National Medical Commission (NMC) Bill, 2017

On 15 December, 2017, the Union Cabinet has approved the National Medical Commission (NMC) Bill, 2017.

Objectives

• This bill seeks to replace the Medical Council of India with National Medical Commission as top regulator of medical education in India.
• It would also put in place a four tier structure for the regulation of medical education. The 20 member National Medical Commission will be at the top of this structure.
• The bill also seeks to put in place a common entrance exam and licentiate exam, which all medical graduates will have to clear to get practicing licences.

Background

Currently, Medical Council of India (MCI) is the apex body to regulate medical education. It was established in 1934 by British government on the lines of General Medical Council (GMC) of UK to regulate medical practice and medical education in the country. This act has been changed from time to time and was last updated in 2001. Its functions can be placed in two categories viz. medical education and ethics. Its key functions included:

• To maintain uniform standards of UG and PG medical courses
• Recognize and derecognize UG and PG medical courses
• Reciprocity with foreign countries regarding the medical degrees in India
• Maintenance of register of medical practitioners in the country.
• Upholding the ethics in medical education and profession in India.

For last many years, MCI has been subject to criticism due to corruption and unethical practices. Its president Ketan Desai was arrested in 2010 for taking bribe from private medical colleges. The issue was discussed at various levels including Parliamentary Committee. The parliamentary committee in 2016 had highlighted the issues such as The Medical Council of India has:

• Failed to create a curriculum suitable for Indian context, particularly rural India.
• Failed to maintain uniform standards of medical education.
• Devaluation of merit in admission to medical colleges, particularly in private medical colleges
• Excessive focus on infrastructure and not quality of human resources.
• Failed to raise the abysmally low doctor-population ratio.
• All focus on medical education, no focus on ethics.

Thus, there was a need to either reform the MCI drastically or replace it with a new architecture.

National Medical Commission (NMC) Bill, 2017: Architecture

The National Medical Commission (NMC) Bill, 2017 makes provisions to establish the following architecture {as per 2016 bill}.

Medical Advisory Council

The Central Government will create a Medical Advisory Council as a platform for states to put their concerns and views before the National Medical Commission. It will be an advisory body to advise the National Medical Commission on matters related to standards and discipline in medical education in India. It will also advise the NMC on measures to enhance the equitable access to medical education. The medical advisory council will be a multimember body comprised of:

• One member nominated by each state. This member will be either Vice-chancellor of a health university in state or a professor from medical institution.
• Two members to represent the Union Territories nominated by Home Ministry (not health ministry kindly note).
• All members and chairperson of the National Medical Commission as ex-officio members of Medical Advisory Council.

The bill provides that the Medical Advisory Council shall meet at least once a year.

National Medical Commission

The central government will create a National Medical Commission as a body corporate and autonomous boards under the overall supervision of the National Medical Commission.

Composition of NMC

• NMC will be a 20 member body comprising a Chairperson, a Member secretary, 8 ex-officio members and 10 part time members.
• Out of the 8 ex-officio members, four shall be presidents of the boards constituted under the act and remaining four shall be nominees from three ministries viz. Health; Pharmaceuticals; HRD and one from Director General of Health Services.
• Of the 10, five part time members will be appointed by the Central Government and they will be eminent personalities from diverse fields such as management, economics, law, consumer / patient rights advocacy, health research etc. Remaining five will be nominated by the states and union territories for two years.

Appointment and Removal of Chairperson / Members of NMC and Directors of Boards

Chairperson of the National Medical Commission will be a person of outstanding ability, proven administrative capacity and integrity with a PG degree in medical education and at least 20 years experience in the field of which 10 years to be in a leadership role.

Presidents of the boards will be persons of outstanding ability and prove administrative capacity with PG degree in medical education and 15 years experience of which 7 years will be in a leadership role.

Appointment of the chairman, presidents / directors of the boards, members of NMC will be done by Central Government through a Search and Selection Committee. This committee will be comprised of Cabinet Secretary and CEO, NITI Aayog.

The chairperson of NMC, its members and presidents of the boards will hold the office for a term of four years.

They can resign by sending their resignation letter to central government. The Central government is empowered to remove them on various grounds such as insolvency, conviction, physical or mental incapacity, abuse of position, proven misconduct etc.

 Secretariat

The secretariat of the commission will be headed by Member Secretary, who shall be appointed by the central government for a term of four years.

Power and Functions of National Medical Commission

The key powers and functions of NMC are as follows:

• It will assess the changing requirements, human resources, and infrastructure of health sector and develop a road map to meet these requirements.
• It will frame policies for governance of medical education in India.
• It will frame regulations for smooth working of commission.
• It will provide overarching policy coordination among the boards with due regard to their autonomy.
• It will ensure that state councils effectively enforce the provisions of the law and take appropriate action in event of non-compliance.
• To exercise as Appellate Authority with respect to decisions of the UGMEB (Under-Graduate Medical Education Board), PGMEB (Post Graduate Medical Education Board) and MARB (Medical Assessment And Rating Board).
• Prescribe fees for proportion of seats.

The bill provides that the commission shall meet at least once every quarter.

National Examinations

NEET

A National Eligibility-cum-Entrance Test (NEET) for admission to undergraduate medical course shall be conducted by NMC or under purview of NMC. However, the institutions which were created by a separate act of parliament will continence to be governed by their respective acts.

National Licentiate Examination

This examination will be conducted by NMC or under its purview to examine the medical graduates for granting them license to practice and get enrolment into the Medical Register. This examination shall serve as NEET for medical graduates and also for enrolment to various post graduate courses.

Under-Graduate Medical Education Board (UGMEB)

The UGMEB is to be an autonomous board, to be established by central government. It will be headed by a president who shall be assisted by such other staff from the NMC secretariat. Its main functions will be:

• To determine and prescribe the standards and all aspects of medical education at undergraduate level.
• Develop curriculum and tests for UG medical exams.
• To develop guidelines to set up medical institutions for UG courses.
• To determine and prescribe minimum requirements and standards for UG courses.

Though UGMEB will work under the rules and regulations of NMC, its president shall be empowered to take all decisions on behalf of UGMEB.

Post-Graduate Medical Education Board (PGMEB)

Like UGMEB, government will establish post-graduate MEB also via notification. It will be headed by a full time president and will do the same functions at PG level as UGMEB does at graduate level. It will also determine and prescribe the standard and norms for infrastructure, faculty and quality of the education in institutions conducting PG and super specialty medical education.

Medical Assessment And Rating Board (MARB)

MARB will be established by central government via notification. It will be headed by a full time president. Its main functions are as follows:

• To determine the process of Assessment and Rating of Medical Educational Institutions.
• To hire and appoint third parties for ratings of medical institutions.
• Conduct an assessment and rating of all medical educational institutions in India.
• To impose penalties on the institutions which are unable to maintain minimum standards.
• A new Medical College can be established only with prior permission of MARB.

Board for Medical Registration (BMR)

This board also, like all others, will be established by Central Government via notification and will be headed by a full time president. It main function is to maintain a live National Register of all licensed medical practitioners. It has to be maintained in electronic form as per prescribed rules. The names of medical graduates who qualify the National Licentiate Examination shall be entered into this register.

Issues & Criticism

A few bodies such as Indian Medical Association have opposed the above bill on grounds that it may cripple the medical education in the country because the entire architecture has been made answerable to the bureaucracy and non-medical administrators. It also expressed concerns on making Licentiate examination as basic qualification to practice instead of MBBS. We have yet to see what further changes are done in the bill before it sees the light of the day.