Dr. Anthony Breslin:

On behalf of the Medical Council, I welcome the opportunity to discuss this important issue with the Oireachtas Joint Committee on Health.

I will say a few words about the role of the Medical Council, which is very relevant in the context of this discussion and recent media commentary. The Medical Council is the statutory body responsible for the regulation of doctors in Ireland. Its purpose is to protect the public by promoting and ensuring the highest standards among doctors. From the day a student first enters medical school until the day he or she retires from practice, the Medical Council works to ensure medical education and training remain up to date and are benchmarked to the highest international standards.

The Medical Council sets standards for all undergraduate education and postgraduate training of doctors and also requires that all doctors fulfil ongoing professional competence requirements to ensure they keep their knowledge and skills up to date throughout their professional lives.

The Medical Council provides guidance to doctors on matters relating to conduct and ethics through its Guide to Professional Conduct and Ethics for Registered Medical Practitioners.

The Medical Council is also where the public may make a complaint against a doctor.

Regarding relevant information about doctors' practice, each year the Medical Council, during the annual retention period when doctors renew their registration, seeks out additional self-declared information which we then use for the production of the medical workforce intelligence report, which provides a detailed overview of doctors’ practice in Ireland, including the exit rates of doctors, the density of doctors in Ireland by county and the globalisation of the workforce.

Since 2012 the Medical Council has been seeking this additional information from registered medical practitioners to learn more about the scope of their practice. These reports have been developed not only to support the council’s work but also to inform wider health system planning and the evolution of systems of care. The detailed insights enabled through the workforce intelligence presented in these reports continue to highlight a number of key challenges, including retention of doctors, variances in skills mix and models of care and practice arrangements.

Regarding doctors on the general division in hospital consultant roles, through sharing information about these challenges, the Medical Council looks to assist all bodies that shape the professional lives of doctors to ensure that the design, development and oversight of the medical workforce continues to foster good professional practice and to protect patients.

This information is based on self-declarations and although the figure for doctors on the general division who describe themselves as hospital consultants seems quite high, once the figure is further examined and broken into its component parts, it reduces. As this question is based on self-declared information, it also includes doctors who are working outside Ireland, doctors in locum or temporary positions, doctors in acting-up positions, some doctors in training or further education, those currently not in a role etc. A number of doctors, who qualified as specialists before the new legislation, did not “grandfather” or transfer over to the specialist register in time, as they were entitled to.

The latest medical workforce intelligence report is still in draft and due to be published in the coming months. However, we have taken the information most relevant to today’s meeting and have made it available to the members of the committee and to the other organisations presenting here, with a full breakdown of the figures.

The supplementary information provided to the committee shows that 698 doctors on the general division have self-declared as hospital consultants in 2017. Delving further into the figures and removing a number of exclusions such as those working abroad, the number of general division doctors indicating that they practise in Ireland as hospital consultants is 254. Of the 254 doctors registered in the general division, 172 practice solely in Ireland with 149 of these working solely in publicly funded services. A total of 165 declared they work in both public and private settings, and 81 indicated that they have a mix of working inside and outside of Ireland.

It is worth noting the term consultant is not defined under the Medical Practitioners Act, to which the council operates. Accordingly the employer is free to hire anyone they want as a consultant, with the only limitation being that the doctor is on the Medical Council register. However, a consultant cannot falsely represent themselves as a specialist if they are not on the specialist register. The council only enters those practitioners on the specialist division who have the requisite higher qualifications in that discipline.

Doctors must be in compliance with maintenance of professional competence requirements and enrolled in a professional competence scheme relevant to their area of practice. A registered medical practitioner must maintain their professional competence on an ongoing basis pursuant to a professional competence scheme applicable to that practitioner.

The register of medical practitioners is a living database. Each working day at the Medical Council offices, doctors are entered in the register, are removed from the register and transferred between different parts of the register. The figures we have provided today are based on data from the 2017 retention period which is a snapshot from one moment in time.

I take this opportunity to thank Mr. Justice Peter Kelly, President of the High Court, for further highlighting this issue recently and allowing the council to address the court on this topic on Monday.

It is also worth highlighting that we are seeing a shift in the make-up of the medical registers which we maintain. The number of doctors on the specialist division is increasing and in 2017 the specialist division was larger than the general division for the first time which is a welcome development.

I thank the Chairman and the committee members for the invitation to address them today. Both Mr. Prasifka and I are happy to address any questions members may have.