Just Released: Much awaited report from the Parliamentary Standing Committee on the National Medical Commission, 2017

Committee proposes to move forward with the NMC Bill, 2017 with substantial recommendations on the Constitution of the NMC, regulation of fees in Medical colleges, the National exit exam and role of States in approving medical colleges

The Department-related Parliamentary Standing Committee has presented its report along with its observations and recommendations to the Rajya Sabha on 20th March, 2018. The report titled “109th report on the National Medical Commission Bill, 2017” also details the depositions received by the Committee from various Bodies, associations and individuals.

Summary of recommendations:

• Larger commission with 29 members

• Larger autonomous boards with 5 members instead of 3 proposed earlier

• More state representation with 10 nominees from States and UTs

• More elected doctor representation with 9 elected members against 5 proposed earlier

• Set up a Medical Appellate Tribunal as appellate body over the NMC in place of Central Government

• Let State governments regulate fees in private medical colleges as prevalent currently

• No separate NLE – Final year MBBS examination to be considered as Licentiate examination

• The Ethics and Medical Registration Board to be headed by a retired High Court Judge, to be independent of the NMC

• State Governments to have higher role in setting up and assessment and rating of medical colleges

• DNB qualification equivalent to MD qualification in all respects with the exception of teaching in medical colleges

• Bridge course clause accepted but to be made a non-mandatory provision

• NMC members to report personal and dependents’ assets on NMC website before and after tenure

• Government should consider overhaul of Dental Council of India, Nursing Council and other Councils

• Students graduating from Government Medical colleges must serve minimum period within country before serving outside the country

• Government should consider compulsory 1 year rural posting

Key excerpts from the report:

1. On the issue of constitution of the NMC and inadequate Doctor representation and inadequate State representation

Committee Recommendation

The Committee, therefore, keeping in view the representative and federal character of the country, recommends that the total strength of the Commission be increased from 25 members to 29 members. The Committee also recommends that out of these 29 members, besides Chairperson of the Commission,

– 6 members should be ex officio members,

– 9 should be elected by registered medical practitioners from amongst themselves,

– 10 members should be from amongst the nominees of the States and Union Territories besides

– 3 part-time members appointed from amongst person having special knowledge and professional experience as mentioned in the clause 4(4)(a).

The Committee also recommends that the ex officio Member Secretary of the Commission should assist the Commission as its Secretary and shall not be a Member of the Commission.

2. On the composition of the Search Committee for appointing Chairperson and members of NMC

Committee Recommendation

…The Committee, however, observes that NITI Aayog has been instrumental in drafting the NMC Bill and hence its own presence in the Search Committee for appointment of Chairperson and Members of the Commission tantamounts to conflict of interest.

The Committee, therefore, recommends for the following composition of the   Search Committee: (a)  the Cabinet Secretary – Chairperson;   (b) three experts, possessing outstanding qualifications and experience of not less than twenty-five years in the field of medical education, public health education and health research, to be nominated by the Central Government — Members;  (c) two experts, from amongst the part-time Members referred to, in clause (c) of sub-section (4) of section 4, to be nominated by the Central Government in such a manner as may be prescribed — Members;  (d) one person, possessing outstanding qualifications and experience of not less than twenty-five years in the field of management or law or economics or science and technology, to be nominated by the Central Government — Member;

3. On the issue of Appellate Jurisdiction

Committee recommendation:

On the issue of appellate jurisdiction over the decisions taken by the Commission, the Committee is of the view that giving the appellate jurisdiction to the Central Government does not fit into the constitutional provision for separation of powers. The Committee, therefore, recommends constitution of a Medical Appellate Tribunal comprising of a Chairperson, who should be a sitting or retired Judge of the Supreme Court or a Chief Justice of a High Court, and two other Members, to have an appellate jurisdiction over the decisions taken by the Commission. One of the Members should have a special knowledge and experience in the medical profession/medical education and the other member with an experience in the field of health administration at the level of Secretary to Government of India.

4. On the issue of regulation of up to 40% of fees in Medical colleges

Committee recommendation:

The Committee notes that there was no provision to regulate fees in the Indian Medical Council Act. Thus the provision of regulating fees is a step in the right direction. The Committee also notes that all States in the country have a well defined process to regulate fees charged by the private medical colleges as per their separate State Acts under the existing fee regulatory mechanism.The Committee, therefore, recommends that the existing fee regulatory mechanism for private medical colleges by the States to protect their rights to regulate fees, should not be diluted.

Further, the Committee understands that the fee charged by several unregulated private medical colleges, the deemed universities and the deemed-to-be universities is not regulated under any existing mechanism. In this regard, the Committee recommends that to remove discrepancies it may be ensured that the fee charged by all such unregulated private medical colleges, the deemed universities and the deemed-to-be universities should be regulated at least for 50% of their seats.

5. On the issue of the common exit exam NLE

Committee recommendation:

…the Committee recommends that the Licentiate examination be integrated with the final year MBBS examination and be conducted at the State Level. The final MBBS examination should be of a common pattern within a particular State, initially due to the logistical constraints, and could be extended across the country as the system streamlines. The Committee also recommends that the final year MBBS exam should be designed in such a way that it takes into consideration not only the cognitive domain but also the assessment of skills by having practical problems/case study types of questions as a major component, with a strong tilt towards primary healthcare requirements.

6. On the constitution and independence of the Ethics and Medical Registration Board

Committee recommendation:

The Committee finds merit with the contention of several stakeholders emphasizing the need for an independent tribunal/Board so that impartiality is maintained to regulate professional conduct and to promote medical ethics in accordance with the regulations made under this Act. The Committee with its considered view recommends that the President of the Ethics and Medical Registration Board (EMRB) should be a retired Judge of a High Court so as to meet the said objective.

The EMRB shall be independent of the NMC and to avoid any conflict of interest, the Committee recommends that its President should not be a member of the NMC so as to maintain its autonomy and independent character.

7. On the recognition of DNB qualification

Committee recommendation:

The Committee notes that India has two parallel systems of Post Graduate Medical Education i.e. MD and DNB. The Committee recommends that the Diplomate of National Board, granted by the National Board of Examinations, in broad specialty course and super-specialty course shall be equal in all respects to the post-graduate qualification and the super-specialty qualification, respectively, as granted under this Act with the exception in teaching in medical colleges as they do not take DNB education in a medical college.  With the coming into force of this Act, all the post-graduate education programmes being conducted by the National Board of Examinations will be brought under the purview of the Commission for award of common degrees.

8. On the issue of Bridge course for AYUSH practitioners

Committee recommendation:

The Committee is of the view that the bridge course should not be made a mandatory provision in the present Bill. However, the Committee appreciates the need to build the capacity of the existing human resources in the healthcare sector, to address the shortage of healthcare professionals so as to achieve the objectives of the National Health Policy, 2017. The Committee feels that every State has its own specific healthcare issues and challenges. The Committee, therefore, recommends that the State Governments may implement measures to enhance the capacity of the existing healthcare professionals including AYUSH practitioners, B.Sc (Nursing), BDS, B.Pharma etc to address their State specific primary healthcare issues in the rural areas. The Committee also recommends that adequate budgetary resources may also be provided to meet the said objective.

9. Other general recommendations

Committee recommendation:

– The Committee observes that there had been a loss of credibility of the existing regulatory body i.e MCI. The Committee, therefore, recommends that all the Members of the National Medical Commission be required to mandatorily declare their professional and commercial involvements and should also declare  their personal assets along with assets of their dependents on the website of NMC as and when they assume office and at the end of their tenure.

– The Committee is of the view thatthe Department should explore the possibility of restructuring and revamping the Dental Council of India, the Nursing Council of India and other such Councils so that there is effective regulation of their education and practice similar to the reform process as envisaged by National Medical Commission Bill, 2017.  The Committee, accordingly, recommends for formulation of regulatory/licensing/accreditation norms for all paramedical and allied health care professions like physiotherapy, optometry, etc. so as to regulate such professionals and their scope of practice in various clinical settings.

– The Committee is also given to understand that a large number of doctors who study in government medical colleges at the cost of the taxpayers money leave the country at the first given opportunity. The Committee recommends that in all such cases a minimum compulsory period of working within the Country be prescribed before such Doctors can be allowed to serve outside the Country.

– The Committee also recommends for consideration of a compulsory one year rural posting for all doctors graduating out of medical schools in the country subject to the condition that the  requisite infrastructure facilities in terms of supporting staff, decent remuneration, necessary medical equipment and appropriate security are made available so that their training can be appropriately utilized for dealing with shortage of doctors in rural/remote areas of the country.

The full report tabled by the Parliamentary Standing Committee may be accessed here:https://bit.ly/NMCParliamentaryCommitteeReport

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