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Opening Statement by Dr Anthony Breslin and Mr Bill Prasifka to the Oireachtas Joint Committee on Health

Opening Statement by Dr Anthony Breslin, Vice-President Medical Council and  Mr Bill Prasifka, CEO Medical Council  to the Oireachtas Joint Committee on Health, 9am, Wednesday, 2nd May, 2018.

Chairperson and members of the Committee, on behalf of the Medical Council, I welcome the opportunity to discuss this important issue with the Joint Oireachtas Committee on Health.

I will say a few brief words about the role of the Medical Council. This is very relevant in the context of this discussion and recent media commentary.

The Medical Council is the statutory body responsible for the regulation of doctors in Ireland. Its purpose is to protect the public by promoting and ensuring the highest standards among doctors. From the day a student first enters medical school until the day he or she retires from practice, the Medical Council works to ensure medical education and training remains up to date and is benchmarked to the highest international standards.

The Medical Council sets standards for all undergraduate education and postgraduate training of doctors and also requires that all doctors fulfil ongoing professional competence requirements to ensure they keep their knowledge and skills up to date throughout their professional lives.

The Medical Council provides guidance to doctors on matters relating to conduct and ethics through its Guide to Professional Conduct and Ethics for Registered Medical Practitioners.
The Medical Council is also where the public may make a complaint against a doctor.

Each year the Medical Council, during the annual retention period, seek out additional self-declared information which we then use for the production of The Medical Workforce Intelligence Report, which provides a detailed overview of doctors’ practice in Ireland, including the exit rates of doctors, the density of doctors in Ireland by county data and the globalisation of the workforce.

Since 2012 the Medical Council has been seeking this additional information from registered medical practitioners to learn more about the scope of their practice. These reports have been developed not only to support the Council’s work but also to inform wider health system-planning and the evolution of systems of care.

The detailed insights enabled through the workforce intelligence presented in these reports continue to highlight a number of key challenges, including retention of doctors, variances in skill-mix and models of care and practice arrangements.

Through sharing information about these challenges, the Medical Council looks to assist all bodies that shape the professional lives of doctors to ensure that the design, development and oversight of the medical workforce continues to foster good professional practice and to protect patients.

This information is based on self-declarations and although the figure of doctors on the General Division who describe themselves as hospital consultants seems quite high, once you examine the figure further and break it into its component parts it is reduced. As this question is based on self-declaration information it also includes doctors who are working outside of Ireland, doctors in locum or temporary positions, doctors in acting up positions, some doctors in training or further education, those currently not in a role, etc. There is also a number of Doctors who qualified as specialists before the new legislation but did not “Grandfather” or transfer over to the Specialist Register in time.

The latest Medical Workforce Intelligence Report is still in draft and is due to be published in the coming months, however we have taken the information most relevant to today’s meeting and have made it available to the members of the Committee and to the other organisations presenting here, with a full breakdown of the figures.

As you will have seen in the supplementary information provided to the committee, 698 doctors on the general division have self-declared as hospital consultants in 2017. 

When you delve further into the figures and remove a number of exclusions such as those working abroad, the number of general division doctors indicating that they practice in Ireland as hospital consultants is 254.

Of the 254 doctors registered in the General Division, 172 practice solely in Ireland with 149 of these working solely in publicly funded services. 165 declared they work in both public and private settings. 81 indicated that they have a mix on working inside and outside of Ireland.

It is worth noting the term consultant is not defined under the Medical Practitioners Act. Accordingly the employer is free to hire whomever they want as a consultant, with the only limitation being that the doctor is on the Medical Council register.

However, a consultant cannot falsely represent themselves as a specialist if they are not on the Specialist Register.

The Council only enters those practitioners on the Specialist Division who have the requisite higher qualifications in that discipline.

Doctors must be in compliance with Maintenance of Professional Competence requirements and enrolled in a professional competence scheme relevant to their area of practice. A registered medical practitioner must maintain their professional competence on an ongoing basis pursuant to a professional competence scheme applicable to that practitioner.

It is worth bearing in mind that the Register of medical practitioners is a “living” database. Each working day at the Medical Council offices, doctors are entered in the Register, are removed from the Register and transferred between its divisions. The figures we have provided today are based on data from the 2017 retention period which is a snapshot from one moment in time.

I would also like to take this opportunity to thank Mr Justice Peter Kelly, President of the High Court, for further highlighting this issue recently and allowing the Council to address the Court on this topic on Monday.

It is also worth highlighting to the Committee that we are seeing a shift in the makeup of the Medical Registers which we maintain. There is an increasing number of doctors on the Specialist Division and in 2017 the Specialist Division was larger than the General Division for the very first time which is a welcome development.

Finally I would like to thank the Chairman and the Committee for the invitation to address you today. Both Dr Breslin and I are happy to address any questions the Committee may have.