Doctor Registration

Registration

Unregistered medical practitioners may not practise medicine or advertise the practitioner’s services as a medical practitioner. Medical practitioners who may also be registered under the provisions of a different Act, including dentists, nurses and midwives, pharmacists and health and social care professionals. It also covers emergency situations where first aid is provided or where the person is a visiting EEA medical practitioner under the terms of section 50.

The Minister may, after consulting with the Council, make regulations to designate titles which may only be used by registered medical practitioners or certain specified classes of registered medical practitioners. Any such action shall be subject to prior consultation with interested people, organisations or bodies and must be in the public interest. Regulations made under this section must be laid before the Houses of Oireachtas for approval.

Only persons entitled to use designated titles may do so. There are offences and penalties relating to registration, including  relating to the practice of medicine or advertising when not registered, or relating to the unauthorised use of a designated title.

It will be an offence to falsely represent oneself as a registered medical practitioner or falsely represent oneself as registered in a particular division of the register or to make a false declaration for the purpose of obtaining registration.

Penalties for summary convictions are a maximum of €5,000 and/or 6 months imprisonment. Convictions on indictment are, for a first offence, a maximum fine of €130,000 and/or 5 years imprisonment. For a subsequent offence, a maximum of €320,000 and/or 10 years imprisonment. Provisions for the award of costs are included. The Act prohibits the charging or recovery of fees for medical services provided while a medical practitioner was unregistered.

The Council shall, at the request of the Minister, or may, of its own initiative, investigate unregistered persons suspected of practising medicine in contravention of this Act or claiming to be registered. If the Council has reason to believe that this is the case, it shall report the matter forthwith to An Garda Siochana and the Minister and may seek an injunction in the High Court requiring the person to cease the activities.

There  additional functions on the Council with regard to the granting of licences to practise anatomy, the appointment of inspectors of anatomy and the receiving of returns made by such inspectors in accordance with the Anatomy Act of 1832.

Divisions

There is a register of medical practitioners, to include the names and qualifications of registered medical practitioners and to consist of four divisions — the General Division, the Specialist Division, the Trainee Specialist Division and the Visiting EEA Practitioners Division. The Council will issue certificates of registration which must be displayed, where practicable, at the principal place of practice. Registered medical practitioners must include their registration number on all medical prescriptions and other documentation and records relating to their practice as a registered medical practitioner.

There is provision for registration applications by medical practitioners and the procedures to be followed by the Medical Council on such an application, including timescales outlined under Directive 2005/36/EC for the determination of applications under the terms of that Directive. The Council must take into account training and experience from a third country, where appropriate, for such applications.

Medical practitioners not otherwise entitled to registration in the Specialist or Trainee Specialist Divisions shall be registered in the General Division. Medical practitioners to be registered in the Specialist Division, including those with Irish, EU or third country specialist qualifications. It provides that, for a period of 5 years, the Council may work with approved specialist training bodies to assist particular medical practitioners registered in the General Division to achieve the necessary standard for registration in the Specialist Division.

The Act provides for the registration of persons who are employed in an approved medical specialist training post in the Trainee Specialist Division of the register, including persons entitled to registration under the terms of Directive 2005/36/EC. It also provides for registration in this Division of third country nationals or persons with refugee status (subject to any other specified requirements under rules) who have passed a prescribed examination or are exempt from such an examination.

The Act provides for the registration of people undertaking an internship in an approved intern training post, in the Trainee Specialist Division. Once the person has completed a period of internship to the satisfaction of the Council, it shall grant that person a certificate of experience. Until such time as the Council is ready to grant certificates of experience, the provisions of the 1978 Act, where such certificates were granted by the medical school at which the medical practitioner undertook his or her basic medical education, shall apply.

EU/ EEA Recognition

The Act provides for the transposition of relevant Articles of Directive 2005/36/EC relating to the provision of temporary and occasional medical services by visiting medical practitioners. Such persons must be registered or licensed by a competent authority in another Member State. Where a person intends to practise medicine under the terms of this section, he or she must first give a declaration in writing to the Council giving specified information and documentation.

It provides that the Council must decide, on a case by-case basis, whether the provision of services is one which should be classed as temporary and occasional. Where all is in order, the Council shall include the name of the person in the Visiting EEA Practitioners Division of the register. Visiting EEA Practitioners may not practise medicine, unless in case of emergency, otherwise than in accordance with the declaration given to the Council.

There is registration of approved additional qualifications in the register and the issuing of certificates including the details of these qualifications. There are procedures for a registered medical practitioner to apply to have his or her name removed from the register. The Council shall not consider such an application where the registered medical practitioner is the subject of an unresolved complaint or has been convicted of an indictable offence until the Council decides whether such registration should be cancelled.

Medical Unfitness

This Act also provides for the Council to remove from the register persons who are suffering from an illness or condition of a permanent or terminal nature which renders their practice unsafe and where he or she is unable to request such removal due to the illness or condition.

An applicant may make a declaration of medical disabilities and for the attachment of appropriate conditions, with the agreement of the medical practitioner, to registration in those circumstances.

There may be a the refusal of registration by the Council on the grounds of the unfitness of a medical practitioner to practise medicine. Such a decision may be appealed to the High Court, which may confirm the decision or cancel it and replace it with another decision, including the attachment of conditions to registration. The Court may direct how the costs of the appeal are to be borne.

The Council may keep the register up to date, Registered medical practitioners must notify the Council of absence from the State for more than 12 months and matters which could affect the continuation of his or her registration within 30 days. These matters include imposition of sanctions by a regulatory body in another jurisdiction.

There is a provision for publication of the register, excluding personal details of medical practitioners which should be protected from disclosure.

Registration of Interns I

The 2020 Act includes reference to new intern registration. It also provides that fees can be charged for recognition of a qualification and for registration for those undergoing a period of adaptation

There is a new Part 5A in relation to interns. Interns will no longer be registered in the Trainee Specialist Division of the register of medical practitioners, but instead, interns will be registered on a new register of interns. This is because a person needs to have completed his/her intern year before he/she is qualified as a medical practitioner.

The new register of interns will have the names of interns and other appropriate information and it can be in paper or electronic form. A certificate of registration will be provided. If conditions have been attached to registration, it will state the conditions. The intern should display the certificate in their workplace if practicable.

They should include their registration number on prescriptions, records etc. The current provision in relation to interns on the Trainee Specialist Division will cease, and there is also a provision for the phasing out of interns currently registered in the Trainee Specialist Division after five years.

A person may apply to have their qualification recognised as an intern qualification. The 2020 Act sets out the requirements for recognition of qualification to be an intern,i.e. a person who holds a medical degree approved by the Medical Council which has been completed mainly in Ireland or a person who is studying for a medical qualification in another EU state and who, if the person completed the intern year, that EU state would recognise the person’s qualification under the EU Professional Qualifications Directive.

A person to apply for registration. To be registered, a person must have the correct qualification, have an intern post, have a knowledge of English or Irish necessary to practise medicine, and be a fit and proper person.

An intern is considered to be a medical practitioner for the purpose of other legislation. This is to allow interns to prescribe drugs, order x-rays etc. It also provides that the Council will grant the intern a certificate of experience when he/she has successfully completed the internship which has been approved. The Council approves intern training places and makes rules in relation to training sites.

In the interest of public safety, the Council can impose conditions on registration if a person applying for intern registration has a disability that impairs their ability to practise medicine; has had conditions attached to their registration; has had registration suspended or refused by a regulatory body in the State or another jurisdiction in relation to the practise of one or more kind of health or social care profession; or has a conviction. If the person does not agree to the conditions, then the Council may refuse to register the person.

Registration of Interns II

If an intern develops a medical disability that impairs their ability to practise medicine, the intern must notify the Council within 30 days, or later if impracticable to notify in 30 days. The Council can impose conditions in the interest of public safety. If the intern does not agree to the conditions, the Council can still attach the conditions.

A person can appeal to the Court a decision to refuse recognition of a qualification; refuse registration; refuse a certificate of experience; or attach conditions. The Court can confirm the decision or cancel the decision and replace it with another decision, which can be to recognise the qualification; register the person with or without conditions; remove or replace conditions; require Council to issue a certificate of experience; require Council to reconsider a decision or give directions to the Council.

The Council will correct clerical errors, remove registrations obtained by fraud, enter changes which come to the attention of Council, and remove registration of interns who have died. Interns must inform the Council within 30 days if another health and social care regulator in or outside the State has attached conditions; suspended or refused registration; or if they have a conviction.

The Council shall publish the intern register, but need not make available home addresses, home telephone numbers or email addresses.

Registration of adapters

Adapters are people who have been assessed under the European Union (Recognition of Professional Qualification) Regulations 2017 and are required to undergo a period of adaptation. A ‘relevant person’ who is a person seeking recognition of their qualification under the European Union (Recognition of Professional Qualifications) Regulations 2017 and who is required to undergo a period of adaptation.

The Council is to establish a register of adapters, which will have the names of adapters and it can be in paper or electronic form. A certificate of registration will be provided. If conditions have been attached to registration, it will state the conditions. The adapter should display the certificate in the workplace if practicable. They should include their registration number on prescriptions, records etc. After the period of adaptation, the entry will be removed from the register.

A relevant person may apply for registration. To be registered, a person must have knowledge of English or Irish necessary to practise medicine, be a fit and proper person, and comply with any relevant rules made.

An adapter is considered to be a medical practitioner for the purpose of other legislation. This is to allow adapters to prescribe drugs, order x-rays etc. The Council will grant the adapter a certificate of adaptation when he/she has successfully completed the period of adaptation. The Council can remove the adapter’s name from the register if the adapter applies; if the adapter is no longer practising medicine as an adapter; or if the adapter has not satisfactorily completed the training.

In  the interest of public safety, the Council can impose conditions on registration if a relevant person applying for registration as an adapter has a disability that impairs their ability to practise medicine; has had conditions attached to their registration, or has had their registration suspended or refused by a regulatory body in the State or outside; or has a conviction, in relation to the practise of any health and social care profession. If the person does not agree to the conditions, then the Council may refuse to register the person.

If an adapter develops a medical disability that impairs their ability to practise medicine, the adapter must notify the Council within 30 days, or later if impracticable to notify in 30 days. The Council can impose conditions in the interest of public safety. If the adapter does not agree to the conditions, the Council can still attach the conditions.

A person can appeal to the Court a decision to refuse to register a relevant person in the register of adapters, refuse to give a certificate of adaptation, or to attach conditions to the registration. The Court can confirm the decision, cancel the decision and replace with another decision, which can be to register the person with or without conditions, remove or replace conditions, require Council to issue a certificate of adaptation, or require Council to reconsider a decision or give directions to the Council.

The Council will correct clerical errors, remove registrations obtained by fraud, enter changes which come to the attention of Council, and remove registration of adapters who have died. Adapters must inform the Council within 30 days if another health and social care regulator in or outside the State has attached conditions; suspended or refused registration, or if they have a conviction.

The Council shall publish the register of adapters, but need not make available home addresses, home telephone numbers or email addresses. The 2020 Act includes a reference to interns and adapters – only medical practitioners, interns and adapters can practise medicine. Only registered medical practitioners can advertise services as medical practitioners.

The Council to issue a permit for up to 30 days to a medical practitioner from another state coming to this State for humanitarian purposes, or who is a specialist and is providing treatment for teaching/training or is accompanying a sports team.

A person can apply to have their qualification recognised as a general qualification (for registration in the General Division of the register) or a specialist qualification (for registration in the Specialist Division of the register).

Requirements for recognition of qualification

A person’s qualification is recognised as a qualification for the General Division of the register if the person has an Irish formal qualification which is an Irish medical degree and a certificate of experience, or the person has a medical qualification from another state and passes an examination set by the Medical Council, or has a qualification which rules made by the Medical Council provide for an exemption to a person with that qualification from the examination, or the person has a qualification recognised under the European Union (Recognition of Professional Qualifications) Regulations 2017. These are similar to the provisions currently in section 46 except the equivalence of the certificate of experience is no longer a route to registration.

A person’s qualification is recognised as a specialist qualification if the person has satisfactorily completed specialist training in the State; the person has completed specialist training and has sufficient experience to a standard that satisfies the Medical Council; or the person has a specialist qualification recognised under the European Union (Recognition of Professional Qualifications) Regulations 2017. The medical specialty must be one which the Council recognizes.

Application for registration (other than in Supervised Division)

A person can apply to be registered in a division of the register other than the Supervised Division. A person must have a minimum level of indemnity (unless it is not required); a general or specialist qualification; knowledge of the English or Irish language necessary to practise medicine; be a fit and proper person; and meet any other rules that apply to that person. A person can only be registered in one division of the register unless the person is a specialist who is training in another medical specialty. Indemnity requirement applies to renewal of registration also.

General Division

A medical practitioner (other than a visiting EEA practitioner) who meets all the requirements in the previous section, will be registered in the General Division if not able to be registered in the Specialist Division or the Trainee Specialist Division.

A medical practitioner (other than a visiting EEA practitioner) who meets all the requirements of section 45 and who has a specialist qualification will be registered in the Specialist Division.

Trainee Specialist Division

A medical practitioner is registered in the Trainee Specialist Division if the medical practitioner meets the requirements of section 45; has a general or specialist qualification; and has a training post which has been approved by the Council for medical specialist training.

This new provision removes the requirement to have the equivalence of a certificate of experience for registration in the Trainee Specialist Division.

A medical practitioner in the Trainee Specialist Division who is no longer in a trainee specialist post is removed from the Trainee Specialist Division and is registered in the General Division.

Supervised Division

A medical practitioner who applies to be registered in the Supervised Division will be registered in that division if they meet the criteria set in rules and are not registered for more than two years, or three years if approved by the HSE. They also need to be working in a post approved by the Council as a supervised post and the post must be a publicly funded post or funded by a third country which is sponsoring the person. The medical practitioner also has to have adequate knowledge of English or Irish and be a fit and proper person. Posts are only approved by the Council where adequate arrangements are in place for the supervision of the medical practitioner.

A medical practitioner in the Supervised Division can only practise medicine in the supervised post and will be removed from the register when no longer in an approved supervised post.

A medical practitioner to apply to have their registration removed. Currently a medical practitioner cannot be removed from the register if there is a complaint against the medical practitioner which has not been dealt with or finalised. This amendment allows registration to be removed if it is in the public interest. If the medical practitioner seeks to be restored to the register, the Council does not have to restore registration if the Council is satisfied that the medical practitioner is not a fit and proper person.

Conditions attached

Formerly, conditions could be attached to registration where a person has a relevant medical disability, i.e., which impairs their ability to practise medicine. This section adds that conditions can be attached where any material matter has occurred, i.e. if they have been refused registration; have been suspended or removed from registration; had conditions imposed in relation to working in one or more kind of health or social care profession; or if the person has a conviction in the State or another jurisdiction.

It also states that if a medical practitioner develops a medical disability that impairs their ability to practise medicine, the medical practitioner must notify the Council within 30 days, or later if impracticable to notify in 30 days. The Council can impose conditions in the interest of public safety. If the medical practitioner does not agree to the conditions or does not respond within 30 days, then a complaint can be made in relation to that medical practitioner.

Appeal to Court

There provision for Council decisions to be appealed to the High Court. These are decisions to refuse to recognise a qualification as a general or specialist qualification; to refuse to register a person; to register in a division other than the division applied for; or to refuse to restore registration. The person has 3 months to appeal a decision and the Court can either confirm the decision; cancel the decision and replace with another decision; recognise the qualifications; register or restore registration with or without conditions in the division the Court considers appropriate; remove or replace conditions; or require Council to reconsider a decision or give the Council directions. The Court can direct how costs of the appeal are to be borne.

Declarations by registered medical practitioners

A medical practitioner, intern or adapter is to give the Council annually, details of any proceedings in the State or another jurisdiction which might result in the person being restricted or prohibited from working as a medical practitioner or working in one or more kind of health or social care profession, or if the proceeding could result in a conviction. They also need to provide details within 3 months of the case concluding.

Council may request from bodies in State or other jurisdictions. The Council may get information from another health or social care regulatory body in or outside the State in relation to a medical practitioner, intern or adapter who has been refused registration; has been suspended; has conditions placed on his/her registration; has a conviction; or in relation to the registrant’s qualification for registration.

Education and Training I

The 2007 Act outlines the duties of the Health Service Executive with regard to medical and dental education and training. The Executive shall facilitate the training of medical students, in accordance with the Health Act 2004.

In relation to specialist medical and dental education and training, the Executive shall promote and co-ordinate their development in co-operation with the Medical and Dental Councils and the medical and dental specialist training bodies. It must advise the Minister on these matters, including related financial matters. It shall also undertake appropriate workforce planning in order to meet the medical and dental specialist staffing and training needs of the health service.

The Executive shall assess the number of intern and specialist training posts required by the health service on an annual basis and make proposals to the Medical Council for the purposes of the Council’s recognition of such posts for training purposes.

The Executive must also assess the need for non-specialist, non-consultant posts which have not been approved for training purposes and publish the results of that assessment. The Minister may request information on the Executive’s functions under this Act by notice in writing and the Executive shall carry out any other functions assigned to it by the Minister in relation to medical and dental education and training.

The Medical Council is designated as the competent authority under Directive 2005/36/EC on the recognition of qualifications of medical practitioners.

Education and Training II

The Medical Council has duties with regard to basic, intern and specialist medical education and training. The Council shall publish standards on education and training. It shall approve and inspect bodies and programmes of medical education and training at basic, intern and specialist level, including the inspection and approval of training facilities. Various provisions regarding the publication of guidance and the results of inspections are included.

The Council must, specifically, develop guidance on ethical standards and behaviour for medical students and advise the Minister and the Minister for Education and Science on matters relating to its functions.

The basic medical qualifications included under the 1978 Act and the bodies approved to award those qualifications are deemed to be approved under the 2007 is section and the Council may approve a basic medical qualification awarded in a third country as equivalent.

The Council shall prepare guidelines on ethical matter relating to the acceptance of non-Exchequer funding in relation to medical education and training. The Council is also given a role in relation to the provision of career information.

The Council is to recognise medical specialist training bodies, training programmes and medical specialties for the purposes of registration in the Specialist Division of the Register. Medical specialties and specialist training bodies already approved under the 1978 Act are deemed to be approved under this Act. A body which has been refused approval by the Council for basic or specialist medical education and training to appeal to the Court against the Council’s decision.

Professional Competence

There are duties for the Medical Council to satisfy itself as to the ongoing competence of registered medical practitioners. The Council is to develop, establish, operate and keep under review one or more than one scheme for that purpose. The Council may recognise medical education and training bodies for the purpose of assisting the Council in performing its functions. A link to the Fitness to Practise system is provided where issues arise in relation to individual medical practitioners following participation in a scheme.

There is an appeal to the Court by a body refused recognition by the Council.

The Health Service Executive and other employers are to facilitate, to the extent practicable, the maintenance of professional competence of registered medical practitioners. The Act outlines the duties of a medical practitioner to maintain his or her professional competence and to co-operate with any requirements relating to these matters.

There are provision  for the confidentiality of information disclosed as part of a professional competence scheme. The Council, may, however, disclose information in summary form which prevents the identity of individual medical practitioners being ascertained, for the purposes of criminal proceedings or investigations, or for the purposes of civil proceedings to which it is a party. Provision for an offence relating to unlawful disclosure of information is included, with a penalty of a fine not exceeding €5,000 and/or imprisonment for 6 months.

2022 Act

The Act addressed an issue which currently prevents holders of UK medical degrees from accessing medical intern training posts in Ireland. The Act also makes other registration related amendments required to ensure the continued provision of a route to registration on the General Division of the Medical Council’s register for certain cohorts of internationally trained doctors. It also made a number of amendments to support the performance by the Medical Council of its triage, investigation, and adjudication of complaints functions under the 2007 Act.

This section amends section 88 of the 2020 Act which had not yet been commenced. It provides that medical degrees completed wholly or mainly in the UK will meet the requirements for recognition as intern qualifications in Ireland subject to meeting qualifying criteria set by the Medical Council.

An Irish intern qualification will be construed in accordance with the 2007 Act and must be completed wholly or mainly in the State.

This section amends section 96 of the 2020 Act which has not yet been commenced. It provides for the continued route to registration on the General Division for certain cohorts of internationally trained doctors. It also provides a transitional provision to ensure that the commencement of section 96 of the 2020 Act and the commencement of this section will be aligned.

This section amends section 110 of the 2020 Act which has not yet been commenced. It further supports the performance of the Medical Council’s triage, investigation, and adjudication of complaints functions under a new system introduced by the 2020 Act. Section 14 also provides a transitional provision to ensure that the commencement of section 110 of the 2020 Act and the commencement of this section will be aligned.