MEDICAL ACT, 1956 (AMENDMENT) (Hansard, 11 June 1958)

§ Mr. John Hynd (Sheffield, Attercliffe)

I beg to move, That leave be given to bring in a Bill to amend the provisions of the Medical Act, 1956, relating to the experience required for full registration and to applications for provisional registration, and of the First Schedule to that Act relating to fees, expenses and allowances. The House will be aware that in 1950 the conditions of registration of medical practitioners, examinations, qualifications, and so on, were reviewed and very considerably examined by the General Medical Council and other bodies and that a number of new provisions were embodied in the Act. Since then a number of cases have come to my notice in which the wording of the Act has proved anomalous. It has led to quite serious injustices and has also resulted in a cumbersome and complicated procedure which it is the desire of everyone concerned to avoid so that the purposes of the Act may be mom effective.

I was a member of the General Medical Council at the time that Measure was introduced and, therefore, I feel some responsibility for the situation it has created. The Bill I ask leave to introduce has reference to the experience of eight years since the passing of the Act and eight years' experience of the new provisions embodied in it, which have not worked out in all cases exactly as desired. The main purpose of my proposed Bill, as shown in the title I have cited, is to simplify the procedure for medical practitioners who have qualified to obtain full registration, on the one hand, and provisional registration, on the other.

In the first case there are two groups of medical practitioners affected by the existing provisions of the Medical Act. The first are those who qualified before 1st January, 1953. Under the provisions of the Act the requirement to obtain full registration in this country is that a medical practitioner should not only have qualified, but have been entered on the Provisional Register and before he could be placed on the Provisional Register he must produce evidence to show that he has secured employment in 218 a hospital. He cannot get on the full Register until he has had 12 months' experience of medicine and surgery in an approved hospital, and he cannot get hospital employment until he is on the Provisional Register.

An anomalous situation has been created in cases where doctors qualified before 1st January, 1953, but, for various reasons, did not apply for full registration on the British Medical Register. For example, doctors who qualified before or during the war and went abroad with the Armed Forces and spent many years in practice, including hospital experience, or went abroad on medical missionary service and had similar experience, but on their return to this country have found that under the provisions of the Act they could not then obtain full registration until they had undertaken another year's internship training in a hospital. Until they had undergone that internship, doctors who have had all the training and experience necessary have thus been unable, because of this technicality, to obtain posts which were open to them and for which their services were required.

The second group is concerned with foreign or Commonwealth doctors with diplomas which are not recognised for registration in this country. In those cases they have first to obtain a British qualification. Whatever may have been their previous qualifications or experience, they must obtain a British qualification, pass a British examination and have a British diploma. They then find that they cannot be registered because they have still to do twelve months' internship in a hospital irrespective of their previous experience.

The result is that, whereas the Act provides that the holder of a foreign or Commonwealth diploma recognised in this country can come here and be placed on the Register immediately, provided he satisfies the General Medical Council that he has had the full hospital experience required under the Act, a doctor with an unrecognised foreign or Commonwealth diploma, and who gets a British diploma in addition, cannot have the same advantage but has to go through the additional formality of an additional year's hospital training.

The anomaly is emphasised by the fact that the Act makes an exception of 219 doctors holding Southern Irish diplomas as well as foreign and Commonwealth diplomas, which are recognised. My Bill would regulate this so that a sensible position would be maintained as in the case of the Irish and recognised foreign and Commonwealth doctors with foreign diplomas from registered schools, and for doctors who qualified in this country before 1953, and can produce evidence that they have at least as much hospital experience as is required from a newly-qualified doctor for registration.

My second point concerns provisional registration and is of particular interest to responsible medical bodies like the General Medical Council. A doctor who has applied for registration on the provisional list in order that he may undertake this twelve months' internship after the qualifying examination and who has obtained a job in a hospital must first produce a certificate of selection for employment in the hospital, which must then be submitted to his examining body, who must then check with that hospital, check his qualification and issue a further certificate. The General Medical Council deals with all these matters all over again, and in the meantime weeks may have gone by. About 2,000 cases a year are dealt with in this category.

The General Medical Council and other bodies concerned will confirm that considerable delays are involved, with the result that those doctors who cannot legally take up posts in a hospital until it is agreed that they shall go on the Provisional Register are either barred from starting in the hospital in a post for which they may be urgently required or, alternatively, they must take up the job in the hospital against the law. There may be many hundreds, even thousands, of doctors who are practising for days or even weeks in hospitals quite illegally because of the anomalous provisions of the Act; they are practising while they are waiting for the formal notification that they have been registered and that the certificate of employment has been received.

I understand that this provision largely is useless. It is cumbersome and embarrassing to everybody concerned and it does not provide an effective check, because it applies only to the first post which a practitioner gets in a hospital and 220 which, in the end, he may not take up, and does not apply to any subsequent post which he may take in the course of his twelve months' experience. I think that it will be generally agreed that it is desirable that the whole situation should be tidied up and that the purely technical provisions involving the time factor between the certificate of employment and provisional registration should be eliminated and the authority left in the hands of the General Medical Council, as was done satisfactorily until the 1950 Act.

My next point is one of detail which, I understand, would probably have been brought forward for rectification in the 1956 Act except for the fact that this was a consolidation Measure and, therefore, not appropriate for an amendment of this kind. It applies to the provisions in the Schedules of the Medical Act under which the fees and expenses of the members of the General Medical Council and its branch councils shall be such as may be decided by the General Medical Council with the approval of the Treasury. This may have been necessary a hundred years ago when the General Medical Council was first set up as an experimental body, but it is no longer necessary and it no longer means anything, because in any case there are no public funds in the General Medical Council's budget.

When we passed the Dentists Act and set up the General Dental Council, it was recognised that this proviso was anomalous and it was, therefore, eliminated from that Act. It might well have been eliminated in 1956 in the Medical Act but for the fact that it was only a consolidating Measure. I believe that this situation is embarrassing to the Treasury, to the General Medical Council and to others and that it means nothing at all, and I should like to take the opportunity of tidying up this point, too.

I assure the House that these suggestions are made only after eight years' experience of the working of the Act and after two years of examination of these points involving discussions with the branches of the Government, the various Ministries, with the General Medical Council and, I understand, with the British Medical Association. All concerned are agreed that these not only desirable but necessary improvements should be made in the Act after those 221 eight years' experience. With that assurance and with the recognition that all these bodies—the General Medical Council, the Ministry and others—have only one purpose in their administration of the medical laws, which is to ensure that the appropriate levels of experience and training shall be observed in the appointments to the Medical Register and in the practice of medicine in this country, I hope that the House will permit me to introduce the Bill.