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Maintaining professional competence: making it happen

With the case for change made, what exactly does Part 11 of the Medical Practitioner’s Act 2007 mean and what work is happening to bring about change?

Part 11 Medical Practitioners Act 2007

“When the music changes so does the dance”. The Medical Practitioners Act 2007 implemented a wide agenda for reform of medical regulation in Ireland which will impact on medical professionalism for years to come. Part 11 of the Act concerns maintenance of professional competence and is central to this reform. It is founded on three complementary duties.

  • First and foremost, it places a duty on registered medical practitioners to maintain professional competence; the practitioners must pursue a professional competence scheme which is applicable to him or her. The Act provides for the Council to invoke complaint and fitness to practice systems wherein a registered medical practitioner is found to fail in this duty.
  • Secondly, it places a duty of the Medical Council to satisfy itself as to the ongoing maintenance of the professional competence of registered medical practitioners. To achieve this, the Act provides for the Council to establish professional competence schemes. The Council may recognise education and training bodies for the purpose of provision of schemes. Importantly, the Act also requires these schemes to be reviewed with recommendations on any steps required for their improvement to be made to the Minister. 
  • Thirdly, it places a duty on the Health Service Executive and other employers to facilitate the registered medical practitioner’s pursuance of a professional competence. 

Part 11 of the Act also makes specific provisions to safeguard the confidentiality of information collected in the operation of professional competence schemes

Working together to make it happen

The Council has established governance structures to direct the implementation of a system for regulation of the maintenance of professional competence in line with Part 11 of the Act and Council policy. Working groups on the development of professional competence schemes (chaired by Prof Paul Finucane) and professional competence assessment (chaired by Prof Anthony Cunningham) will make proposals to give effect to this system.

Research on methods conducted for the Council by Dr Lynda Sisson (“Professional Practice Review: Developing Standards 2008” and “Performance Assessment: Developing Standards 2008”) is informing this work. Ongoing research on the feasibility and utility of multisource feedback for doctors working in secondary care and a survey on the current and preferred alignment of registered medical practitioners to postgraduate training bodies is also being taken into account.

Within the postgraduate training bodies, work to establish operational schemes is well advanced. The Forum of Irish Postgraduate Medical Training Bodies is providing a useful structure for sharing approaches across individual bodies. This work takes place within the context of a framework, agreed with the Medical Council, which will subsequently provide for recognition of schemes.

A Professional Competence Steering Committee is providing a valuable forum for communication and coordination between all parties involved in making the system for maintenance of professional competence a reality: the Medical Council, the postgraduate training bodies, the HSE, independent hospitals, and the Department of Health and Children. The consensus and momentum developed by this structure has been considerable and will be instrumental in achieving success.

Significant progress has been achieved to date and the fundamental elements of the system for regulation of the maintenance of professional competence have been agreed. With commencement of Part 11 of the Act, the pace of work will accelerate to ensure an operational system in May 2011.

May 2011 – the beginning of a process of change to maintain trust


With commencement of Part 11 of the Act, the Medical Council is seeking to embed effective and sustainable change which will ensure trust between the public and medical practitioners is maintained. Its approach is incremental. May 2011 is the beginning of a process of change. The seamless change and predominance of a learning model in the new system for regulation of the maintenance of professional competence will be easy for medical practitioners to support. Through building on existing systems and working closely with postgraduate training bodies, the Council is confident that from the beginning this process of change is primed for success.

It is expected, however, that the system established in May 2011 will evolve over time in the light of experience.

Maintaining competence, maintaining trust - challenges and choices

Once operational, and in line with specific provision of the Act, the Council will review the operation of this new system to ensure the system for the maintenance of professional competence is practical and effective.

There are a number of challenges.

The system must have credibility with the public whose trust in medical practitioners it seeks to maintain. It must coordinate and integrate with the national framework for quality and safety in healthcare, including local clinical managerial and governance arrangements and the efforts of other regulators. Particular care is required to ensure that regulation of the maintenance of professional competence is faithful to the purpose and motivation of medical practitioners: “hitting the target but missing the point” must be avoided.

Any process of change requires a starting point, but once commenced, choices will need to be made.

The Council is considering the contribution which multisource feedback can make to the maintenance of professional competence. In addition, the question of evolving from a system based predominantly on a learning model requires consideration: should there be stronger integration an assessment model with continuous monitoring or periodic evaluation of medical practitioners?

The Council will inform these choices through its own review of professional competence schemes as they become operational. Evidence emerging from similar developments internationally will be informative.

Above all, however, Council will ensure that choices are informed by the dialogue which it has already commenced between the public and medical practitioners so as to ensure that systems to maintain competence are also effective in maintaining trust.