Features of the National Medical Commission Act, 2019:

1. The NMC Act has been passed by the Parliament. It repeals the
erstwhile Indian Medical Council Act, 1956. [Note—the 2017 Bill lapsed
with the dissolution of the 16 th  Lok Sabha.  The 2019 Bill was introduced
in the 17 th Lok Sabha with certain changes.

2. The contrast between the two legislations is striking if one reads the
preambles of the two Acts:

Preamble of the 1956 Act:
“An act to provide for the reconstitution of the medical council of India and the maintenance of a medical register for India and for matters connected therewith.”

Preamble of the 2019 Act:
“An Act to provide for a medical education system that improves access
to quality and affordable medical education, ensures availability of
adequate and high quality medical professionals in all parts of the
country; that promotes equitable and universal healthcare that
encourages community health perspective and makes services of
medical professionals accessible to all the citizens; that promotes
national health goals; that encourages medical professionals to adopt
latest medical research in their work and to contribute to research; that
has an objective periodic and transparent assessment of medical
institutions and facilitates maintenance of a medical register for India
and enforces high ethical standards in all aspects of medical services;
that is flexible to adapt to changing needs and has an effective
grievance redressal mechanism and for matters connected therewith or
incidental thereto.”

3. The following provisions of the Act came into force with effect from
the 02nd day of September, 2019 through a gazette notification last
year: sections 3, 4, 5, 6, 8, 11, 16, 17, 18, 19, 56 and 57.
[NOTE—The said sections primarily pertain to the constitution of the
National Medical Commission and the various bodies under it. Sections
3,4,5,6 deal with the composition, the constitution, the appointment of
the search committee and the term of members of the Commission
respectively. Section 8 deals with Appointment of Secretary, experts,
professionals, officers and other employees of the National Medical
Commission Section 11 of the NMC Act deals with the Constitution and
composition of Medical Advisory Council while section 16, 17, 18 and 19
deal with Constitution, Composition of Autonomous Boards, the Search
Committee for appointment of President and Members and the Term of
office and conditions of service of President and Members respectively.
Section 56 and 57 define the powers to make rules and regulations
under the Act.]

4. According to a recent government notification:

-The NMC Act takes effect from 25-09-2020, from which date the IM
Act, 1956 stands repealed.
-Former head of Delhi All India Institute of Medical Sciences ENT
department, Dr Suresh Chandra Sharma has been appointed for a
period of three years with effect from September 25 while Rakesh
Kumar Vats, the Secretary General in the Board of Governors of the
MCI, presently, would be the secretary of the commission.
-Rakesh Kumar Vats, the Secretary General in the Board of Governors
of the MCI was appointed as the secretary of the commission for a
similar term on January 2.

5. Some of the reasons for repealing the IMC Act, 1956, were as
follows:

i) There were grave charges of corruption against the MCI.

a)MCI has the dubious distinction of being the only regulatory body to
have been dubbed as a “den of corruption” by a high court, a “big source
of corruption” by a health minister and “corruption-ridden” by a
parliamentary panel. dailyo.in/medical-council-of-india-health-sector-national-medical-commission/

b) The MCI was supposed to be the legal custodian of medical
education (licencing of medical colleges and curriculum), medical ethics,
licencing of doctors, medical negligence. However, the MCI failed in
each of these areas. Its leaders, especially Dr Ketan Desai, have
brought disgrace to the medical fraternity.

c) The March 2016 report of the parliamentary committee was
unprecedented as it contained one full chapter titled “Corruption in MCI”
and recorded the unqualified admission by the MCI president that there
was “corruption in sanctioning of medical colleges or increasing or decreasing medical seats.” The Committee noted–“The situation has
gone far beyond the point where incremental tweaking … can give the
contemplated dividends. That is why the Committee is convinced that
the MCI cannot be remedied…”

d) In 2001, the Delhi High Court described the MCI as “a den of
corruption”. Its former president Dr. Ketan Desai was arrested for
corruption in April 2010. 

ii) The MCI consisted only / mainly of doctors. There was a view that it
should not be the sole preserve of the medical community. It must
include eminent people from different walks of life, particularly public
health experts, social scientists, and health economists.  For example, in
the United Kingdom, the General Medical Council which is responsible
for regulating medical education and practice consists of 12 medical
practitioners and 12 lay members (such as community health members,
administrators from local government etc. As a matter of fact, a non-
medical member can even become its chairman.
(Note–In the British Medical Council, non-doctors are in majority and
can even become its chairman.)

iii) The MCI is an elected body where its members are elected by
medical practitioners themselves, i.e., the regulator is elected by the
regulated.  Experts have recommended nomination based constitution of
the MCI instead of election, and separating the regulation of medical
education and medical practice. 

6- The states will establish their respective State Medical Councils
within three years.  These Councils will have a role similar to the NMC,
at the state level

7- Composition of the NMC
A–“4. (1) The Commission shall consist of the following persons to be
appointed by the Central Government, namely:—
(a) a Chairperson;
(b) ten ex officio Members; and
(c) twenty-two part-time Members.
(2) The Chairperson shall be a medical professional of outstanding
ability,”

B—“(3) The following persons shall be the ex officio Members of the
Commission, namely:—
(a) the President of the Under-Graduate Medical Education Board;
(b) the President of the Post-Graduate Medical Education Board;
(c) the President of the Medical Assessment and Rating Board;
(d) the President of the Ethics and Medical Registration Board;
(e) the Director General of Health Services, Directorate General of
Health
Services, New Delhi;
(f) the Director General, Indian Council of Medical Research;
(g) a Director of any of the All India Institutes of Medical Sciences, to be
nominated by the Central Government;
(h) two persons from amongst the Directors of Postgraduate Institute of
Medical Education and Research, Chandigarh; Jawaharlal Institute of
Postgraduate Medical Education and Research, Puducherry; Tata

Memorial Hospital, Mumbai; North Eastern Indira Gandhi Regional
Institute of Health and
Medical Sciences, Shillong; and All India Institute of Hygiene and Public
Health, Kolkata; to be nominated by the Central Government; and,
(i) one person to represent the Ministry of the Central Government
dealing with Health and Family Welfare, not below the rank of Additional
Secretary to the Government of India, to be nominated by that Ministry.”

C—“(4) The following persons shall be appointed as part-time Members
of the Commission, namely:—
(a) three Members to be appointed from amongst persons of ability,
integrity and standing, who have special knowledge and professional
experience in such areas including management, law, medical ethics,
health research, consumer or patient rights advocacy, science and
technology and economics;
(b) ten Members to be appointed on rotational basis from amongst the
nominees of the States and Union territories, under clauses (c) and (d)
of sub-section (2) of section 11, in the Medical Advisory Council for a
term of two years in such manner as may be prescribed;
(c) nine members to be appointed from amongst the nominees of the
States and Union territories, under clause (e) of sub-section (2) of
section 11, in the Medical Advisory Council for a term of two years in
such manner as may be prescribed.”

8- Functions of the NMC—“10. (1) The Commission shall perform the
following functions, namely:—
(a) lay down policies for maintaining a high quality and high standards in
medical education and make necessary regulations in this behalf;
(b) lay down policies for regulating medical institutions, medical
researches and medical professionals and make necessary regulations
in this behalf;
(c) assess the requirements in healthcare, including human resources
for health and healthcare infrastructure and develop a road map for
meeting such requirements;
(d) promote, co-ordinate and frame guidelines and lay down policies by
making necessary regulations for the proper functioning of the
Commission, the Autonomous Boards and the State Medical Councils;
(e) ensure co-ordination among the Autonomous Boards;
(f) take such measures, as may be necessary, to ensure compliance by
the State Medical Councils of the guidelines framed and regulations
made under this Act for their effective functioning under this Act;
(g) exercise appellate jurisdiction with respect to the decisions of the
Autonomous Boards;
(h) lay down policies and codes to ensure observance of professional
ethics in medical profession and to promote ethical conduct during the
provision of care by medical practitioners;
(i) frame guidelines for determination of fees and all other charges in
respect of fifty per cent. of seats in private medical institutions and
deemed to be universities which are governed under the provisions of
this Act;
(j) exercise such other powers and perform such other functions as may
be prescribed.”

9-Regulatory bodies under the NMC?
The Act sets up four autonomous boards under the supervision of the
NMC.  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).  These
bodies are:
 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: 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.
10—NEET—“14. (1) There shall be a uniform National Eligibility-cum-
Entrance Test for admission to the undergraduate and postgraduate
super-speciality medical education in all medical institutions which are
governed by the provisions of this Act.”
11—NET—“15. (1) A common final year undergraduate medical
examination, to be known as
the National Exit Test shall be held for granting licence to practice
medicine as medical practitioners and for enrolment in the State
Register or the National Register, as the case may be.

12-Professional misconduct

The State Medical Council will receive complaints relating to
professional or ethical misconduct against a registered medical
practitioner.  If the medical practitioner is aggrieved of a decision of the
State Medical Council, he may appeal to the Ethics and Medical
Registration Board.  If the medical practitioner is aggrieved of the
decision of the Board, he can approach the NMC to appeal against the
decision. 
(NOTE– It is unclear why the NMC is an appellate authority with regard
to matters related to professional or ethical misconduct of medical
practitioners. 
It may be argued that disputes related to ethics and misconduct in
medical practice may require judicial expertise.  For example, in the UK,
the regulator for medical education and practice – the General Medical

Council (GMC) receives complaints with regard to ethical misconduct
and is required to do an initial documentary investigation in the matter
and then forwards the complaint to a Tribunal.  This Tribunal is a judicial
body independent of the GMC.  The adjudication decision and final
disciplinary action is decided by the Tribunal.

13-Community health providers
“32. (1) The Commission may grant limited licence to practice medicine
at mid-level as Community Health Provider to such person connected
with modern scientific medical profession who qualify such criteria as
may be specified by the regulations:
Provided that the number of limited licence to be granted under this sub-
section shall not exceed one-third of the total number of licenced
medical practitioners registered under sub-section (1) of section 31.”
“(3) The Community Health Provider may prescribe specified medicine
independently, only in primary and preventive healthcare, but in cases
other than primary and preventive healthcare, he may prescribe
medicine only under the supervision of medical practitioners registered
under sub-section (1) of section 32.”