Doctors are regulated by the Medical Council whose functions are established by the Medical Practitioners Act, 1978 and 2007. The Council maintains the general register of medical practitioners.
The Council also maintains registers of medical specialists. Medical practitioners may be registered in a general division, specialist division or a trainee specialist division.
It is an offence for unregistered medical practitioners to practise medicine. Certain designated titles may not be used without proper registration.
There is provision for recognition of EEA practitioners providing services on a temporary basis or permanently. The Council may recognise the admission of EEA practitioners in accordance with EU regulations.
Persons from other EU States qualifications may be recognised under EU derived laws. A person may be refused registration where he is considered unfit to practice.
Education and Competence
Only persons holding the requisite qualifications and duly registered may hold themselves out as medical practitioners. The Medical Council has functions in relation to ensuring the suitability of education, practice, clinical training and experience as well as the adequacy and suitability of postgraduate education and training.
The Council publishes standards of medical education and training for basic and specialist qualification and manages adherence. The Council must satisfy itself 0n the ongoing maintenance and professional competence of registered medical practitioners. It must establish a professional competence scheme, postgraduate medical and dental board roundup.
In order to be entered, persons must hold requisite qualifications from recognised bodies, colleges or universities. Experience in an approved hospital is also required.
There are requirements in relation to maintaining professional competence. An unregistered person shall not practise medicine. It is an offence t subject to a fine and summary conviction or indictment.
The Health Service Executive has a role in promoting basic medical education and facilitating education and training. They promote specialist medical and dentist education. It assesses the ongoing numbers of intern posts and the need and appropriateness of the medical posts.
There are procedures for complaints regarding registered medical practitioners. Complaints are considered by a preliminary proceedings committee. Complaints may be resolved by informal means.
More serious complaints are referred to the fitness to practice committee. Court confirmation is required before the more serious decisions must become effective.
Any person may make a complaint to a preliminary proceedings committee on a practitioner on a number of bases: including poor professional performance, misconduct, disability, contravention of codes and consents.
The preliminary proceedings committees may investigate complaints. If the complaint is such as to render the practitioner unfit to practise or it is in the public interest if may be referred to the fitness to practice committee.
Proceedings before the preliminary proceedings committee are more informal and inquisitorial than the fitness to practice proceedings. Details must be given of the nature of the complaint and the complainant.
The preliminary proceedings committee has a number of options in relation to dealing with complaints. It may refer the matters further to another body or consider mediation.
Preliminary proceedings committee refers rather than making a decision. It may decide no further action is taken, direct to another body, refer the complaint to the professional competence scheme, refer to mediation or direct further action, refer to fitness to practice committee.
Fitness to Practice Committee
A person may be found guilty of professional misconduct or unfit to practise because of physical or mental reasons may be erased, struck off or suspended by the fitness to practice committee. The legislation allows for due process, notice and hearings together with a right of appeal, constitutional rights to fair procedures, good name and right to make a living.
There are detailed regulations regarding fitness to practice allegations of misconduct. There is power to hold an enquiry. The person whose conduct is reviewed has the opportunity to be represented and made representations.
The fitness to practice committee hears evidence on oath or by Affidavit. In holding the enquiry the body has powers to enforce the attendance of witnesses, examine witnesses on oath in the same manner as a judge. The body may have the power to strike off or enter sanctions on the conclusion of the committee investigations.
It is an offence not to comply with the requirements of the committee. The fitness to practice committee on completion of enquiry submits to the Council a report in writing of its findings.
If the committee finds an allegation is proved one or more sanctions may be imposed. These range from censure to fines to cancellation of registration or restriction.
A decision to impose a sanction other than censure requires confirmation by Court. A decision to impose a sanction other than censure may be appealed to Court within 21 days. Where the decision is not appealed the Council must make an Application to Court for the confirmation of the decision. The Court will confirm the decision unless it sees a good reason not to do so.
The Medical Practitioners (Amendment) Act was intended to urgently assist in addressing the current difficulty relating to Non- Consultant Hospital Doctor (NCHD) vacancies. The level of vacancies at NCHD level had significant implications for the maintenance of acute services, particularly in smaller hospitals and in certain locations where vacancies are concentrated. The reasons for the shortage of NCHDs (or junior doctors) in Irish hospitals are quite complex and include the fact that the posts in question are mainly non-training posts (and therefore not attractive to doctors) and that there is a general international shortage of junior doctors.
Under the current Medical Practitioners Act 2007 (No. 25 of 2007), an applicant can seek to register in one of four divisions of the register of medical practitioners — the General Division, the Trainee Specialist Division, the Specialist Division and the Visiting EEA Practitioners Division. To be registered, an applicant must demonstrate through an examination (called the PRES) or through higher training, that they are competent to practice prior to becoming registered. Registration, if granted, is for life and a registered medical practitioner can only be removed from the register via Fitness to Practise procedures. Those registered on the General Division can take up any post including, for example, unsupervised, locum general practice positions, and may work wholly in private practice.
There is an issue in regard to the registration of doctors from countries outside the European Union. In summary, many are reluctant to travel to Ireland to sit the PRES examination (which is considered to be more suitable for recent graduates and has a high failure rate) and current legislation does not provide for any type of supervised registration.
This Act provided for the establishment of a new division of the register which will be known as the Supervised Division. Those applying to be registered in this division were to undergo a two-part assessment specific to their medical speciality and to this division. If successful, an applicant would be registered in the Supervised Division
Directive Re Medical Practitioners
Article 4(2)(d) of EU Directive 2011/24/EU of the European Parliament and of the Council of 9 March, 2011 on the application of patients’ rights in cross-border health care, obliges Member States to ensure that systems of professional liability insurance, or a guarantee or similar arrangement that is equivalent or essentially comparable as regards its purpose and which is appropriate to the nature and extent of the risk, are in place for treatment provided by medical practitioners who practise medicine.
In recent years various Acts have been published in the Dail and the Seanad which attempted to put in place a regulatory framework to introduce a mandatory requirement for indemnity insurance cover, but none of these progressed through the Houses of the Oireachtas.
Government approved the Heads of this current Act on 21 February, 2012.
Purpose of 2017 Act
The Medical Practitioners (Amendment) Act 2017 requires that medical practitioners who are engaged in medical practice must provide evidence to the Medical Council that they hold an adequate minimum level of medical indemnity insurance. A minimum level of indemnity is set for various classes of medical practitioners by the Medical Council, which consults with the State Claims Agency and other relevant parties in order to set these minimum levels. A medical practitioner will only require indemnity if s/he falls within a class of medical practitioners specified as requiring indemnity.
The Act should not require medical practitioners to pay any more than what would be the normal adequate indemnity cover for the medical practice in which they are engaged. If a medical practitioner is not engaged in medical practice and does not pose a risk to another person relating to his or her medical practice (e.g. a medical practitioner who is a full time lecturer) there is no legal obligation on that medical practitioner to have medical indemnity cover.
“Indemnity” is defined as a policy of medical indemnity insurance, or other indemnity arrangement, against losses arising from claims in respect of civil liability incurred by a medical practitioner in respect of any act or omission of that medical practitioner arising from his or her practice as a medical practitioner.
The Medical Council must specify the minimum levels of indemnity which will apply to various classes of medical practitioners.
Medical Council may make Rules to specify;
- the evidence that must be submitted by the medical practitioner to the Council to satisfy the Council that the minimum level of indemnity applicable to the class of medical practitioners to which the medical practitioner belongs is in
- How that evidence should be displayed.
There is a duty on the medical practitioner to ensure that s/he has the minimum level of indemnity cover at all times when registered, appropriate to that class of medical practitioner, unless s/he does not fall within a class that requires indemnity. A medical practitioner who contravenes the requirement must inform the Council in writing not later than 14 days after such contravention, with particulars of what gave rise to the contravention and whether or not s/he is still in contravention of the subsection.
A medical practitioner must display at all times when registered, the evidence of minimum level of indemnity cover in the principal place where he or she practices medicine.
The Medical Council to publish a notice in Iris Oifiguil setting out the minimum levels of indemnity which apply to different classes of medical practitioners, following consultation with the State Claims Agency and any other person the Council considers appropriate. The criteria for the level include awards or settlements where the claim arose out of an alleged breach of duty involving a member of that class of medical practitioners in his or her capacity as a medical practitioner who falls within that class.
A medical practitioner must provide evidence in the manner which the Council may specify in Rules, of the minimum level of indemnity which applies to his or her practice.
A medical practitioner who is not engaged in medical practice and therefore who does not fall into a class of medical practitioners who must have medical indemnity, is to provide evidence that s/he is not engaged in practice, again in accordance with Rules which may be set out by the Council.
The Council cannot register a medical practitioner, who falls within a class of medical practitioner which requires indemnity, unless the medical practitioner has provided evidence of his or her minimum level of indemnity cover, as may be set out in Rules under section 11(2)(va).
A visiting EEA practitioner may not practise medicine in the State unless s/he furnishes evidence, in accordance with Medical Council rules, if any, of the minimum level of indemnity held by that medical practitioner.
The Council may remove a medical practitioner from the register if he or she fails to provide evidence of the minimum level of indemnity. The Council may proceed with processing a pending complaint, if a medical practitioner was no longer registered.
A similar system of registration applies to dentists. A registration council maintains the register of dental surgeons. Persons may be admitted based on recognised qualifications and training in Ireland. EU qualifications are also recognised in accordance with EU legislation. A person may not practice dentistry or use titles without the requisite qualifications.
Only persons entered into the register are entitled to use the description dental surgeon or dental practitioner. It is an offence to hold oneself out as such without being registered. It is an offence to practice dentistry or hold oneself out as practising dentistry without being a registered dentist.
The Dental Council maintains a register of dental specialists. It provides registration of additional qualifications. The Council satisfies itself in relation to the suitability of dental education and training standards, standards of practical knowledge, standards of postgraduate education and training. The Council may recognise specialities from time to time.
Companies may not perform dentistry services. The Council may provide schemes for the establishment of auxiliary dental workers. Similar provisions in relation to training, registration etc apply.
The Council has disciplinary powers in relation to misconduct and unfitness. It may suspend apply conditions, advise, admonish or censure a person. It may remove the dentist’s name from the register. Most serious penalties require confirmation of the High Court.
The procedure in relation to fitness to practice committees is broadly similar to that in respect of doctors. The fitness to practice committee initially considers whether a complaint is sufficient to warrant an enquiry.
The procedures in relation to enquiries are broadly similar to that in respect of doctors. The committee has the powers and privileges of a High Court Judge in hearing the case. It is an offence for witnesses to fail to attend or co-operate.
The Council following an enquiry and report by the fitness to practice committee may attach conditions, strike off, admonish. It may decide that the person\’s name be erased from the register. The person may apply within 21 days of the decision to apply to the High Court to have the decision cancelled.
The High Court may cancel the decision, declare it proper or give to the Council as the Court thinks proper. If the person does not apply to the High Court the Council may apply for confirmation of the decision and the Council confirms decision unless it sees a good reason to the contrary.