The document discusses the UK system for approving doctors to conduct seafarer medical examinations and potential international collaboration on mutual recognition. It notes there are 225 approved doctors in the UK and overseas, who conducted over 54,000 examinations in 2013. The UK provides support to doctors through medical standards, training, and oversight. International meetings have discussed aligning medical standards between countries like Norway, Germany, the Netherlands and the UK. While progress has been made in understanding each other's systems, further work is still needed before mutual recognition of approved doctors across countries can be achieved.

1. Defining the level of competence for approved doctors, the experience of the UK - is international consensus on the mutual recognition of approved doctors possible?
Caroline Livingstone
Medical Administration Manager
Maritime and Coastguard Agency UK

2. UK Seafarer Medical System (ENG 1) Certificates
•225 Approved Doctors (ADs) in the UK and overseas
•54,311 examinations conducted in 2013
•49 medical reviews (appeals) in 2013
•Dr Sally Bell, Chief Medical Adviser (CMA)
•Administration Team of four

3. UK and Overseas
UK; 31448; 58%
Overseas; 22863; 42%
UK and Overseas Comparison 2013
UK
Overseas

4. Comparison by Country
Philippines
France
USA
South Africa
2011
4850
2285
1405
1207
2012
4719
2653
1814
1332
2013
4056
2835
2152
2255
0
1000
2000
3000
4000
5000
6000
No. of ENG 1 examinations
Country
Comparison by Country
2011
2012
2013

5. Competence
•Doctors to deliver consistent decisions that are aligned with the UK medical fitness standards
•Doctors to conduct the examinations in a way that is thorough, fair and acceptable to seafarers
•The examination is seen as providing good value for money

6. Support for doctors
•UK medical fitness standards (MSN 1839)
•AD manual, available on-line
•Twice yearly, clinical updates (Newsletter)
•Training CD
•Annual training seminar
•Chief Medical Adviser advice, available quickly to ADs and admin helpline

7. Support for doctors
•This level of support defines the type of competence that is required
•Inexperienced ADs are offered additional guidance
•We monitor competency through, audits, complaints, annual statistics review and questions asked by ADs

8. Maintaining competency
•All ADs must complete an annual return form of examinations conducted
•MCA conducts an audit of all new ADs
•New ADs must attend the annual training seminar
•Medical Referee system
•We issue warning letters to ADs who are not following our medical standards or procedures
•We do end appointments of ADs

9. Defining competence
•Competence – requires a great deal of medical autonomy and this needs to be initial, consistent and regular training
•There needs to be Quality Assurance of doctors
•Clinical support and guidance
•However, there are established doctors who think they know best and looking up standards is for novices and wimps. These doctors may be difficult to engage with

10. International meetings
•The revision of the ILO guidelines on the medical examinations of seafarers, the recent STCW Manila amendments and the introduction of the Maritime Labour Convention (MLC) should lead to consistency of medical standards and their application internationally
•Norway, Germany, the Netherlands and the UK have held a number of meetings to discuss if it is possible to reach an international consensus
•Denmark attended the last two meetings and Finland have expressed a wish to attend the next meeting

11. The aims of collaboration
•Better access to statutory seafarer medicals that meet the requirements of all the countries involved
•Greater effectiveness and efficiency in the provision of support for doctors and for the improvement of their performance
•The adoption of common fitness criteria aligned with the requirements of the MLC and STCW and following the revised ILO/IMO Guidelines on medical examinations which support these conventions
•An improved service to seafarers and to their employers

12. Appointment criteria
•All countries in the group require confirmation that a doctor is registered with the appropriate national medical registration body
•All seek applicants who have occupational and/or maritime experience but none have specific qualification based requirements
•Decisions on appointments are taken by the maritime authority on the advice of a doctor in Germany, Netherlands and UK. In Norway this is an administrative decision for the authority in Norway and for an embassy elsewhere

13. Comparison of certificates and their compliance with STCW and MLC
•The group invested time in the comparison of our seafarer medical certificates and medical fitness standards
•We bench marked each against the MLC and new STCW requirements

14. Discrepancies between the four national medical fitness criteria
•Vision – criteria for colour and monocular vision and the supplementary tests used, if the Ishihara plates are failed vary
•Hearing – testing and duties
•There are some differences in the ways in which criteria for diabetes, epilepsy and obesity are expressed between the countries

15. Where are we now?
•The group has been working on a joint statement for our websites, confirming that seafarer medical certificates are mutually accepted by Norway, UK and the Netherlands
•Investigating basic and refresher training for doctors
•Links to our websites and lists of doctors
•A further meeting is planned in November

16. Is international consensus on the mutual recognition of approved doctors possible?
•A great deal of progress has been made, mapping our respective seafarer medical systems
•However, further work is needed before mutual recognition is possible

17. Thank you for listening