NMC Regulations in a Nut shell.

 NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023

    National Medical Commission (NMC), the apex regulatory body for medical education and practice in India, issued new guidelines on professional conduct for doctors, which mandate them to prescribe only generic drugs instead of specific brands.

This has sparked a protest from the Indian Medical Association (IMA), the largest body of doctors in the country, which has called the guidelines “unscientific” and “impractical”.

What are the National Medical Commission (NMC) Guidelines?

Social Media Usage Guidelines:

• Doctors can provide information online, ensuring it is verifiable and not misleading.
• Prohibition on discussing patient treatment specifics or sharing patient scans.
• Restriction on sharing patient testimonials, images, and videos.
• Prohibition on soliciting patients directly or indirectly through social media.

Right to Refuse Treatment:

• Doctors may refuse treatment to abusive, unruly, or violent patients and relatives.
• Doctors may deny treatment if the patient cannot afford it but not in medical emergencies.
• Prohibition on discrimination based on gender, race, religion, caste, socio-economic factors.

Prescription and Medication Guidelines:

• Prescriptions to be written in legible, capital letters.
• Generic medicines should be prescribed, except for specific cases.
• Judicious use of fixed-dose combinations, prescribing approved combinations only.
• Encouraging education about the equivalence of generics and branded medicines.

Continuous Professional Development (CPD):

• Mandatory for doctors to continue learning throughout their active years.
• Doctors should undertake 30 credit points in their relevant fields every five years.
• Annual CPD sessions are recommended, with a maximum of 50% online training.
• Recognized degrees and courses added to the national medical register.

Conference Participation Guidelines:

• CPD sessions or conferences cannot be sponsored by the pharmaceutical industry.
• Doctors should not participate in third-party educational activities with pharma sponsorships.
• Doctors or their families should not receive gifts, hospitality, cash, or grants from pharmaceutical companies.
• Prohibition on accepting commissions from diagnostic centers, medical equipment, etc., for referrals or endorsements.

What is the National Medical Commission?

The NMC, is a statutory body established in 2019, replaced the Medical Council of India (MCI) and functions under the National Medical Commission Act, 2019. It serves as India's regulatory body for medical education.

Mission and Vision:

Ensure availability of adequate and high quality medical professionals in all parts of the country.

Promote equitable and universal healthcare that encourages community health perspective and makes services of medical professionals accessible to all the citizens.

Encourages medical professionals to adopt the latest medical research in their work and to contribute to research.

Enforce high ethical standards in all aspects of medical services.

It also has the authority to regulate fees for medical courses and to conduct inspections of medical colleges to ensure that they meet the necessary standards.

What are the Issues with the NMC Guidelines?

A)Generic Medicine Prescription:

• One of the main concerns raised by doctors is the quality and efficacy of generic drugs available in India.
• They claim that there is a lack of standardization and regulation of generic drugs and that many of them are substandard, spurious, or counterfeit.
• According to IMA less than 0.1% of the drugs manufactured in India are tested for quality. Doctors argue that prescribing generic drugs without ensuring their quality and safety could compromise patient care and outcomes, and expose them to legal and ethical risks.
• They also point out that there is no mechanism to monitor the adverse effects or drug interactions of generic drugs in India.
• The new guidelines do not allow doctors to write a specific brand, which means that you will get whichever medicine with the relevant active ingredient in pharmacist stocks.
• Additionally, doctors' choice in prescribing the most suitable drug for a patient may be restricted, potentially affecting treatment efficacy.
• Doctors also allege that there is a nexus between drug manufacturers, wholesalers, retailers, and regulators, which allows substandard and spurious drugs to enter the market.
• They demand that the government should ensure strict quality control and testing of generic drugs before making them mandatory for prescription.
• Other Issues:

·         Imposing an additional burden on doctors to accumulate credit points through CPD sessions.

·         Limited availability of recognized continuous training courses for doctors to meet CPD requirements.

·         Reduced educational sessions due to prohibition of pharmaceutical industry sponsorships.

·         Impact on doctors' exposure to medical advancements and research.

·         Doctors expressing concerns about increased administrative burden due to adherence to the comprehensive guidelines.

·         Balancing ethical conduct with the practical challenges faced by medical practitioners in diverse healthcare settings.

·         Challenges in clearly delineating situations in which doctors may ethically refuse treatment.

·         Legal and ethical concerns arising from doctors refusing treatment based on patients' ability to pay.

Way Forward

·         Enhance the quality and safety of generic drugs by setting up more testing labs, conducting regular inspections, imposing strict penalties, and creating a national database for drug quality.

·         Educate doctors and patients about the pros and cons of generic drugs, using scientific evidence, dispelling myths, and promoting rational medication practices.

·         Encourage medical institutions and professional bodies to organize regular CPD sessions that cover a wide range of medical advancements.

·         Facilitate open discussions and consultations between the NMC, medical practitioners, pharmaceutical industry representatives, and patient advocacy groups.

·         Create platforms for ongoing feedback and suggestions to refine and adapt the guidelines to address emerging challenges and ensure ethical patient care.

 

The National Medical Commission (NMC) has released several regulations in 2023, including:

1.Registered Medical Practitioner (Professional Conduct) Regulations, 2023. These regulations we have discussed above.

This regulation requires doctors to prescribe drugs by their generic names, rather than by brand. The Indian Medical Association (IMA) has called the guidelines "unscientific" and "impractical", raising concerns about the quality and efficacy of generic drugs in India.

2.Post-graduate medical education regulations, 2023

This regulation requires doctors to recognize the health needs of the community, have mastered competencies, and be aware of contemporary advances in their discipline.

3.UG Medical Education Guidelines, 2023

This regulation includes the Family Adoption Program (FAP), which requires MBBS students to adopt a minimum of three families, and ideally five.

4.Revised CBME Guidelines

This regulation reduces the minimum passing percentage for subjects with two papers from 50% to 40%. It also requires candidates to obtain 50% marks in aggregate, with a minimum distribution of 60:40 or 40:60 in Theory and Practical components.

5.Graduate Medical Education Regulations, 2023

This regulation requires clinicians to understand and provide preventive, promotive, curative, palliative, and holistic care with compassion. It also requires clinicians to demonstrate knowledge of normal human structure, function, and development, as well as knowledge of medico-legal, societal, ethical, and humanitarian principles that influence healthcare.