Healthcare overhaul in Dubai

DUBAI // All medical professionals will need to reapply for their right to practise under new measures designed to unify Dubai's fragmented licensing regime and ensure patients are treated by someone who is competent and qualified.

Proposals for the new set of standards were disclosed yesterday at the MEED Middle East Healthcare Conference by Dr Essa Kazim, the director of health regulation at the Dubai Health Authority (DHA). The DHA's new regulatory arm would implement the new standards. Among the numerous regulatory gaps in Dubai's healthcare system, there is no method in place to uniformly assess doctors, nurses or other professionals working in the private sector once they have received their licence to practice.

"They come to Dubai, apply for a licence, and go out to practise, we have got no evaluation mechanism," said Dr Kazim. "We do not know what standard of practice is out there unless we get a complaint." There are about 10 regulatory bodies overseeing medical practitioners in Dubai, including Dubai Police and Dubai Healthcare City (DHCC). This fragmented system creates "disharmony and confusion" among professionals, he said, because with each different body comes different legislation and procedures. The new regulatory body would set a clear minimum standard for professionals.

More than 15,000 health professionals will be affected by the new rules, including doctors, nurses, pharmacists and physiotherapists. About 6,000 doctors and 6,000 nurses will need to prove they meet the chosen minimum standard, even if it means further training. About 1,300 doctors work in the government sector, with most in private practice. Dr Kazim said the DHA had created new scopes - or limits - of practice for each profession.

"Information on these will be posted on the DHA website," he said, "so that the public can see the qualifications and scopes of practice of individual practitioners in the emirate. It will be transparent." Eventually the authority wants to rate and make public the performance of professionals by assessing the outcomes of their patients. Both government and private facilities would be included. "We are not under any illusion that this is an easy task," Dr Kazim said. "It is going to be difficult. We think it will take around three or four years for everyone to be brought up to the standards, it might be earlier than that but you have to manage expectations."

Those who do not meet the new standards will be given support to help them reach the target level and a period of grace before they were shut down. "If you have someone working in a solo practice in Dubai and you say 'we are going to give you one year to obtain a postgraduate qualification, or some evidence that you have professionally improved', they would have great difficulty to try and continue being the sole bread winner and at the same time improve themselves."

Physicians will come under scrutiny first, followed by nurses and other professionals such as physiotherapists and pharmacists. Final details of the new licensing process are still being worked out, but Dr Kazim said the criteria would probably be based on several well-recognised international qualifications. Cultural, population and demographic differences mean it is not possible to simply apply standards from one country to the UAE, he said.

As it stands a doctor wanting to work in Dubai must get a licence from the Department of Health and Medical Services, the agency being replaced by the DHA. The same doctor wanting to move to a facility in Dubai Healthcare City would need to get another licence and go through a different set of procedures. "It requires a lot of time and effort," Dr Kazim said. "We will now make a system whereby there is just one licence needed to work in Dubai. If DHCC say they want extra, that is their prerogative. But in terms of regulation and licensing, there will be only one."

One doctor, who runs a private practice in a busy area of Dubai, said he was concerned about reapplying for a licence. The doctor, who spoke on the condition of anonymity, said: "I have worked in Dubai for more than 10 years since I moved from India where I qualified. "To hear that I need to reapply for my licence is worrying. My qualifications are now old, so what if they are not accepted? Will they make me do more work? I have a lot of patients who I need to see for my business, I cannot afford to take lots of time off to study."

Dr Kazim said he was aware the regulatory body could face some resistance from the medical profession. "The doctors here work very hard for the qualifications they have attained," he said. "But I think whichever method we come up with, the objective is to ensure that doctors are competent, as much as we can be sure, to work in Dubai." The licensing details have not been finalised, so he could not say what qualifications would be accepted and whether additional training would be required.

As well as assessing the quality and number of health professionals in Dubai, the DHA also plans to document what specialities are offered in the emirate's various inpatient and outpatient facilities, and assess what is needed and where. One directorate has been set up to collect information on the specialities, and another has been created to analyse what has been gathered. "Because of the nature of Dubai," Dr Kazim said. "There may be oversupply today, but by tomorrow there will not be."

The regulatory body is also looking into related professions in the emirate, for example police paramedics. More details on the regulatory agency are expected to be released in coming weeks. munderwood@thenational.ae