Health services in Jammu & Kashmir State have expanded to enormous proportions from 1947. Back in those days two main hospitals and dispensaries in main towns and cities were augmented with small health centres in villages. The outlying areas were catered for with one LMP or Hakim run one room outfit that was offered as some basic need of health care. The District Medical Officer known as Civil Surgeon then was answerable to the provincial head or deputy Director who were under the control of Director Health Service for J&K. This was the structure that became the basic framework which was developed to present day medical colleges, district hospitals and equipped primary health centres. Administration pecking order now is streamlined from district to provincial level and Director Health Services for each province at the top. The main medical colleges are autonomous and administered by the Principal and Dean of the colleges. This structure is a stereotyped copy of other states of India and has embedded streams of hierarchy from the Health Ministry to a doctor in a remote village. The DHS has a spread of Chief Medical Officers and Assistant Health Services in sub-specialities.
General Medical Council GMC has an important role in the overall delivery and control of health services. J&K State level Medical Council has an office in Ghandi Nagar Jammu. It normally has 8 members, 2 for licentiates 3 nominated by the government and 3 elected by registered doctors. This office is threadbare and not functional in full. The president is not in office, the registrar has a make shift address and the government for over three years turned blind eye to reviving the institution, appoint the members with a mandate to regulate the functioning of the medical services. Two basic clerks receive BDS, MBBS qualification certificates and issue registration to new doctors. That is the total scope of work in this institution.
Regulating a highly technical institution of health service is not bureaucratic domain. A case is made to establish an organization with a limited sphere of activity like Institute of Clinical Excellence (ICE) based on realistic grounds. This initiative is derivative of NICE (National Institute of Clinical Excellence) that functions as regulatory body in UK and has a final word in the scope of how medical services are delivered to the population. Prevention and management of disease is the central theme.
ICE will send out alerts with every unprecedented free coasting of fatal and non-fatal medical conditions in hospitals or clinics. Evaluation of experience of doctors is an area of scrutiny so that for any medical procedure that is conducted or treatment undertaken, the expertise and qualifications of the doctor as well as the adequate facilities available has to match before the procedures are undertaken.
Doctors in private practice work under a code of practice with existing laws against negligence or in certain cases gross negligence entering criminal spheres. There are books published on the subject and education and awareness is important. Registration Certificates issued by the clerks at GMC to authorise medical practice can be a red herring.
The proposed ICE involves humble encumbrance on existing healthcare structures. I hope this introductory page has been enough to enlighten the basic concept. The proposal can be expanded in a project form after the authorities have agreed it in its conceptual stage.