Context: National Medical Commission (NMC) has come into being from 25 September and the six-decade-old Indian Medical Council Act 1956 has been repealed. There are four autonomous boards under the NMC Act--- the Under-Graduate Medical Education Board (UGMEB), the Post-Graduate Medical Education Board (PGMEB), the Medical Assessment and Rating Board and the Ethics and Medical Registration Board.

Role of autonomous board under NMC

• The Under-Graduate Medical Education Board (UGMEB) and the Post-Graduate Medical Education Board (PGMEB): These two bodies will be responsible for formulating standards, curriculum, guidelines for medical education, and granting recognition to medical qualifications at the under-graduate and post-graduate levels respectively.
• The Medical Assessment and Rating Board: The Board will have the power to levy monetary penalties on institutions which fail to maintain the minimum standards as laid down by the UGMEB and the PGMEB. It will also grant permissions for establishing new medical colleges, starting postgraduate courses, and increasing the number of seats in a medical college.
• The Ethics and Medical Registration Board (EMRB): This Board will maintain a National Register of all the licensed medical practitioners in the country, and also regulate professional and medical conduct. Only those included in the Register will be allowed to practice as doctors. The Board will also maintain a register of all licensed community health providers in the country.
• Each Board will consist of a President and four members (of which two members will be part-time), appointed by the central government (on the recommendation of a search committee).

The key functions of the NMC will be

• Further streamlining regulations
• Rating of institutions
• HR assessment
• Focus on research
• Prepare guidelines for fee regulation by private medical colleges
• Developing standards for Community Health Providers to serve in primary healthcare with limited practicing licence
• Besides, they will also work on modalities of the common final year exam after MBBS (NEXT- National Exit Test) to serve for both registration and PG entrance

About the National Medical Commission

• The Centre has notified the 33-member NMC, which will be chaired for three years by Suresh Chandra Sharma.
• Apart from the Chairman, the NMC will consist of 10 ex-officio members and 22 part-time members appointed by the Central government.

Functions of NMC

• laying down policies for regulating medical institutions and medical professionals.
• assessing the requirements of human resources and infrastructure in healthcare.
• ensuring compliance by the State Medical Councils with the regulations made under the Bill.
• framing guidelines for determination of fee for up to 50% of the seats in the private medical institutions.

Significance

• This historic reform will steer medical education towards a transparent, qualitative and accountable system.
• The basic change that has happened is that the Regulator is now selected on merits, as opposed to an elected Regulator.
• Men and women with impeccable integrity, professionalism, experience and stature have been placed at the helm to steer the medical education reforms further.
• Increasing Doctor-Patient ratio: The doctor to population ratio in India is 1:1456 compared to the World Health Organisation standard of 1:1000.
• By providing limited license to community health providers, the  aims to increase Doctor-Patient ratio.This is similar to other countries where medical professionals other than doctors are allowed to prescribe allopathic medicine. For example, Nurse Practitioners in the USA, after completing some basic course, training and registration, are eligible to provide a full range of health care services.
• Standardization: The NMC standardizes the quality of doctors by introducing a common exam for the medical license.
• Regulation of fees of Private medical colleges: It will counter the commercialization of medical education through capitation fees. The States will alsohave the freedom to regulate fees for the remaining seats.

Associated Issues
Audit by Third Party

• The NMC Act proposed to set up a “Medical Assessment and Rating Board” to hire and authorise any other third-party agency or persons for carrying out inspections of medical institutions for assessing and rating such institutions.
• The authenticity of quality audits by private bodies can be questioned.

Issue of Autonomy

• The Act provides NMC as a complete subsidiary of the government. From the selection of its office-bearers and members to its finances, its functioning and powers, all being comprehensively controlled by the government.
• This absolute control of the government of the NMC, threatens its autonomy.

Formalizing Quackery

• The Act is silent on the method by which the “commission” will grant “limited licence” to community health providers to practise modern medicine.
• The absence of clarity on this front, may allow some unqualified personnel to perform duties of a medical practitioner.

Issue of Federalism

• Though health is primarily a state subject, the Act empowers the central government to give such directions and the state government shall comply with such directions.

Conclusion

• The achievement of the 3rd Sustainable Development Goal (SDG) in India will need well-functioning health systems that work towards ensuring universal health coverage.
• In this context, the NMC Act is consciously contributing to medical education to channelise the supply-side to meet the future requirements. However, holistic governance reforms in the medical sector are the need of the hour, so as to instil the medical ethos of transparency, equity and accountability.