The regulatory landscape in which doctors in Ireland practise continues its rapid pace of change. Following on from making fitness to practise hearings public events, the Medical Council has just introduced on-site practice assessments of doctors’ performance for the first time. It means a small number of doctors can expect their standard of patient care to be looked at as they actually go about their daily work; their interaction with patients and how they perform clinically will now be closely examined.
The actions of disgraced medical practitioners such as Harold Shipman and Michael Neary were rare and exceptional; nonetheless they caused the public to re-evaluate their trust in all doctors. A possible reflection of this trend is the MPS experience of the past five years, which has seen medical claims costs increase by 26% per annum in Ireland.
A small number of doctors can expect their standard of patient care to be looked at as they actually go about their daily work
In turn, politicians took steps to tighten oversight of doctors’ professional activities. In the Republic a new Medical Practitioners Act came into force: among many changes it increased lay representation on the Medical Council; fitness to practise proceedings now take place in public unless the complainant specifies otherwise; and it strengthened the oversight of doctors’ continuing medical education.
Not least, the new Act made it easier to detect and help doctors who were underperforming because of personal illness or addiction. And new performance assessments will now further strengthen the Medical Council’s regulatory role. In the run-up to the new procedures, a consultation process invited views on each of the individual draft rules governing performance assessment; the Medical Council then invited comments on the proposed performance procedures.
Approximately 25 organisations and individuals provided feedback with three main issues emerging as areas of concern:
- The standard against which doctors will be assessed
- The timeliness and confidentiality of the procedures
- Processes for communication with the employer.
Some 355 doctors were surveyed last September, with the following among the opinions expressed about performance assessment: respondents would like to see the process record areas of satisfactory practice as well as those requiring improvement; and they want the process to record health and structural issues within the health service that may be preventing the doctor from engaging in good practice.
It is in everybody’s interest that the Medical Council has a robust process in place to ensure patients receive a high standard of professional care from their doctors
Anecdotally, there is concern among practitioners as to who will be responsible for the not insubstantial costs of what may be a 2/3 day on-site visit. The Medical Council reserves the position that it may levy fees and expenses for the performance procedures and activities. It is currently determining policy in relation to how it will exercise this position, which it says “includes engagement with indemnifiers and the Department of Health and Children”.
“It is in everybody’s interest that the Medical Council has a robust process in place to ensure patients receive a high standard of professional care from their doctors,” said John Delap, Chairman of the Irish College of General Practitioners.
“It will be important that the standards set are based on the highest quality for patients within the level of resources available in our health system. The College will have a role in providing opportunities and support for doctors to meet their educational needs.”