CONSULTATION PAPER BY DG INTERNAL MARKET AND SERVICES ON THE PROFESSIONAL QUALIFICATIONS DIRECTIVE 15 March 2011

Transcription

1 EUROPEAN UNION OF GENERAL PRACTITIONERS / FAMILY PHYSICIANS UNION EUROPEENNE DES MEDECINS OMNIPRATICIENS / MEDECINS DE FAMILLE PRESIDENT: VICE-PRESIDENT: VICE-PRESIDENT: VICE-PRESIDENT: VICE-PRESIDENT: Dr. Ferenc HAJNAL (Hungary) Dr. Eirik Bø LARSEN (Norway) Dr. Francisco TOQUERO (Spain) Dr. Nena KOPCAVAR GUCEK (Slovenia) Dr. Joseph PORTELLI DEMAJO (Malta) CONSULTATION PAPER BY DG INTERNAL MARKET AND SERVICES ON THE PROFESSIONAL QUALIFICATIONS DIRECTIVE 15 March

2 The European Union of General Practitioners/ Family Physicians (UEMO) is an organization of the most representative national, non-governmental, independent organizations representing general practitioners/family physicians in the countries of Europe. Founded in 1967 by the national organizations in Belgium, France, Germany, the Netherlands and Italy, the UEMO quickly grew to encompass organizations from all the current Member States of the European Union from the countries of the European Economic Area and as well as other European countries. As one of its main objectives, UEMO aims to study and promote the highest standard of patient care, training, continuing medical education and continuing professional development, professional practice conditions within the field of the general practice/family medicine throughout Europe, to keep up the role of general practitioners/family physicians in the healthcare systems and to promote the ethical, scientific, professional, social and economic interests of European general practitioners/family physicians and to secure their freedom of practice in the interests of the patient. We thank the opportunity to share our experience and suggestions during the process of public consultation of DG Internal Market on the Professional Qualification Directive. Under this topic, UEMO would like to mention one specific difficulty which arises with the growing number of Member States that have introduced Family medicine as a medical specialty and the general practice rules as defined in the Directive 2005/36 /EC. UEMO very much agrees with the intention of the call for consultation to simplify the recognition procedure and facilitate mobility of professionals through EU, namely mobility of general practitioners/family doctors. As mentioned in the 1.4 paragraph, most parts of the acquis on professional qualification were agreed between six or nine Member States of the then European Economic Community. According to the UEMO survey, out of the 27 EU countries, 22 recognize Family medicine as a specialty under the Title III of the Directive 2005/036, in 4 countries (Austria, Bulgaria, Italy and UK) general practitioners are not specialists, functioning under the Title IV, in one country (Belgium) the status is currently changing. Question 1: Do you have any suggestions for further improving citizen's access to information on the recognition processes for their professional qualification in another Member State? UEMO opinion is that professional organizations at EU level could provide links to national websites which provide this information and add a section on frequently asked questions. Publishing experiences of members with the authorities ordered per country could give additional factual information. It is also highly important to inform members who want to work in another country, that it is not an easy switch: any change of country has to be well planned in advance in order to be a success. Migrant doctors should also be made aware of the need of language skills for exercising the profession. The Point of Single Contact could be useful to signpost migrants to the competent authorities. Moreover, the competent authorities could facilitate access to information by providing their website content in a common European language in addition to their home language 2

3 Question 2: Do you have any suggestions for the simplification of the current recognition procedures? If so, please provide suggestions with supporting evidence. In order to simplify current recognition procedure and to facilitate free movement of general practitioners/family physicians through EU countries, UEMO suggests recognizing General Practice/Family Medicine as a specialty. General practitioners/family physicians are in principle the first point of contact with health care for the patients. Health education, preventive activities, early detection, problem oriented care, terminal care and palliation are the tasks GP/Family physicians should be able to address and perform, as well as coordination with the specialists treatment and knowledge on all existing services within the local health care system. There is a very fast, worldwide professional evolution and growing role of GP/FM. One reason for increasing the competence of doctors in the primary health care is to limit the pressure on institutional care and thereby increase efficiency. To fulfill all its missions and deliver high quality of care, many Member States have introduced in the recent years a medical specialty on Family medicine in order to extend the period of training and obtain better qualified doctors as for any other specialty This shift should be embraced by the EUinstitutions and be incorporated in Article 25 of the Directive 2005/36/EC by acknowledging family medicine as a specialty on equal terms with other specialties. This would simplify the recognition procedures and increase mobility. However, this change is not yet translated to EU (EEA) level for different reasons. First of all, the introduction of a new medical specialty is still a very long process that requires a vote of the Member Sates under the comitology procedure. The procedure laid down in Article 26 needs to be revised by achieving a more modern and efficient way to adapt to the evolution of the art of medicine. Secondly, the introduction of family medicine as a specialty will require repealing the current rules governing the specific training in general practice. This switch would of course generate a legislative process for the revision of the directive but would ultimately better reflect the role of family physicians in a modern health system focusing more on primary care. Therefore, the European Commission and the Member States should analyze how to reflect in the Directive the changes that are operating in the Member States with the development of Family medicine as a medical specialty at national level and use the opportunity of revising the Directive to introduce this necessary update. Question 3: Should the Code of Conduct become enforceable? Is there a need to amend the contents of the Code of Conduct? Please specify and provide the reasons for your suggestions. UEMO supports that the Code of Conduct should not be made legally binding, but this Code should be made more known by migrants in order to better protect their rights. Question 4: Do you have any experience of compensation measures? Do you consider that they could have a deterrent effect, for example as regards the three years duration of an adaptation period? 3

4 These questions concern more the general system and professions that do not benefit from automatic recognition. In certain cases (Article 10 of the Directive), doctors could fall under the general system but it is very marginal. Therefore, we would not enter into the debate on compensation measures which do not concern doctors. However, the issue of partial access could be envisaged and should be further studied by UEMO as other health professionals could have various competences depending on their countries of qualifications. Question 6: Do you see a need to include the case-law on partial access into the Directive? Under what conditions could a professional who received "partial access" acquire full access? In the opinion of UEMO, partial access is leading to unclear legal situations and is difficult to explain to the public. Its extension to the health sector could jeopardize patient safety. Only the full license to practice medicine entitles the holder to unrestricted exercise of the practice of medicine. Question 7: Do you consider it important to facilitate mobility for graduates who are not yet fully qualified professionals and who seek access to a remunerated traineeship or supervised practice in another Member State? Do you have any suggestions? Please be specific in your reasons. It is a very complex question and UEMO agrees that countries should make arrangements to ensure that those graduating in medicine from their own universities can complete the basic elements of training. However, the movement of new graduates in the specific training should be facilitated. There is evidence that traineeships abroad helps to improve doctor-patient relationship in intercultural contact. Question 8: How should the home Member State proceed in case the professional wishes to return after a supervised practice in another Member State? Please be specific in your reasons. This is an accepted practice throughout Europe with many Junior Doctors seeking training in other Member States and returning to practice in their home Member State. UEMO agrees with the position of CPME that the sheer number of young physicians who complete part of their training in other EU Member States is a testament to the fact that there are no major constraints, and that the recognition of knowledge, skills and training times acquired in other EU Member States is not a problem. Question 11: What are your views about the objectives of a European professional card? Should such a card speed up the recognition process? Should it increase transparency for consumers and employers? Should it enhance confidence and forge closer cooperation between a home and a host Member State? While this could be a beneficial tool to family doctors, UEMO position is, however, that due to the responsibility of physicians in terms of patient safety and care, it requires comprehensive security measures to ensure the integrity of the card. While it would be also beneficial to consumers and employers, it would require considerable infrastructure and support to ensure the integrity of the card and the information that it holds. The introduction of a new card could lead to administrative duplication and difficulties around interoperability. 4

5 The information contained on a professional card would be held already by the competent authorities in the doctor s home member state. Question 12: Do you agree with the proposed features of the card? According to UEMO, the integrity of this card is paramount to the medical profession. While we agree the proposed features of the card, there may need to be additional features to ensure the card cannot be falsified, or access to information on the card cannot be altered by unauthorized person. While competent authorities of the Home Member State should be responsible for verifying the original card, responsibility for the maintenance of the card once the physician starts practicing in another/or several Member State needs to be identified, particularly in terms of recording CME/CPD and disciplinary/misconduct issues. The maintenance of information on the card, particularly in regards to the medical profession, needs to be mapped out to ensure the veracity of the individual practicing medicine. Question 13: What information would be essential on the card? How could a timely update of such information be organized? Apart from basic identification information like any identity card, further information associated with the card could include information regarding the medical education of the individual, training information, specialties etc. information required for the recognition of qualifications. If professional misconduct/competence issues regarding the individual raise serious questions about their ability to safely practice medicine, there should be a mechanism to identify this information associated with the card. Therefore it would be necessary to have the card linked to a profile/record with the details of physician. For the medical profession, updating data would be vitally important, however it needs to be ensured that this can be done in a safe manner, and can be verified by competent authorities. Again, a mechanism to cancel the card would be required to ensure the card or the information on the card cannot be used by unauthorized persons. Question 14: Do you think that the title professional card is appropriate? Would the title professional passport, with its connotation of mobility, be more appropriate? Both titles, "professional card" and "professional passport", are compatible with the objectives of the card. Question 15: What are your views about introducing the concept of a European curriculum a kind of 28th regime applicable in addition to national requirements? What conditions could be foreseen for its development? The existing system of automatic recognition should be optimized and should recognize General Practice/Family Medicine as a specialty, rather than introducing a European medical training and continuing medical education program in the sense of a 28th regime applicable in addition to the national requirements. 5

6 Question 16: To what extent is there a risk of fragmenting markets through excessive numbers of regulated professions? Please give illustrative examples for sectors which get more and more fragmented. These questions do not concern the medical profession. The medical profession is regulated for obvious reasons of patient safety. Question 18: How could the current declaration regime be simplified, in order to reduce unnecessary burdens? Is it necessary to require a declaration where the essential part of the services is provided online without declaration? Is it necessary to clarify the terms temporary or occasional or should the conditions for professionals to seek recognition of qualifications on a permanent basis be simplified? Due to the specific nature of medical care, the current declaration regime is not onerous to ensure patient safety. It may be beneficial to clarify the terms temporary or occasional to provide consistency throughout the EU, to therefore determine if the physician should hold temporary or full registration. Question 19: Is there a need for retaining a pro-forma registration system? UEMO agrees with the CPME s opinion in this regard. As medicine is a profession affecting health and safety, a system of prior registration is imperative. Other less restrictive options are not apparent. Only with such a system in place is it possible to monitor health professionals with regard to the laws on access to and exercise of a profession. The competent authorities would not be able to operate efficiently without registration and thus without knowledge of the provision of services. The extent to which the registration of the service providers can be reinforced by other legal mechanisms (e.g. assistance from employers or as a pre-employment requirement) is another question. Question 20: Should Member States reduce the current scope for prior checks of qualifications and accordingly the scope for derogating from the declaration regime? UEMO position is that health professions should continue to be subject to prior checks for the provision of temporary services. Question 21: Does the current minimum training harmonization offer a real access to the profession, in particular for nurses, midwives and pharmacists? Directive 2005/36/EC has made the migration of physicians in Europe substantially easier. Access to the profession in other Member States of the European Union has been made considerably simpler by the minimum training requirements set out in Article 24 of the Directive. The medical profession provides a prime example of the advantages of automatic recognition with regard to (specialty) designations and the minimum period of specialty training. Adding General Practice/Family Medicine as a new medical specialty would simplify the recognition procedures and increase mobility. 6

7 Question 22: Do you see a need to modernize the minimum training requirements? Should these requirements also include a limited set of competences? If so what kind of competences should be considered? According to UEMO, the introduction of quality criteria for post-graduate training (Articles 25 and 28) is necessary. Time based criteria are not sufficient to guarantee high level of training. Quality criteria should be introduced. There is a need to develop the minimum training conditions quality criteria in General Practice/Family Medicine. We suggest keeping the minimum quality requirements as simple as possible, but they need to be of a high standard to safeguard patient safety. Question 23: Should a Member State be obliged to be more transparent and to provide more information to the other Member States about future qualifications which benefit from automatic recognition? The position of CPME is supported by UEMO. The current regime of automatic recognition, which has proven successful in recent years, should be made more transparent. Member States could contribute to more transparency in the system by making information on the content of medical training and specialization accessible to the public, for example via electronic platforms. Such action would specifically help the process of having General Practice/Family Medicine recognized as a specialty. Question 24: Should the current scheme for notifying new diplomas be overhauled? Should such notifications be made at a much earlier stage? Please be specific in your reasons. The system for notifying new diplomas must be able to react faster and more flexibly to changes at a national level, as well as possible current mistakes. The inclusion of General Practice/Family Medicine as a new specialty should be reflected as soon as possible in the Annex V in order to have a uniform regime at EU level and enhance patient safety. A faster system will help the migration of doctors and would reduce the uncertainty of the status of graduated doctors holding new specialties. Question 27: Do you see a need for taking more account of continuing professional development at EU level? If yes, how could this need be reflected in the Directive? UEMO supports CPME position on this issue. Question 28: Would the extension of IMI to the professions outside the scope of the Services Directive create more confidence between Member States? Should the extension of the mandatory use of IMI include a proactive alert mechanism for cases where such a mechanism currently does not apply, notably health professions? UEMO position is that the Directive should be revised in order to introduce a legal duty on all medical regulators to share registration and fitness to practice information proactively. Data protection issues which prevent some EU Member States from doing this must be addressed 7

8 and resolved as a matter of urgency. In addition to the proactive sharing of data when regulatory action is taken against a doctor (an alert system ), the IMI system must be made compulsory for all EU competent authorities so that competent authorities can be confident that they will receive a timely and reliable response to any justifiable concerns they may have over an applicant. Question 29: In which cases should an alert obligation be triggered? The instances that are currently being highlighted (professional malpractice issues) should certainly trigger an alert, however there must be safeguards to ensure that this is utilized in appropriate circumstances and clear standards and criteria should be developed around this procedure. Question 30: Have you encountered any major problems with the current language regime as foreseen in the Directive? UEMO supports CPME position on the language regime. Sufficient knowledge of the national language(s) is a necessary prerequisite for cultivating a relationship of trust between patients and physicians. As such, it makes an essential contribution to patient safety. In addition, proven language abilities help to prevent communication difficulties between physicians which can have serious consequences for patients. 8