Medical Council seeks general division reform

The Medical Council is examining how doctors’ skillsets can be reflected on the general division of the register, as well as additional “rules” for this registration category. 

The regulator has expressed concern about the growing size of the general division, which accounts for over one-third of clinically active doctors. 

According to the Council’s Medical Workforce Intelligence Report 2021, general registrations have increased in tandem with unfilled specialist posts, which represents an “unacceptable risk” to patient safety. The Council referred to the “considerable proportion of NCHDs” required to perform the duties of hospital consultants and an over-reliance on international medical graduates “who report being overworked, undervalued, experiencing discrimination, and unable to access specialist training”. The Council further highlighted excessive working hours and “acute” doctor shortages. 

As part of its recommendations, the regulator is calling for a healthcare workforce strategy. 

Council CEO Mr Leo Kearns told the Medical Independent the general division was “never intended [to be] of this scale and proportion”. Asked if an alternative training pathway may be introduced for these doctors, Mr Kearns said: “I don’t think an alternative training pathway…. We have to make it easier for people who are on the general division to get onto the specialist training path.” 

“We also have to recognise that someone could be working as an SHO or registrar and have competencies that are relevant to those roles, they may not be on the specialist track, but have very valuable skillsets. We have to recognise that and see how we might reflect that in the register and reflect it obviously in [terms of] training.” 

The “structures” and “controls” relating to the general division needed to be examined, indicated Mr Kearns. 

While the Council may require legislation to implement new rules, this may be achievable through other means. 

A Department of Health spokesperson said it understood the Council was examining the “supervision and oversight” of doctors on the general division. “Potential legislative amendments will be considered in the context of any new measures proposed.” 

All NCHDs in the HSE “report to a consultant supervisor” and the Executive provides a number of professional development supports, added the Department.