMEB then the board can penalise it monetarily.

Important provisions

The Indian Medical Association (IMA) has uplifted the affair over Section 32 of the NMC Bill that issues the licensing for 3.5 lakhs non-medical individuals or Community Health Providers to exercise current or modern medicine. According to the Bill, the Commission may grant a limited licence to practice medicine at mid-level as Community Health Provider to such a person connected with the modern scientific medical profession who qualifies such standards as might be mentioned by the statute.

Earlier there was a programme of bridge course clearing which was a substitute that medical doctors could practice modern medicine. The provision was opposed by doctors on a large scale when the Bill was proposed. The government proposed a similar bill and projected it as a new idea for Community Health Providers to help tackle the disease burden in rural areas.

Based on the current Bill, the Community Health Provider may independently prescribe specific medicines only in primary and preventive medical care, but in cases other than primary and preventive healthcare, he may prescribe medicines only under the supervision of medical professionals enrolled under subsection (1) of Section 32.

“The phrase Community Health Provider has been loosely defined to permit anyone linked with modern medicine to become certified in NMC and licensed to practice modern medicine,” the IMA stated in a public announcement.

“This means that people without a medical background can now practice modern medicine and write prescriptions autonomously. This law makes quackery legal. “This provision, as well as the other contentious provisions, will never be accepted by the country’s medical fraternity,” it further asserted.

Section 15 (1) of the bill proposes a single final-year MBBS exam, the National Exit Test (NEXT) before a person begins practicing medicine or seeks admission to postgraduate medical programmes or the State or National Register. It will also be used to screen international medical graduates.

In its current form, NEXT has been roundly condemned by the medical student fraternity. In a joint statement, the All India Institutes of Medical Sciences (AIIMS) Resident Doctors Association (RDA), the Federation of Resident Doctors Association (FORDA), and the United-RDA stated that “merit alone should be the determining factor in securing a PG seat and the current NEET-PG should not be scrapped.” “The NMC Bill is a blatant violation of medical ethics and a complete disregard for the noble profession. The provisions of the aforementioned bill are nothing short of draconian, encouraging gross incompetence and completely disregarding the professionals who are currently working day and night”, according to the joint statement.

NMC, if instated, would also govern fees as well as other expenses for 50% of seats in private medical colleges and deemed universities. The Bill states, “The NMC will frame guidelines for determining fees and all other charges in respect of 50% of seats in private medical institutions and deemed to be universities that are monitored under the guidelines of this Act.”

The fees charged by unaided medical institutions should be limited. As a result, the current Fee Regulating Authority fee regulation system should win out in the end, and the relevant provision in the bill should be amended accordingly. (See section 10(1)(i)). According to the Bill, only five of the proposed 25 members for the NMC would be elected, which means the remaining members would be either public officials or those appointed by the authorities. The allopathic health care system should be governed solely by qualified MBBS graduates. Furthermore, rather than being nominated, members should be democratically elected. on 4. The NMC should continue to maintain its decision-making. and be an open and transparent Autonomous body of regulators with the highest intellectual conduct, and the Central Government can guide the NMC on matters of public interest but should not be authoritarian in nature.

State Medical Council

There are currently 29 states that have established a national medical council to prescribe a code of ethics for regulating the professional behaviour of medical practitioners and take disciplinary measures against those who break the Code. The State Medical Council is an elected body composed primarily of medical practitioners in several states, including Gujarat, Maharashtra, and Delhi.

Complaints about professional or ethical misconduct committed by a registered medical practitioner will be handled by the State Medical Council, which is established by state law. If a medical practitioner disagrees with a decision made by the State Medical Council, he may file an appeal with the Ethics and Medical Registration Board.

How NMC Bill may help curb corruption in MCI?

Some of the provisions of the Bill might prove themselves to be useful to help fight corruption, which has been affecting MCI for a long time. The members of NMC have to declare their assets at the time of assuming the office and when they vacate their office. They will have to submit a conflict of interest declaration as well. This provision was not in MCI. The members also have to fulfill a two-year cooling-off period after their term, which nonetheless, could be waived by the government if it thinks it is necessary.

Conclusion

India has been suffering from the problem of inappropriately and poorly trained doctors of varying quality for a long period. The World Health Organization has prescribed a medical doctor to patient ratio of 1:1,000, however as reviews indicate, India is a long way from attaining that target. Most of our rural and poor are denied the right to good care. Estimates show that there should be about eight lakh doctors actively practicing, which means that we need an additional five lakh doctors. It is important to note that at present 57.3% of people presently exercising allopathic remedy do now no longer have a medical qualification. Allowing ‘Community Health Providers’ to prepare medicinal drugs is possible to plug this shortfall to a few extents. The concept is very familiar in other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine.  For example, In the United States of America nurses perform a wide variety of functions, providing primary, acute, and special healthcare facilities which include performing diagnosis and prescribing drugs to the patients but for this, they have to complete a master’s or doctoral degree program, advanced clinical training and obtain national certification.

This bill was passed in the upper house by a voice vote and an important amendment was brought in the bill by the government, the amendment increased the representation of the states in the commission according to the demand of the opposition.

References


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