The National Medical Commission Act, 2019 (NMC Act) has been notified vide the Gazette Notification dated August 8, 2019. The NMC Act aims to repeal the Indian Medical Council Act, 1956 (IMC Act) and constitute the National Medical Commission (NMC), which shall supersede the Medical Council of India (MCI).
This blog post is part of a multi-part series. In this first part, we provide an overview of the salient features of the NMC Act and the regime proposed by it. In subsequent parts, we will endeavour to analyse the various contentious issues in the NMC Act in greater detail as the same has been met with significant angst from medical professionals.
1. The National Medical Commission: Chapter II of the NMC Act (The National Medical Commission) provides for the constitution of the NMC by the Central Government. In terms of Section 4(1), the NMC will be comprised of thirty three members, including one Chairman, ten ex officio members and twenty two part-time members. Out of the twenty two part-time members, a total of nineteen will be will nominated by States and Union Territories.
Section 5 of the NMC Act provides that the Chairperson, certain part-time members (in terms of Section 4(4)(a) of the NMC Act), and the Secretary of the NMC (in terms of Section 8 of the NMC Act) shall be appointed by the Central Government on the recommendation of a Search Committee (a seven member committee, the constitution of which will be governed in terms of Section 5(1) of the NMC Act).
Section 10 of the NMC Act elaborates on the powers and functions of the NMC. The powers and functions are two-fold and include, inter alia, the laying down of policies and regulations for: (a) maintaining high quality and standards in medical education; and (b) regulating medical institutions, medical research and medical professionals. By extension, the NMC has also been empowered to lay down policies and codes to ensure: the observance and promotion of professional ethics in the medical profession and during provision of care by medical practitioners; assess requirements in healthcare, including human resources for health and healthcare infrastructure; and develop a road map for meeting such requirements.
In relation to regulation of medical education, Section 10(1)(i), requires the NMC to frame guidelines for determination of fees and all other charges in respect of fifty percent of seats in private medical institutions and 'deemed to be Universities', which are governed under the provisions of the NMC Act.
Chapter V of the NMC Act (Autonomous Boards) provides for constitution by the Central Government of the following autonomous boards under the supervision of the NMC:
- Under-Graduate Medical Education Board;
- Post-Graduate Medical Education Board;
- Medical Assessment and Rating Board; and
- Ethics and Medical Registration Board.
The powers and functions of the abovementioned autonomous boards have been provided for under Sections 24, 25, 26 and 27 of the NMC Act.
2. Medical Advisory Council: Chapter III of the NMC Act (The Medical Advisory Council) provides for the constitution of an advisory body, known as the Medical Advisory Council (MAC) by the Central Government. Section 11 of the NMC Act provides that the MAC would be comprised of the Chairperson and all members of the NMC (as ex-officio members), the Chairman of the University Grants Commission, the Director of the National Assessment and Accreditation Council, and various other members to be nominated by the State Governments, Ministry of Home Affairs in the Government of India, State Medical Council, and the Central Government. The MAC shall act as the primary platform through which the States and Union Territories may put forth their views and concerns before the NMC and help in shaping the overall agenda, policy and action relating to medical education and training. Further, the MAC shall advise the NMC on measures to determine and maintain, and to co-ordinate maintenance of, the minimum standards in all matters relating to medical education, training and research, and measures to enhance equitable access to medical education.
3. Community Health Providers: In a notable addition, Section 32 of the NMC Act provides for the power of the NMC to grant a limited licence to practise medicine at mid-level as a Community Health Provider (CHP)1. The CHP is required to qualify the criteria as specified under the NMC Act and the regulations that may be formulated thereunder. Further, CHPs have been allowed to prescribe specified medicine, independently, in primary and preventive healthcare. However, in cases other than primary and preventive healthcare, the CHP can prescribe medicine only under the supervision of duly registered medical practitioners.
4. Entrance and Exit Tests: Section 14 of the NMC Act mandates a National Eligibility-cum-Entrance Test (NEET) for admission to the undergraduate and postgraduate super-specialty medical education in all medical institutions that are governed by the provisions of the said Act. The NMC has been entrusted with the responsibility of conducting the NEET and regulating by way of regulations the manner of conducting common counselling by the designated authority for admission to undergraduate and postgraduate super-specialty seats in all the medical institutions that are governed by the NMC Act. Additionally, the NMC Act under Section 15 has also brought in a common final year undergraduate medical examination, to be known as the National Exit Test (NEXT), to be held for granting licences to practise medicine as medical practitioners and for enrolment in the State Register or the National Register. Further, the NMC is also responsible for conducting the NEXT, which shall become operational on a date appointed by the Central Government, which shall be within three years from the date of commencement of the NMC Act.
NMC Act versus the IMC Act
The table contained hereinbelow highlights the differences between the NMC Act and the IMC Act.
|S. No.||NMC Act||IMC Act|
|1.||The Governing body under the NMC Act is the NMC.||The Governing body under the IMC Act is the MCI.|
|2.||All the members of the NMC will be appointed or nominated by the Central Government.||MCI is majorly comprised of members who are elected from amongst members of the medical faculty of Universities and State Medical Registers.|
|3.||Section 5 of the NMC Act provides for the composition of a seven- member Search Committee, which shall include, the Chairperson, part-time Members (in terms of Section 4(1) and 4(4)(a) of the NMC Act) and the Secretary (in terms of Section 8 of the NMC Act), who shall be appointed by the Central Government upon the recommendation of the Search Committee.||
No such provision is provided under the IMC Act.
|4.||Section 6(6) of the NMC Act provides that the Chairperson and every member of the NMC shall make declaration of his assets and liabilities at the time of entering and leaving office. Moreover, the Chairperson and each member is also required to declare their professional and commercial engagement or involvement in the prescribed form and manner. Such aforementioned declarations shall also to be published on the website of the Commission.||Declarations of this nature were not required under the IMC Act.2|
|5.||With the aim of promoting transparency, Section 6(7) of the NMC Act provides that the Chairperson or members, post leaving the respective offices, shall not accept any employment3 for a period of two years||No such provision is provided under the IMC Act.|
|6.||Section 15 of the NMC Act provides for a NEXT (as elaborated above). It is pertinent to note that the said examination has been deemed to be the basis on which a person with a foreign medical qualification shall obtain a licence for practising medicine as a medical practitioner and for enrollment in the state/ national register.||No such provision is provided under the IMC Act.4|
- Enforcement of NMC Act: Though the NMC Act has been notified vide Gazette Notification dated August 8, 2019, Section 1(3) of the said Act provides that: "It shall come into force on such date as the Central Government may, by notification in the Official Gazette, appoint, and different dates may be appointed for different provisions of this Act and any reference in any such provision to the commencement of this Act shall be construed as a reference to the coming into force of that provision."
- Repeal of IMC Act: Section 61 of the NMC Act clarifies that notwithstanding the repeal of the IMC Act, the educational standards, requirements and other provisions of the IMC Act, and the rules and regulations made thereunder, shall continue to be in force and operate till new standards or requirements are specified under the NMC Act or new rules or regulations are made thereunder.
- Violence against medical professionals: Owing to instances of violence against doctors and the property of healthcare establishments, there were demands by doctors and allied practitioners to enact specific laws that specifically dealt with such situations. However, the NMC Act does not delve into this issue. Faced with incessant demands by doctors and protests in this regard, the Department of Health and Family Welfare (Medical Services Division) of the Ministry of Health and Family Welfare, vide a notification dated September 2, 2019 published the draft of a proposed legislation entitled 'The Healthcare Service Personnel and Clinical Establishments (Prohibition of Violence and Damage To Property) Bill, 2019'5 to address the issue of violence causing injury/ danger to the lives of healthcare service personnel, and damage and loss to the property of clinical establishments. This Bill is still at the preliminary/ consultative stage, and the general public can submit their objections and suggestions in this regard within the specified time frame. Please see our blog in this regard.
1 The introduction of the concept of CHPs has met with great resistance, especially from healthcare professionals on the ground that this measure would encourage quacks. This issue will be discussed in greater detail in Part 2 of this post.
2 In terms of Section 3A(9) of the IMC Act, a member having any financial or other interest in any matter coming before the board of governors for decision, was required to disclose his interest in the said matter before he participates (if allowed by the board of governors) in such proceedings.
3 Employment means employed in any capacity, including as consultant or expert in any private medical institution whose matter they might have dealt with directly or indirectly.
4 The Sections 12, 13 and 14 of the IMC Act only provide for recognition of medical qualifications by foreign institutions and any foreign student having a medical degree and qualifying under the aforementioned sections could automatically practice as a medical practitioner.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.