The publication of the heads of a new Medical Practitioners Bill represents a major step forward in ensuring the highest professional standards for doctors in order to protect the public interest, writes Dr Muiris Houston, Medical Correspondent.
The 1978 Medical Practitioners Act has long been recognised as outdated and cumbersome. The expectations of the public and the need for doctors to keep abreast of new developments have greatly increased since that Act came into force.
In specifying proposals to protect professional whistleblowers and by making it easier to make a complaint against a doctor, the Minister for Health has recognised many of the concerns raised by the recent Lourdes Hospital Inquiry.
Inevitably, much comment will focus on the lay versus professional representation on the next Medical Council. Ms Harney has fudged the issue of an overall lay majority on the 25-member council. While doctors could in theory form a majority depending on ministerial nominations, they are only guaranteed to have 12 members. The Minister's intent is more clearly illustrated by her decision to limit those elected by the profession to seven and to insist on a lay majority on the committee that investigates allegations of medical malpractice.
For some doctors, these changes will be difficult to accept. Amid reports that 1,000 medical practitioners have signed a petition opposing a lay majority on the Medical Council, one senior doctor last night said: "The profession will be furious because of a lack of elected medical members. It will be seen by some as representing a loss of self-regulation". However, John Hillery, the Medical Council president, pointed out that self-regulation remains an option under the new proposals. In contrast, another prominent medic said there should be no issue about an overall lay majority, noting there is no evidence that a new medical council would be "anti-doctor".
What differences will patients who approach the Medical Council with a complaint notice under the new proposals? A complaint will be first considered by a new preliminary proceedings committee. Its function will be to decide if the complaint is to go to a professional conduct committee (the old fitness to practise body but now with a lay majority) or to a health committee (for cases where a doctor's ill health is felt to be the reason for poor competence). In addition, the preliminary proceedings committee can appoint an expert person to investigate the complaint in more detail before referring the case back to the committee, which will then decide whether it represents a health or a professional conduct problem. There will also be a new option to go to mediation if both the doctor and the patient are agreeable. Another significant change is an option to have a fitness to practise inquiry held in public, "unless the complainant or person being investigated objects".
The new proposals represent greater flexibility and clarity for complainants. Until now, the fitness to practise committee had to prove there was a prima-facie case before it could proceed with a formal inquiry.
Although much of the Bill is devoted to professional misconduct, it could be argued that its proposals on competence assurance are just as important in protecting the public interest. The heads make it compulsory for a doctor to maintain professional standards.
Under current proposals this will effectively mean that doctors will be licensed to practise on a five-yearly basis.
While no legislation can completely prevent medical malpractice, this Bill, when enacted, will certainly help minimise harm to patients by the 1 to 2 per cent of doctors who underperform.