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Annual Report and Financial Statements 2017

The Annual Report and Financial Statements highlight the Council's activities in 2017. Developments during the year include;

  • By the end of 2017, there was a record high of 22,649 doctors registered with The Medical Council.
  • In March 2017, the Medical Council and the Office of the Ombudsman signed a Memorandum of Understanding (MoU) that will allow for the exchange of information and complaints between both offices.
  • Our first joint guide with the Pharmaceutical Society of Ireland is on the Safe Prescribing and Dispensing of Controlled Drugs and was published in October.
  • Your Training Counts Survey 2017 was carried out again and the results from the 2016 survey were used to help drive ongoing support and improvement in trainee experiences in Ireland.

22,649

doctors registered in 2017

35%

of registered doctors are 35 years old or younger

356

complaints received in 2017

62%

pass rate for clinical based PRES 

4%

increase of website visits on 2016

42%

of the medical workforce are female

More Information

Registration

The Medical Council maintains the Register of Medical Practitioners, which in 2017 reached its highest ever membership, with 22,649 doctors on the Register.

Changes to Professional Indemnity requirements

Some major changes were instigated around registration requirements in 2017. One of the biggest changes to impact on registered medical practitioners were the amendments to requirements surrounding Professional Indemnity.

Professional Indemnity is a mandatory requirement, protecting the practitioner against claims arising in respect of medical malpractice, negligence and other civil claims that arise from a breach of duty associated with your practice as a doctor. All doctors practising medicine in Ireland must have indemnity cover appropriate to the nature of their employment/practice arrangement and their area of practice.

The Minister for Health, Simon Harris TD, signed the commencement order for The Medical Practitioner’s (Amendment) Act 2017, which came into effect on Monday, 6th November 2017. This Act amends the Medical Practitioners Act 2007, and outlines new mandatory legal requirements for all medical practitioners currently registered or applying to register with the Medical Council regarding levels of professional medical indemnity.

Divisions of the Medical Register

For the first time, in 2017 the number of registered medical practitioners on the Specialist Division surpassed that of practitioners on the General Division. This follows a trend over recent years.

Doctors by Location of Primary Qualification

58% percent of registered medical practitioners in Ireland in 2017 received their primary medical qualification in Ireland with a further 14% receiving their qualification in another EU member State or European Economic Area country. 28% of registered practitioners received their primary medical qualification outside of a European Union member state or European Economic Area country.

Professional Standards

The main functions of the Professional Standards team are to support the work of the Preliminary Proceedings (PPC) and Fitness to Practise Committees (FTPC) and Monitoring Working Group.

This includes corresponding with complainants and registered medical practitioners with regard to complaints filed for review by the PPC, and organising Fitness to Practise hearings into the conduct, fitness to practise, poor professional performance, or relevant medical disability of registered medical practitioners. They also prepare documentation for each PPC and FTPC meeting, deal with the correspondence following those meetings, and draft the arising minutes for approval. The Professional Standards staff deal with complainants, doctors and doctors’ legal representatives on a daily basis, as well as drafting guidelines required under the legislation and carrying out investigations on the direction of the PPC.

In 2017, 356 complaints were received by the Medical Council.

Professional Competence

The Professional Competence team is responsible for implementing the system for the regulation of the maintenance of professional competence. This is achieved through operating and monitoring schemes for the maintenance of professional competence applicable to all registered medical practitioners and schemes for the assessment of professional performance in response to specific concerns regarding individual registered medical practitioners.

Since the inception of mandatory Maintenance of Professional Competence (MPC) in May 2011, much has been progressed and achieved to facilitate Registered Medical Practitioners’ (RMPs) compliance with the MPC requirements. Enrolment on Professional Competence Schemes (Schemes) and engagement in the CPD activity promoted by the Schemes has been positive.

Noticeable improvement has been reported by the postgraduate medical training bodies (PGTBs) during the early implementation of the MPC. As the MPC model has been implemented, the Medical Council, in collaboration with the Postgraduate Training Bodies, has sought to support and address issues that have arisen through audit and verification processes.

Two key action areas were addressed during 2017:

  1. Addressing Non-enrolment on a Professional Competence Scheme; and
  2. Evolvement of the MPC model.

Addressing Non-enrolment on a Scheme

Through its monitoring role, the Medical Council established that the enrolment rates on a Scheme should be higher than what was being reported by the PGTBs. However it was identified in December 2016 that the data used to determine the size and characteristics of the non-enrolled pool was inconsistent.

The Medical Council took steps to rectify this during the course of 2017. The PCS declaration contained in the Retention of Registration process was amended and all RMPs were required to have paid their Scheme enrolment fee prior to completing the retention for registration form. Three data snapshots were obtained from the PGTBs from June to December of RMPs enrolled on their Scheme and RMPs on training programmes. The Medical Council also contacted RMPs to remind them of their legal obligation to enrol on a Scheme and engage in MPC activity.

A collaborative effort between the Medical Council and PGTBs has resulted in increased enrolment rates, with approximately 95% now being compliant. The Medical Council continues to engage with stakeholders, particularly employers who have a responsibility for ensuring the RMPs they employ are enrolled and engaging in ongoing MPC, and will actively pursue nonenrolled RMPs, enforcing regulatory action as required.

Evolvement of the MPC model

The Medical Council also has a role to play in reviewing the operations of Schemes and recommending improvements. In 2017, Scheme reporting was streamlined to focus on a smaller set of key performance indicators which measure compliance with CPD activity, annual review process and costs, and provide more information on trends to develop the Schemes. A deadline was introduced for registered doctors to enrol in a Scheme. Increased communication to doctors on compliance via the training bodies, the Medical Council and various newsletters was also undertaken.

In October, the Medical Council and Forum for Postgraduate Medical Training Bodies jointly organised a Symposium, focussing on addressing the challenges in MPC and developing Schemes. The Symposium was well attended with participants from, among others, Postgraduate Training Bodies, the Health Service Executive, indemnifiers, and the Private Hospital Association. A number of key opportunities were broadly defined on how to facilitate and manage maintenance of professional competence compliance, especially emphasising the need to move away from considering professional competence as a box ticking exercise and engage in more meaningful lifelong learning. These will be implemented from 2018.

The Medical Council’s Performance Assessment Procedures

The Medical Council’s performance assessment procedures are a non-punitive pathway for supporting RMPs who are experiencing performance issues that can be remediated through a professional development process.

In 2017, 13 cases were referred for performance assessment and covered a range of medical specialties. The performance assessment can incorporate a number of activities such as record review, case-based assessment, direct observation of the doctor, peer and patient feedback, and self-reflection. Occupational Health Assessment is available where necessary to establish if any personal, physical or mental health problems may have influenced the doctor’s performance.

Following a performance assessment, an action or professional development plan may need to be completed dependant on the range and scope of any areas for development. The RMP must demonstrate that any actions required for remediation are completed. Typically, these include attending and completing record keeping, prescribing and communication skills courses. Self-reflection is also utilised in order for the doctor to consider their actions that resulted in referral to performance assessment and how such referral could be mitigated in the future.

The performance assessment procedures available to the Medical Council seek to support the doctor in identifying areas for development in their day to day practice whilst also helping to reassure the public that doctors are keeping their knowledge and skills up to date.

Education, Training and Professionalism

Accreditation

Undergraduate medical education and training

In 2017, the Medical Council conducted reaccreditation visits to two medical schools to assess three undergraduate medical education and training programmes in total, namely the Direct Entry
Programme at National University of Ireland, Galway (NUIG); and both the Direct Entry and Graduate Entry Programmes at University College Cork.

Intern Training

Initial findings from the annual survey of NCHDs and Interns, Your Training Counts, highlighted a need to prioritise concerns raised regarding the quality of intern training – a crucial first year of postgraduate clinical experience for all medical graduates. The Medical Council initiated the formation of a new Medical Intern Board, comprising representatives from the Medical Council, HSE NDTP, Forum of Postgraduate Training

Bodies, Intern Network Executive, Irish Medical Schools Council and the National Lead NCHD. The Board was formed following a consultation process involving all
key stakeholders. Its purpose is to streamline the governance of the intern year with the ultimate aim of providing a more consistent, high-quality experience for interns, leading to better-trained doctors, for better patient outcomes. The Board had its inaugural meeting in October 2017 and will continue its work in 2018. The Council is very grateful to the HSE for accommodating Board meetings and funding and accommodating a new Medical Intern Unit to provide much-needed administration and leadership to run and develop the intern training programme.

Specialist medical training

On the recommendation of the Medical Council, following a thorough accreditation process, the Minister for Health approved the following Specialist Medical Training Programmes in 2017:

  • Vascular Surgery
  • Pharmaceutical Medicine
  • Paediatric Cardiology
  • Neonatology
  • Geriatric Medicine
  • Respiratory Medicine
  • Sports and Exercise Medicine
  • Military Medicine


Clinical Training Sites

Clinical training sites where intern and specialist training are delivered are required to meet standards set by the Medical Council, to ensure they are suitable for training. These sites, which include hospitals, clinics, GP practices, etc., must be inspected by the Medical Council to assess if the standards are being met. In 2016, the Medical Council decided to adopt a “regional” approach to clinical training site inspection visits, starting with HSE Hospital Group sites, and a four-year schedule of Regional Inspection Visits commenced in 2017. The Medical Council visited the Saolta University Healthcare Group in May and the South/Southwest Hospital Group in November. A total of nine clinical training sites underwent a thorough inspection visit and the reports of these visits will be published by mid 2018.

External review of specialty recognition process

The Medical Council currently recognises 57 medical specialties for the purpose of registration in the Specialist Division of the Register of Medical Practitioners. Most of these specialties were “grandfathered” over when the Medical Practitioners Act 2007 commenced. The Irish healthcare system is relatively small when compared to other developed countries, such as the UK, USA, Canada and Australia.

The need for medical specialisation must be counterbalanced with the need to maintain appropriate healthcare services for the population of Ireland. It was therefore decided that, before any further specialties are recognised by the Medical Council, a full, external review of the process of recognising specialties should be undertaken, bearing in mind international practice and alternatives to specialty recognition. This review was completed in 2017 and the Council will consult with relevant stakeholders on a newly proposed process in early 2018.

Recruitment of new Assessor Panel

When the Medical Council accredits undergraduate and postgraduate medical education and training programmes and inspects clinical training sites, it forms an Assessor Team to conduct the accreditation/ inspection and write a report, which is then approved by the Council via its Education, Training and Professional Development Committee. Some years ago, the Medical Council identified a set of competencies required to be an Assessor for Medical Council Education and Training matters, before recruiting a Panel of Assessors. A procurement process was undertaken this year to invest in appropriate training for these Assessors. The Medical Council was delighted to recruit 31 new Assessors to the Panel in 2017. Assessor Training will commence in 2018 and the Medical Council looks forward to working with the Panel on its many accreditation and inspection activities.

Joint Guidance with the Pharmaceutical Society

Following the launch of the Council’s ‘Guide to Professional Conduct and Ethics for Registered Medical Practitioners’ (8th Edition, 2016) and booklet entitled: ‘Working With Your Doctor: useful information for patients’ last year, the Council, in collaboration with the Pharmaceutical Society of Ireland, formed a Joint Working Group to develop guidance for doctors and pharmacists/pharmacies on areas of ethics and professionalism which are of joint concern to both professions. The first joint Guide entitled Safe Prescribing and Dispensing of Controlled Drugs was launched in November this year, following the recent changes in Controlled Drugs regulations, which are also addressed in the joint Guide.

Anatomy

The Medical Council is committed to inspecting, collating and publishing annual returns from places licensed for anatomy practice in Ireland. A database of anatomy donors is maintained and 110 donations were made to medical schools in Ireland during 2017. This was an increase of 12 in comparison to 2016 when 98 donations were made.

Corporate Services

Finance

During the 2017 Financial Year the Finance team successfully implemented a necessary upgrade of the Finance Accounting Software, transitioning from Integra I to Integra II. The system has moved from a client based server to a web based server allowing increased mobility and efficiency within the Finance function. This will support the Council in maintaining a sustainable and high performing organisation in line with Strategic Objective 6 of the Council’s Strategy.

The Finance team have also implemented changes in public sector circulars and legislation with regard to payroll, expenses and financial transactions throughout 2017 in a timely and efficient manner which in turn has benefited our stakeholders.

Human Resources

The number of employees at the Medical Council grew in 2017, following approval by the Department of Health of the Workforce Plan which had been in development for a number of years. Several key vacancies were filled during the year, with this process expected to continue in coming months.

With the focus on recruitment this left little time for projects however the team continued to roll out the Leadership and Development programme and conducted a review of the internal Performance Measurement and Development process. The team have also begun a programme to address succession planning within the organisation to support our staff in their careers and ultimately maintain the expertise and specialist knowledge that enables the organisation to deliver at the level it does.

Information and Communications Technology (ICT)

Unfortunately the Medical Council tragically lost a long serving staff member, our Head of ICT, Jim McDermott suddenly in January of 2017. Over the course of his career with the Medical Council he was involved in many areas of the business and significant projects within facilities and ICT such as our office move from Lynn House to Kingram House in 2009. In recent years he led the ICT team in supporting the Council and its future direction. He is sorely missed and will be remembered by all of his friends and colleagues at the Medical Council.

The ICT department has undergone significant change in 2017 with a new team members rolling out significant projects supported and implemented across the organisation. Progress on strategic projects is well underway to enhance the ICT infrastructure and ensure best in class levels of support and service to our clients and stakeholders, both internal and external, in the coming years.

The ICT department has begun the process of reviewing the ICT policies and maintaining key relationships with third party providers to deliver on its strategic goals.
These include:

  • Membership of HEAnet
  • Upgrade of our phone system
  • Significant service tenders

Communications

Throughout 2017, the Council took the opportunity to get out and meet our stakeholders in person. CEO Bill Prasifka attended several events, including Grand Rounds at University Hospital Galway, Grand Rounds at St James’ Hospital, Dublin, and a speaking opportunity at University Hospital Waterford where he spoke to groups of doctors about the role of the Medical Council, ongoing work, and future plans. In addition, the Communications team spearheaded a number of appearances at other events, with support from an Internal Engagement Group, including the Future Health Summit and the National Patient Safety Office Conference.

There were 949,610 visits to the Medical Council website in 2017, up 11% on visits the previous year. The most popular page after the homepage was “Check the Register”, which received 283,350 unique page views, an increase of 29% on 2016. The Medical Council’s social media presence has developed further over the past 12 months. Increased engagement with our various audiences is of key importance to the Communications team, and our social media channels provide the perfect platform to interact with all stakeholders.

Procurement and Facilities

A number of key procurement items were delivered in 2017 including the implementation of a new Procurement Policy. 21 new contracts and 17 contract renewals were successfully completed by the in-house Procurement Team as well as utilising available OGP Frameworks. These services and supplies included Insurance Brokerage, Internal Audit, HRM System, IT Hardware and Software, Catering, Disaster Recovery and Cold Site, Omnibus/ research, Translation, Training and Engineering.

Key Facilities Management items delivered during 2017 include:

  • Delivery of energy consumption reduction of 82,466.49 kWh on 2016 figures in excess of the 2017 target under Council’s Energy Management Programme. Further recommendations arising out of the SEAI mentoring programme were implemented in 2017 including the installation of LED lighting retrofit.
  • In line with the Council’s Information Governance Framework, a Record Audit was completed with Record Management policies implemented in 2017 to reflect best practice.

Corporate Governance and Council

The first set of guidelines on corporate governance in State bodies entitled “State Bodies Guidelines” was published by the Department of Finance in March 1992. The guidelines were updated in October 2001 and May 2009. The 2016 update by the Department of Public Expenditure and Reform is to take account of governance developments, public sector reform initiatives and stakeholder consultations. The Medical Council have been working to ensure compliance with the updated code since its release and even provided the Department of Health with a working compliance template which was recognised for its value and disseminated for use amongst the other regulators under its aegis.

The team also undertook a governance review of the Council and its term under the new Code of Practice to ensure that the incoming Council of 2018 can benefit from any recommendations and learnings arising from the 2013 – 2018 Council term. This report is due in 2018.

Freedom of Information

The Medical Council received 50 Freedom of Information requests in 2017, an increase of 15 requests on 2016 figures. The requests broke down to 23 personal, 25 non-personal and two were a mix of personal and nonpersonal requests.

Risk Management

The Medical Council recognises the importance of adopting a proactive approach to the management of risk, to support both the achievement of objectives and compliance with statutory and governance requirements.

The Council is committed to ensuring that risk management is embedded both as part of normal day to day business, and informs the strategic, business and operational planning and performance of the organisation.

To this end, the Medical Council is dedicated to effectively managing its risk on a formal basis, and in pursuit of this objective, the Council has set out a framework consisting of a series of simple but well defined steps to support ongoing risk management, to raise the awareness of risk and the need to manage it consistently and effectively across all levels of the organisation.

Risk management is the identification, assessment, and prioritisation of risks followed by coordinated and proportionate application of resources to control the impact of events or to maximise opportunities. The risk management framework in operation within the Medical Council is designed to support the ongoing monitoring, review and management of risks and was developed with reference to the Code of Practice for the Governance of State Bodies 2016, ISO 31000 Risk Management standards and other published guidance for risk management in the public and private sector. 

Role of the Board of Council and Committee: Audit Strategy and Risk

The Board of the Medical Council leads on the appetite, tolerance and management of risk, with the support of the Audit Strategy and Risk Committee, who oversee the quarterly risk register reports. The risk register is designed to identify, manage and mitigate potential material risks to the achievement of the Council’s strategic and business objectives. A sectional Risk Register is compiled by each section of the Medical Council administration, and coordinated and reported to the Audit Strategy and Risk Committee and the Medical Council, by the Chief Risk Officer.

The level of risk tolerance and appetite by the Medical Council is explained below. A sample of the principal risks and uncertainties facing the Council in the short to medium term are also set out below, together with the principal measures in place to mitigate against such risks. This is not an exhaustive statement of all relevant risks and uncertainties. The mitigation measures that are maintained in relation to these risks are designed to provide a reasonable, but not absolute, level of protection against the impact of the events in question.

Risk Appetite

Risk appetite refers to “the amount of risk that an organisation is prepared to accept, tolerate, or be exposed to at any point in time”. The Medical Council, as any organisation, must accept an element of risk across its activities. However, as a public interest organisation, the Medical Council will seek to mitigate risk as far as possible. Its key role is to protect the interests of the public when dealing with medical doctors and as such, its risk appetite is generally low to zero. It recognises however, that to successfully deliver on its mission, to enhance its public service role and provide a greater return to key stakeholders, it must be prepared to avail of opportunities where the potential reward justifies the acceptance of a certain level of additional risk.

In recognition that risk may arise at multiple levels in varying forms, from taking strategic decisions to implementing supporting actions, a risk register is compiled at regular intervals throughout the year, and reported to the Audit, Strategy and Risk Committee, and the Council.