The provisions outlined, while voluntary at first, will become compulsory, writes Dr Muiris Houston, Medical Correspondent
The presentation of the details of a scheme to ensure the competence of doctors, coming just after last month's publication of the heads of a new Medical Practitioners Bill, is timely.
The Bill has as its prime objective the protection of the public. It puts an onus on doctors to remain up to date and says the Medical Council has a duty to satisfy itself that doctors are maintaining their competence.
The provisions outlined by the Medical Council yesterday, while voluntary at first, will be compulsory under a new Act.
They build on competence assurance developments that have evolved since 1997. At present, doctors are asked by their postgraduate training body to carry out 50 hours of continuing medical education (CME) per annum.
Although CME is audited, there is little evidence to show that it accurately assesses a doctor's competence or identifies poorly performing doctors.
But the most significant proposal from the Medical Council is the introduction of a formal professional practice review scheme. A doctor will nominate eight medical and eight non-medical peers as well as 25 patients, each of whom will fill out a questionnaire. This will record the individual practitioner's standard of patient care, communication skills and clinical performance. The Medical Council will receive a confidential copy of the results for doctors who score in the lowest 5 per cent.
For these doctors, an onsite performance evaluation of the doctor's practice will be carried out over a two-day period by experienced assessors. Recommendations for retraining or other remedial action will be made for underperforming doctors.
Some 400 doctors will be invited to participate in professional practice reviews starting in October. This pilot scheme will tell us how well the proposals work in practice as well as giving an indication as to the potential cost of a wider scheme. These will have to be borne by the Health Service Executive for the public sector and will give rise to increased fees in the private health system.
Will the new scheme work? It is based on best international practice and has been the subject of much consultation. But it will take up to six months for the pilot scheme to be evaluated. Patients will want to see evidence that the estimated 1-2 per cent of doctors who under-perform are identified. And doctors will want reassurance that they will be given protected time to participate fully in the scheme and that adequate support is given to those who require retraining or assistance for health reasons. Whatever the outcome, competence assurance is here to stay.