New Delhi : The Ethics and Medical Registration Board (EMRB) of National Medical Council (NMC) notified National Medical Commission Registered Medical Practitioner (Professional conduct) Regulations, 2023 on 2nd August, 2023 to regulate the conduct of Registered Medical Practitioner across India. The regulation compromise of five chapters and eleven guidelines. For the first time the NMC has recognized the right to remuneration of the RMP. The regulations state “ RMP can refuse to treat or continue to treat a patient if the fees as indicated are not paid. At the same time it does not apply to doctors in government services or emergencies but the doctor must ensure that the patient is not abandoned.” Also the regulations permits RMP to refuse the treatment of the patient in case of abusive and violent patient or relatives but the RMP must ensure that the patient is not abandoned. For the first time the notification has regulated the use of social media by RMPs. The regulators have issued 11 Do’s and Don’ts for regulating the social media by RMPs. The regulators have directed the RMP’s to stop posting their “success stories” in the social media platforms.
The regulations has directed the RMPs to display the unique registration ID assigned to them by EMRB in their prescription, certificate and money receipt given to the patient. The RMP can only display the medical degrees/diploma as provided in the nomenclature of the regulation and the RMPs having foreign degrees or qualification must use the NMC approved equivalent medical prefixes and suffixes only. The regulations speak about the vicarious liability of the RMP for the acts of their assistant in the due course of practice. The regulations have made compulsory for the RMP to attend Continuing Professional Development (CPD) Program. A minimum of 30 credit hours has to be scored by the RMP from the date of issue of license till the renewal i.e. within a period of five years. The credit hours for the purpose of this regulation will be considered that are given by accredited or authorized medical colleges/health institutions/medical societies by EMRB/State Medical council.
The regulations have directed the RMP to prescribe drugs using generic names only. The prescription must use generic names written legibly and rationally. The regulations has completely banned the practice of fee splitting / commissions for the referrals to other RMP, diagnostic centers, scanning and imaging centers, medical, surgical or other treatment. The regulation has also barred RMP for using online platforms or using agents for procuring patients.
The regulations bans RMP from endorsing product/s, drug brand, medicine or equipment in any way. RMP has been banned from endorsing products individually or being part of an organization/ association/ society. The regulation has also defined as to when an RMP can issue certificate of proficiency to individuals. The regulations has clearly demarked the advertisement an RMP can make in print, electronic and social media. The regulators have allowed to place advertisement which can have the type of treatment or admission offered, doctors available, facilities offered and fees. The regulation has restricted any sought of soliciting patients for themselves or the hospital.
RMP has to maintain medical records of inpatients for 3 years from the date of the last contact with the patient for treatment. The patient request for medical records should be acknowledged and supplied within 5 working days. In case of medical emergencies the medical records should be made available at the earliest. The regulators have promoted the computerization and digitization of medical records for quick retrieval and security. RMPs have been directed to maintain a register giving full details of certificates, notifications, reports and other documents to individual or institutions signed by them in their professional capacity for subsequent use in courts or administrative or other purpose. RMP has to be in time with appointments or visiting/consultation hours and if delayed for a valid reason should inform the patient. RMP has been given the liberty to choose from the patient he wants to treat except in case of a life-threatening emergence.
According to the regulations RMP and their families must not receive any gifts, travel facilities, hospitality, cash or monetary grants, consultancy fee or honorariums or access to entertainment or recreation from pharmaceutical companies or their representatives. RMP should also not be involved in any third-party educational activity like CPD, seminar, conference which involves direct or indirect sponsorship from pharmaceutical companies.
| Clause/ Guidelines | Do’s and Don’ts |
| Clause 3.A. | Unique ID number of RMP in prescription, certificate, money receipt to the patient. |
| Clause 3.B. | Foreign degree barred from display. Display of degrees or qualification as per NMC allowed. |
| Clause 3.E. | RMP vicariously liable for the act of his assistants. |
| Clause 4 | RMP has to attend Continuing Professional Development (CPD) Program and has to score a minimum of 30 credit hours within a period of 5 years. |
| Clause 4 | The CPD program conducted by EMRB/State Medical Council accredited or authorized institutions will only be considered for the purpose of score calculation. |
| Clause 6 | Right to remuneration of the RMP recognized by NMC. |
| Clause 8 | RMP to prescribe drugs using generic names only. |
| Clause 9 | The practice of fee splitting / commissions for the referrals by RMP completely banned. |
| Clause 9 | RMP has been barred from using online platforms or using agents for procuring patients. |
| Clause 10 | The regulations bans RMP from endorsing product/s, drug brand, medicine or equipment in any way. |
| Clause 11 | The regulation has restricted any sought of soliciting patients for themselves or the hospital. |
| Clause 13 | RMP has to maintain medical records of inpatients for 3 years. |
| Clause 13 | The patient request for medical records should be acknowledged and supplied within 5 working days. |
| Clause 13 | RMPs have been directed to maintain a register giving full details of certificates, notifications, reports and other documents to individual or institutions signed by them in their professional capacity. |
| Clause 22 | RMP has to be in time with appointments or visiting/consultation hours. |
| Clause 26 | RMP has been given the liberty to choose from the patient he wants to treat except in case of a life -threatening emergence. |
| Clause 26 | RMP has been allowed to refuse the treatment of the patient in case of abusive and violent patient or relatives. |
| Clause 35 | RMP and their family not to receive gift/in kind/monetary benefit from pharmaceutical companies or their representatives directly or indirectly. |
| Guideline 4 | This guideline brings uniformity across India in assessment of breach by the RMP and the award of disciplinary action in case of professional misconduct by the RMP. The level of breach are five with level 1 the lowest breach with advisory being issued to the RMP while level 5 being the highest breach wherein the RMP is permanently debarred from practice. |
| Guideline 5 | This guideline states the regulation related to informed consent. In emergencies the RMP can document the absence of surrogate decision makers and proceed in the best interest of the patient. In the case of minor it says that the parents or guardian must provide consent assent of the child above 8 years of age is required. |
| Guideline 6 | This guideline states the regulation related to usage of social media by RMPs. The RMPs are allowed to educate patients but are barred from soliciting the patients in any way. Testimonials or recommendation of the patient of the RMP should not be shared by the RMP in social media. RMPs should not indulge in the practice of purchasing “likes”, “followers” and other means for higher rating or soliciting patients. |