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JUAN CARLOS I REY OF SPAIN

To all who present it and understand it.

Sabed: That the General Courts have approved and I come to sanction the following law.

EXPLANATORY STATEMENT

I

The first regulation of the health professions in Spain is produced in the 19th century, since the Regulation for the Subdelegations of the Interior Health of the Kingdom of 24 July 1848 determined that the exercise of the Professions of Medicine, Pharmacy and Veterinary Medicine was included in the Health Care branch.

By the Law of 28 November 1855 on the General Health Service, the Provincial Medical Juries of Qualification were instituted, which were aimed at preventing, admonishing and qualifying the faults that were committed by the professionals in the exercise of their faculties, as well as regularise their fees, repress abuse and establish a severe medical morality.

Both the Law of 1855 and the General Instruction of January 12, 1904, were concerned to regulate, even in embryonic form, the professional exercise of what they called "the art of healing" with the establishment of a register of professionals who have been put in charge by the Health Subdelegates.

The entry into force, already in the middle of the twentieth century, of other health laws, meant the abandonment of the system of ordination followed until then. The Law of National Health Bases of 25 November 1944 dedicated only its base 12 to the professional organization of physicians, practitioners and dentists, with a single forecast, that of the existence of professional corporations.

Law 14/1986, of 25 April, General of Health, only refers to the free exercise of the health professions, without facing its regulation, although it provides, as a competence of the State, the approval of programs of post-graduate training, further training and specialisation of health personnel, as well as the general approval of the health services ' jobs. This is because the General Health Law is a rule of a predominantly organizational nature, the primary objective of which is to establish the structure and functioning of the public health system in the new political and territorial model of the A state that derives from the 1978 Constitution.

Because of this, the essential of the exercise of medicine and the rest of the health professions, with the exception of dentistry and other professions related to dental health, as referred to in Law 10/1986, of 17 In March, other provisions, be they the regulators of the educational system, already those of the relations with the patients, already the ones regarding the rights and duties of the professionals as such or those that regulate the relations service of the professionals with the centers or the institutions and public corporations and private.

This situation of practical vacuum, united to the intimate connection that the exercise of the health professions has with the right to the protection of the health, with the right to the life and the physical integrity, with the right to personal and family intimacy, with the right to human dignity and with the right to the free development of the personality, advises the specific and differentiated legislative treatment of the health professions.

It cannot be forgotten, on the other hand, of the European Communities ' rules, which are based on the directives on mutual recognition between the Member States of diplomas, certificates and other evidence of formal qualifications. the health professions which, in so far as they make access to the health professional activities subject to the possession of the diplomas which are required in the directives, undoubtedly introduce a limitation to the professional exercise which must establish, in our internal law, by standard with formal rank of law, such as requires Article 36 of our Constitution.

The content of the law, in this field, should focus on regulating the conditions of exercise and the respective professional fields, as well as measures to ensure the basic, practical and clinical training of professionals.

By virtue of all this, this law aims to provide the health system with a legal framework that provides for the different instruments and resources that make it possible to integrate professionals into the service. health, preventive and care, both in its public and private sectors, facilitating co-responsibility in the achievement of the common goals and in improving the quality of health care provided to the population, ensuring that all healthcare professionals comply with the necessary levels of competence to try to continue safeguarding the right to health protection.

II

The concept of profession is an elusive concept that has been developed from sociology according to a series of attributes such as higher education, autonomy and self-organizational capacity, code of ethics and spirit of service, which are given to a greater or lesser extent in the different occupational groups that are recognized as professions. In spite of these ambiguities and considering that our political organization is recognized only as an existing profession, the one that is normalized from the State, the criteria to be used to determine the health professions, base on the pre-existing rules. This regulation corresponds to two areas: education and the one regulated by the collective corporations. This is why it is recognized as health professions in this law that the university regulations recognize as qualifications in the field of health, and that they currently enjoy a collegial organization recognized by the public authorities.

On the other hand, there is a need to resolve, with interprofessional pacts prior to any regulatory regulation, the issue of the competencies of the health professions while maintaining the will to recognize simultaneously the growing interprofessional shared competence spaces and the very relevant spaces specific to each profession.

Therefore, in this law, it has not been intended to determine the competences of some and other professions in a closed and concrete form, but establishes the basis for these pacts to be produced between professions, and that the practices Professionals in increasingly multidisciplinary organizations evolve in a non-conflictive, but cooperative and transparent way.

III

With the aim of fulfilling the objectives set out above, as well as the objective of better health protection as provided for in Article 43 of the Spanish Constitution, this law is structured in a preliminary title and in five other titles.

The preliminary title and Title I are aimed at determining the essential aspects of the exercise of the health professions, stating, in an express way, what these professions are, reserving to the corresponding graduates the exercise thereof, by identifying the functional areas of each of them, and by listing the rights of the users of their professional services.

Title II of the law regulates the training of healthcare professionals, contemplating both pre-graduate and specialized training and, what is a normative innovation of singular relevance, continuous training. The need for the latter, in general, with effect on the recognition of the professional development of the health services staff, must have a particular influence on the development, consolidation, quality and cohesion of our health services. sanitary system.

Professional development and recognition is the subject of regulation in Title III, which establishes its general principles, common and homologable throughout the Health System. This is the basis of an essential system for promoting the development of the Health System in accordance with the principle of quality of care and the permanent improvement of health benefits, a system that is required by the own professionals, by the autonomic health services and by the private health services.

The professional exercise in the private sphere is regulated in Title IV of this law, which establishes, as a general principle, the application to health services of such ownership of the criteria that are determined in this rule, in order to ensure the highest quality of health benefits, whatever the funding of these benefits.

The law is supplemented by Title V on the participation of health professionals in the development, planning and management of health professions, which is articulated through the Commission. Professional Consultative Committee, in which all professional bodies are represented.

PRELIMINARY TITLE

General rules

Article 1. Object and scope of application.

This law regulates the basic aspects of the health professions entitled to their own or other self-employed, the general structure of the training of professionals, the professional development of the health professions, The Commission has also been involved in the planning and management of health professions. It also establishes the records of professionals who can make effective the rights of citizens with respect to health benefits and the proper planning of human resources in the health system.

The provisions of this law apply whether the profession is exercised in public health services or in the field of private health.

Article 2. Health professions entitled.

1. In accordance with Article 36 of the Constitution, and for the purposes of this law, they are health professions, entitled and regulated, those whose pre-graduated or specialized training is specifically and fundamentally directed to provide the the knowledge, skills and attitudes of health care, and which are organised in professional bodies officially recognised by the public authorities, in accordance with the provisions of the rules specifically applicable.

2. Health professions are structured in the following groups:

(a) From a licensed level: the professions for whose exercise they enable the degrees of Licentiate in Medicine, in Pharmacy, in Dentistry and in Veterinary Medicine and the official titles of specialist in Health Sciences for Licentiates referred to in Title II of this Law.

b) Diplomated level: the professions for whose exercise the degrees of Diplomacy in Nursing, in Physical Therapy, in Occupational Therapy, in Podology, in Optics and Optometry, in Logopedia and in Human Nutrition and Dietetics and the official titles of specialist in Health Sciences for such Diplomates referred to in Title II of this Law.

3. Where this is necessary, due to the characteristics of the activity, in order to improve the effectiveness of the health services or to adapt the preventive or health care structure to scientific and technological progress, the the status of a health profession, entitled and regulated, of a given activity not provided for in the previous paragraph, by means of a rule of law.

According to the provisions of Law 10/1986 of March 17, on dental practitioners and other professionals related to dental health, they are of a health profession that of dental prosthetic and dental hygienist.

4. In the rules referred to in paragraph 3, procedures shall be laid down for the Ministry of Health and Consumer Affairs to issue, where necessary, an attestation of evidence to enable the professional exercise of the interested.

Article 3. Professionals in the health area of vocational training.

1. In accordance with Article 35.1 of the Constitution, professional health professionals who hold the vocational training qualifications of the health professional family, or diplomas or certificates equivalent to those of the same.

2. Professionals in the health field of vocational training are structured in the following groups:

(a) From a higher grade: those who hold the titles of Superior Technician in Pathological Anatomy and Cytology, in Dietética, in Sanitary Documentation, in Dental Hygiene, in Image for Diagnosis, in Diagnostic Laboratory Clinical, in Orthopreprosthetic, in Dental Protheses, in Radiation Therapy, in Environmental Health and in Audioprostheses.

b) Average grade: those who hold the titles of Technical in Nursing Care and Pharmacy.

3. They shall also have the consideration of professionals in the field of vocational training who are in possession of professional qualifications which, in the health professional family, establishes the General Administration of the State. as provided for in Article 10.1 of the Organic Law of 19 June 2002 on Qualifications and Vocational Training.

4. The superior and technical technicians referred to in this Article shall carry out their occupational health activities in accordance with the rules governing vocational training, their various levels of training and their specific qualifications, in the a framework for respect for professional competence, responsibility and autonomy of the health professions referred to in Articles 6 and 7 of this Law.

5. The health authorities shall, where appropriate, establish the models for the integration and incorporation of the higher and technical technicians referred to in this Article and their health professional activities to the establishments and establishments which are dependent or attached to such administrations, and shall regulate the systems of continuous and development training.

TITLE I

From the exercise of health professions

Article 4. General principles.

1. In accordance with Articles 35 and 36 of the Constitution, the right to the free exercise of the health professions is recognized, with the requirements laid down in this law and in the other applicable laws.

2. The exercise of a health profession, on its own or outside, shall require the possession of the corresponding official title which it expressly provides for, or, where appropriate, the certification provided for in Article 2.4, and shall, where appropriate, comply with the requirements laid down in Article 4 (2). the provisions of this Directive, in the other applicable laws and in the rules governing professional colleges.

3. Healthcare professionals develop, among others, functions in the fields of care, research, teaching, clinical management, prevention and health information and education.

4. It is up to all health professions to participate actively in projects that can benefit the health and well-being of people in health and disease situations, especially in the field of disease prevention, health education, research and the exchange of information with other professionals and with the health authorities, for a better guarantee of these purposes.

5. The professionals will have as their guide the service to the society, the interest and health of the citizen to whom the service is provided, the rigorous fulfillment of the deontological obligations, determined by the own professions in accordance with the legislation in force, and of the criteria of normo-praxis or, where applicable, the general uses of their profession.

6. Healthcare professionals will carry out continuous training throughout their professional life, and will regularly demonstrate their professional competence.

7. The exercise of the health professions shall be carried out with full technical and scientific autonomy, without further limitations than those laid down in this law and by the other principles and values contained in the legal and deontological system, and agreement with the following principles:

a) There will be written formalization of your work reflected in a clinical history that should be common for each center and unique for each patient cared for in it.

Clinical history will tend to be supported in electronic media and shared among professionals, centers and levels of care.

b) The unification of the criteria for action, which will be based on the scientific evidence and the means available and supported in guidelines and protocols of clinical and care practice, will be aimed at. The protocols should be used for guidance, as a decision guide for all professionals in a team, and will be regularly updated with the participation of those who must apply them.

(c) The organisational effectiveness of services, sections and equipment, or equivalent care units, whatever their name, shall require the written existence of internal operating rules and the definition of objectives and both general and specific functions for each member of the staff, as well as the completion by the professionals of the care, information or statistics documentation that the center determines.

d) The care continuity of patients, both those who are cared for by different professionals and specialists within the same center as those at different levels, will require in each field The existence of procedures, joint development protocols and indicators to ensure this purpose.

e) The progressive consideration of the interdisciplinarity and multidisciplinarity of professional teams in healthcare.

Article 5. General principles of the relationship between healthcare professionals and people cared for by them.

1. The relationship between healthcare professionals and people cared for by them is governed by the following general principles:

(a) Professionals have the duty to provide adequate technical and professional health care to the health needs of the persons they serve, in accordance with the state of development of scientific knowledge of each time and with the levels of quality and safety set out in this law and the other applicable legal and deontological standards.

b) Professionals have a duty to make rational use of the diagnostic and therapeutic resources in their care, taking into account, among others, the costs of their decisions, and avoiding overuse, underutilisation and improper use of the same.

c) Professionals have a duty to respect the personality, dignity and intimacy of the persons in their care and must respect the participation of the professionals in the decision-making that affects them. In any case, they must provide sufficient and adequate information to enable them to exercise their right to consent to such decisions.

d) Patients are entitled to the free choice of the doctor who should attend them. Whether the professional exercise is carried out in the public system or in the private sector for an employed person, this right shall be exercised in accordance with an explicit regulation which must be publicly known and accessible. In this situation, the professional can exercise the right to give up health care to that person only if it does not entail neglect. In the exercise of the public or private system, such waiver shall be exercised in accordance with regular, established and explicit procedures and shall be formally established.

e) Professionals and health care providers shall provide their patients with the exercise of the right to know the name, title and specialty of the healthcare professionals who attend to them, as well as to know the category and function of these, if they are defined in their institution or institution.

f) Patients have the right to receive information in accordance with the provisions of Law 41/2002 of 14 November, basic regulation of patient autonomy and of rights and obligations in relation to information and clinical documentation.

2. In order to ensure effective and facilitate the exercise of the rights referred to in the previous paragraph, professional bodies, regional councils and general councils, in their respective territorial areas, shall establish the records of the public professionals who, according to the requirements of this law, will be accessible to the population and will be available to the health administrations. These records, in compliance with the principles of confidentiality of the personal data contained in the implementing rules, must permit the knowledge of the name, title, specialty, place of exercise and the other data that in this law determine how public.

In addition, they may exist in health centers and in insurance entities operating in the disease class, other records of professionals of a complementary nature to the previous ones, that serve the purposes indicated in the the previous paragraph, as provided for in Articles 8.4 and 43 of this Law.

The general criteria and minimum requirements for these registers will be established by the Health Administrations within the general principles to be determined by the Interterritorial Council of the National Health System, which may agree to integrate them into the Health Information System of the National Health System.

Article 6. Medical graduates.

1. In general, it is up to the Health Licensors, within the scope of action for which they have their corresponding title, the direct personal benefit that is necessary in the different phases of the comprehensive health care process and, where appropriate, the direction and assessment of the overall development of such a process, without prejudice to the competence, responsibility and autonomy of the various professionals involved in the process.

2. Without prejudice to the functions which, according to their specific qualifications and competence, are to be developed for each health care professional or for which other professionals may develop, they are functions of each of the health professions. Level of Licentiates the following:

(a) Doctors: it is up to the Licensados in Medicine to indicate and carry out the activities aimed at the promotion and maintenance of health, to the prevention of diseases and to the diagnosis, treatment, therapeutic and rehabilitation of patients, as well as the prosecution and prognosis of the processes under consideration.

b) Pharmacists: it is up to the Licensates in Pharmacy to activities aimed at the production, conservation and dispensing of medicinal products, as well as collaboration in the analytical, pharmacotherapeutic and monitoring of public health.

(c) Dentists: it is up to the graduates in Dentistry and the Medical Specialists in Estomatology, without prejudice to the functions of the Medical Specialists in Oral and Maxillofacial Surgery, the functions related to the promotion of the health of the buco-dental health and the prevention, diagnosis and treatment mentioned in Law 10/1986 of 17 March on dentists and other professionals related to dental health.

(d) Veterinarians: it is up to Licensas in Veterinary Control to control hygiene and technology in the production and processing of food of animal origin, as well as the prevention and control of animal diseases, particularly zoonoses, and the development of the techniques necessary to avoid the risks that in man can produce animal life and its diseases.

3. They are also licensed healthcare professionals who are in possession of an official title of specialist in Health Sciences established, as provided for in Article 19.1 of this Law, for psychologists, chemists, biologists, biochemists or other university graduates not included in the previous number.

These professionals will develop the functions that correspond to their respective qualifications, within the general framework established in article 16.3 of this law.

4. Where a professional activity is formally declared as a health profession, entitled and regulated, at the level of Licentiate, the corresponding rules shall be set out in the relevant standard, within the general framework provided for in this Regulation. Paragraph 1 of this Article.

Article 7. Health diplomats.

1. In general, it is up to the health professionals to provide their own professional competence in the various stages of the work, in order to enable them to give their appropriate qualifications, the personal provision of care or the services of their professional competence. the health care process, without prejudice to the competence, responsibility and autonomy of the various professionals involved in such a process.

2. Without prejudice to the functions which, according to their specific qualifications and competence, are to be developed for each health care professional, or for which other professionals may develop, they are functions of each of the health professions. Diplomatic level:

a) Nurses: it is up to the university graduates in Nursing to address, evaluate and provide nursing care oriented to the promotion, maintenance and recovery of health, as well as to the prevention of diseases and disabilities.

b) Physiotherapists: it is up to the university graduates in Physiotherapy to provide the care of their discipline, through treatments with means and physical agents, aimed at recovery and rehabilitation of people with somatic dysfunctions or disabilities, as well as the prevention of them.

(c) Occupational therapists: it is up to university graduates in Occupational Therapy to apply techniques and to carry out occupational activities that tend to enhance or supplement physical functions or Reduced or lost psychics, and to guide and stimulate the development of such functions.

(d) Podogists: University Diplomates in Podology perform the activities aimed at the diagnosis and treatment of the conditions and deformities of the feet, using the therapeutic techniques of their discipline.

e) Opticos-optometrists: University Diplomates in Optics and Optometry develop activities aimed at detecting the defects of ocular refraction, through its instrumental measure, to the use of techniques for reeducation, prevention and visual hygiene, and for the adaptation, verification and control of optical aids.

f) Logopedas: University Diplomates at Logopedia develop activities for the prevention, evaluation and recovery of hearing, phonation and language disorders, using their own therapeutic techniques. discipline.

g) nutritionists: University graduates in Human Nutrition and Dietetics develop activities aimed at feeding the person or groups of people, appropriate to the physiological needs and, in their (a) case, pathological of the same, and in accordance with the principles of prevention and public health.

3. Where a professional activity is formally declared as a health profession, entitled and regulated, at the level of Diplomacy, the relevant rules shall be set out in the relevant standard, within the general framework laid down in the paragraph 1 of this article.

Article 8. Professional exercise in healthcare organizations.

1. Professional practice in health organisations shall be governed by the rules governing the link between professionals and such organisations, as well as by the provisions of this and the other legal rules applicable to them.

2. Professionals will be able to provide joint services in two or more centres, even if they maintain their links to only one of them, when strategic alliances or shared management projects are maintained between different health facilities. In this case, new establishment appointments or contracts may be linked to the project as a whole, without prejudice to the rules on incompatibilities.

3. Health centres shall review, at least every three years, that the health professionals in their workforce meet the requirements necessary to pursue the profession in accordance with the provisions of this law and the other applicable rules, including the qualifications and other diplomas, certificates or professional credentials thereof, in order to determine the continuity of the qualification to continue providing patient care services. The centres shall have a personal file of each professional, in which their documentation shall be kept and the person concerned shall have the right of access.

4. To make possible the choice of physician provided for in Article 13 of Law 41/2002 of 14 November, basic regulation of the autonomy of the patient and of rights and obligations in the field of information and clinical documentation, and according to In accordance with Article 5 (2) of this Law, health centres shall have a register of their medical staff, of which the name, title, specialty, category and function of the professionals shall be brought to the attention of the users.

5. In the event that, as a result of the legal nature of the relationship under which a profession is pursued, the professional must act in a case, by force, on the basis of professional criteria other than his own, to do so in writing, with the safeguard in any case of professional secrecy and without prejudice to the effectiveness of its action and the principles contained in Articles 4 and 5 of this law.

Article 9. Interprofessional relationships and teamwork.

1. Comprehensive health care involves multidisciplinary cooperation, integration of processes and continuity of care, and avoids fragmentation and the simple overlap between care processes attended by different graduates or specialists.

2. The team of professionals is the basic unit in which the professionals and other staff of the care organizations are structured in a uni or multiprofessional way to effectively and efficiently carry out the services that they are required.

3. Where a health performance is carried out by a team of professionals, it shall be articulated in a hierarchical or collegiate manner, where appropriate, taking into account the criteria of knowledge and competence, and in its case of certification, of professionals who integrate the team, based on the specific activity to be carried out, on the mutual trust and knowledge of its members ' capacities, and on the principles of accessibility and continuity of care of the people served.

4. Within a team of professionals, the delegation of actions shall be possible, provided that the conditions under which such delegation or distribution of actions may occur are previously established within the team.

The necessary condition for the delegation or distribution of the work is the ability to perform it on the part of the one who receives the delegation, which will have to be objectivable, whenever possible, with the appropriate accreditation.

5. The teams of professionals, once constituted and approved within the health organizations or institutions, will be recognized and supported and their actions facilitated, by the management bodies and managers of the same. Institutions and institutions shall be responsible for the ability of professionals to perform a proper performance in the tasks and functions entrusted to them in the process of distributing the teamwork.

Article 10. Clinical management in healthcare organizations.

1. Health administrations, health services or governing bodies of health centres and establishments, as appropriate, shall establish the means and systems of access to the clinical management functions, through procedures in which the professionals themselves are to be involved.

Such functions can be performed according to criteria that demonstrate the necessary knowledge and adequate training.

2. For the purposes of this law they have the consideration of functions of clinical management those relating to the leadership or coordination of health and care units and equipment, the tutoring and the organization of specialized, continuous and Research and participation in internal committees or institutional projects of health centers aimed, among others, to ensure quality, safety, efficacy, efficiency and health care, continuity and coordination between levels or the reception, care and well-being of patients.

3. The exercise of clinical management functions shall be subject to the evaluation of performance and results. Such assessment shall be of a periodic nature and may determine, where appropriate, the confirmation or removal of the person concerned in those tasks, and shall have an impact on the assessment of the professional development achieved.

4. The performance of clinical management functions shall be the subject of the appropriate recognition by the centre, the health service and the health system as a whole, in the manner in which it is determined in each autonomous community.

Article 11. Research and teaching.

1. The entire healthcare structure of the healthcare system will be available to be used for health research and for the teaching of professionals.

2. The health administrations, in coordination with the educational administrations, will promote research and teaching activities in all health centers, as an essential element for the progress of the health system and its professionals.

The health center and health services will be able to formalize agreements and concerts with the Carlos III Health Institute, with other research centers, public or private, and with other institutions that have an interest in health research, for the development of research programmes, for the provision of linked, or specific research, places in health facilities for the designation of research tutors and for the establishment of specific systems for the training of researchers during the period immediately after obtaining the specialist title.

3. Health services, institutions and health centres and universities will be able to formalise the concerts provided for in the Organic Law 6/2001, of 21 December, of Universities, in Law 14/1986, of 25 April, General of Health and in the Article 14 of this Law, to ensure the practical teaching of the health teachings that so require, in accordance with the general bases established by the Government for such a concert regime, under the provisions of the provision The seventh additional organic law.

accredited health centres for specialised training must have a teaching commission and the heads of studies, teaching coordinators and training tutors who are appropriate in terms of their capacity teacher, in the form provided for in Title II of this Law.

accredited health centres for the development of continuing training programmes should have the heads of studies, teacher coordinators and training tutors who are appropriate in the light of the activities to be carried out. develop.

TITLE II

From the training of healthcare professionals

CHAPTER I

General rules

Article 12. Guiding principles.

They are guiding principles of training and teaching in the field of health professions:

(a) Permanent collaboration between the bodies of public administrations competent in the field of education and health.

b) The consultation of universities and vocational training institutions and health institutions and institutions in order to ensure the practical teaching of the teaching that so requires.

c) The provision of the entire structure of the healthcare system to be used in the pre-graduated, specialized and continuous teaching of the professionals.

d) The consideration of health centres and services, also, as centres of scientific research and training of professionals, to the extent that they meet the appropriate conditions for such purposes.

e) The permanent review of teaching methodologies and teaching in the field of health for the best adaptation of professional knowledge to scientific and technical evolution and to the health needs of the population.

f) The continuous updating of knowledge, through continuous training, of healthcare professionals, as a right and a duty of health professionals. To this end, institutions and health centres will facilitate the implementation of continuing training activities.

g) The establishment, development and updating of methodologies for the assessment of knowledge acquired by professionals and the functioning of the training system itself.

CHAPTER II

Pre-graduated training

Article 13. From university education.

1. The Commission of Human Resources of the National Health System will inform, with a mandatory nature, the projects of royal decrees for which, according to the provisions of article 34 of the Law of the Organic Law 6/2001, of 21 December, of Universities, establish the official titles and general guidelines of their respective curricula, where such titles correspond to health professions.

2. Where necessary, in order to ensure that the training of professionals is more appropriate to the needs of the health system, to scientific and technical progress, or to the provisions of the European Community, the Minister for Health and Consumo may, after agreement of the Human Resources Commission of the National Health System, urge the Ministry of Education, Culture and Sport to initiate the process of establishing new titles or review and incorporation of new areas of knowledge in the general guidelines of the corresponding study plans.

3. In accordance with the provisions of Article 44 of the Organic Law of Universities, the determination of the number of students admitted to pre-graduate training will respond to the needs of healthcare professionals and the existing capacity for their training. training.

Article 14. Concerts between universities and health services, institutions and health centers.

The universities will be able to agree with health services, institutions and health centers that, in each case, are necessary to ensure the practical teaching of the health teaching that so requires. The institutions and health centres shall be able to add the university adjective to their name.

It is for the Government, on a joint proposal from the Ministries of Education, Culture and Sport and for Health and Consumer Affairs, prior to the report of the University Coordination Council, the establishment of the general bases to which The above mentioned concerts will have to be adapted, in which the participation of the competent organ of the autonomous communities will be foreseen in the singular concerts that, according to those, are signed between universities and health institutions.

CHAPTER III

Specialist Health Sciences Training

SECTION 1. OBJECT AND DEFINITIONS

Article 15. Character and subject of specialised training.

1. Specialized training in Health Sciences is a regulated and official training.

2. The purpose of the specialized training in Health Sciences is to provide professionals with the knowledge, techniques, skills and attitudes of the corresponding specialty, simultaneously with the progressive assumption by the interested in the responsibility inherent in the self-employed exercise of the same.

Article 16. Titles of Health Sciences Specialists.

1. It is up to the Government, on a proposal from the Ministries of Education, Culture and Sport and of Health and Consumer Affairs, to report from the Human Resources Commission of the National Health System, from the National Council of Specialties in Science Health and the organization or collective organizations that correspond, the establishment of the titles of Health Sciences Specialists, as well as their deletion or change of denomination.

2. The title of specialist has official character and validity throughout the territory of the State.

3. Without prejudice to the powers of the health professionals referred to in Article 6.2 and 7.2 of this law, nor of the rights recognized, by law or regulation, to those who are entitled to perform specialist without the corresponding title, the possession of the specialist title will be necessary to use in a way express the name of specialist, to practice the profession with such a character and to occupy places of work with such denomination in public and private establishments and establishments.

Article 17. Issue of the specialist title.

1. The titles of specialist in Health Sciences will be awarded by the Ministry of Education, Culture and Sport.

2. Obtaining the specialist title requires:

(a) Be in possession of the degree of Licentiate or University Diplomat which, in each case, is required.

(b) Access to the appropriate training system, as well as complete this in its entirety in accordance with the training programmes to be established, without prejudice to the provisions of Article 23 of this Law for the alleged of new specialization.

c) Overcome assessments to be determined and deposit the rights of issue of the corresponding title.

Article 18. Professional recognition of specialist qualifications obtained in foreign countries.

1. The Government, acting on a proposal from the Ministry of Health and Consumer Affairs, shall establish the cases and procedures for the recognition in Spain of certificates of specialist obtained in non-EU Member States, in accordance with what, if necessary, establish international treaties and conventions that are applicable.

2. The recognition of specialist titles provided in the previous issue will have professional, but not academic, effects. In order for these latter effects to be produced and such titles to be provided for access to university teaching bodies and related places in hospitals, it will be necessary to grant them prior approval in accordance with the procedure laid down by the Government on a proposal from the Commission. Ministry of Education, Culture and Sport.

3. The recognition of specialist qualifications obtained in the Member States of the European Union, or in States where the free movement of workers and the freedom of establishment and freedom to provide services are applied (a) professionals shall comply with the provisions of the Community rules governing such recognition.

SECTION 2 OF THE STRUCTURE AND TRAINING IN HEALTH SCIENCES SPECIALTIES

Article 19. General structure of the specialties.

1. Specialties in Health Sciences may be established for professionals expressly referred to in Articles 6 and 7 of this Law.

Specialties in Health Sciences may also be established for other university graduates not mentioned in the above mentioned precepts, when their undergraduate training is in line with the relevant professional field. craft.

2. Specialties in Health Sciences shall be grouped, where appropriate, on the basis of high quality criteria. The specialties of the same trunk shall have a common training period of at least two years.

3. The Government, when establishing the titles of specialist in Health Sciences, will determine the title or titles necessary to access each of the specialties, as well as the trunk in which, if any, they are integrated.

Article 20. Specialist training system.

1. The training of specialists in health sciences will involve both a theoretical and practical training and a personal and progressive participation of the specialist in training in the activity and in the responsibilities of the specialist. be treated.

2. The training will take place through the residence system in accredited centres.

In any case, the centres or units in which the training is to be developed shall be accredited in accordance with Article 26.

3. The training by residence will meet the following criteria:

a) The residents will perform the specialty training program with full-time dedication.

Residence training will be incompatible with any other professional or training activity, with the exception of doctoral studies.

(b) The duration of the residence shall be that laid down in the training programme of the speciality and shall be indicated in accordance with the provisions of the Community rules.

c) The professional activity of the residents will be planned by the management bodies in conjunction with the teaching commissions of the centers so that it will be totally incardine in the ordinary, continuous operation. and emergency care of the health center.

(d) Residents shall, in a programmed and tutored manner, develop the activities provided for in the programme, assuming progressively, as they progress in their training, the activities and responsibility of the financial year The stand-alone of the craft.

e) The activities of the residents, which must be included in the Resident's Book, will be the subject of the evaluations that are to be determined. In any case, annual evaluations and final evaluation shall be available at the end of the training period.

f) A special working relationship between the health service or the centre and the training specialist will be established during the residence. The Government, taking into account the specific characteristics of the training activity and the care activity developed in the health centres, and in accordance with the criteria set out in this chapter and in the additional provision first of this law, will regulate the special employment relationship of residence.

4. The principles laid down in the preceding number and the other principles set out in Sections 1 and 2 of this Chapter may be adapted by the Government to the specific characteristics of the training in the field of health sciences. professions referred to in Articles 6.2, b), c) and d), 6.3 and 7 of this Act.

Article 21. Training programmes.

1. Programmes for the training of specialties in health sciences shall specify the qualitative and quantitative objectives and the professional skills to be met by the applicant for the title during each of the annual courses. in which the training programme will be divided.

2. The training programmes shall be drawn up by the National Speciality Commission. Once ratified by the National Council of Specialties in Health Sciences and prior to the report of the Human Resources Commission of the National Health System and the Ministry of Education, Culture and Sport, they will be approved by the Ministry of Health. Health and Consumer Affairs.

Training programs will be periodically reviewed and updated by the procedure provided in the previous paragraph.

Once approved, the training programs will be published in the "Official State Gazette" for general knowledge.

3. In the case of specialties of the same trunk, the programme of the common training period shall be drawn up by a specific commission composed of representatives of the National Commissions for the relevant specialities.

4. In the case of multi-disciplinary specialties, training programmes may provide for specific training courses depending on the qualifications of the source.

Article 22. Access to specialized training.

1. Access to specialised health training shall be carried out by means of an annual national call.

2. The Ministry of Health and Consumer Affairs, prior to the report of the Ministry of Education, Culture and Sport and the Human Resources Commission of the National Health System, will establish the rules that will regulate the annual call that will, in any case, be in a test or set of tests that will evaluate theoretical and practical knowledge and clinical and communicative skills, as well as in an assessment of the academic and, if any, professional merits of the applicants.

The tests will be specific to the different academic degrees that can be accessed in the different specialties. Specific tests may also be established for trunk specialties.

3. Access for persons with disabilities to specialized health training, provided that the degree of disability is compatible with the performance of the functions corresponding to the specialty to which it is chosen, will be inspired by the principles (a) equal opportunities, non-discrimination and compensation for disadvantages, where appropriate, in the case of the adaptation of the tests to the special needs and singularities of these persons.

4. The system of award of all the places offered in the annual call shall be determined, which shall be carried out in accordance with the order of decreasing the score obtained by each applicant, with the peculiarities to be established with regard to places of private ownership centres.

5. The offer of places for the annual call will be fixed, previous reports from the National Council of Specialties in Health Sciences and the Ministry of Education, Culture and Sport, by the Human Resources Commission of the National Health System, taking into account the proposals made by the Autonomous Communities, the needs of specialists in the health system and the availability of budgetary resources.

Article 23. Training for a new specialization.

Health Sciences Specialists with at least five years of professional practice as such, may obtain a new specialist degree, in the same trunk as the one they possess, by the procedure that (a) to determine whether the applicant is in a position to be responsible for the assessment of the applicant's competence in the field of the new specialty.

The training period in the new specialty and the program to be developed during the new specialty will be defined by the adaptation of the general training program to the training and professional curriculum of the person concerned.

The third and successive specialist titles for this procedure cannot be accessed until at least eight years after obtaining the previous one.

Article 24. Specific Training Areas.

1. The Government, in accordance with the procedure referred to in Article 16.1, may establish Specific Training Areas within one or more Specialties in Health Sciences.

2. The Specific Training Area Diploma has official status and validity throughout the State. It will be issued by the Ministry of Health and Consumption and its possession will be necessary to use in a way express the name of specialist with specific training in the area. It may be valued as merit for access to high specialization jobs in public and private establishments or establishments.

Article 25. Training in Specific Training Areas.

The assumptions and requirements for Health Sciences Specialists to be able to access the Specific Training Area Diploma will be established, provided that the Area has been constituted in the (a) the relevant specialty, and credit at least five years of professional practice in the specialty.

Access to the given diploma may be obtained through a scheduled training, or through the professional exercise specifically oriented to the relevant area, accompanied by teaching activities or training. continued in that area, and, in any case, after the assessment of the professional competence of the person concerned in accordance with the requirements laid down in Article 29.

SECTION 3. TRAINING SUPPORT STRUCTURE

Article 26. Accreditation of schools and teaching units.

1. The Ministry of Health and Consumer Affairs and the Ministry of Education, Culture and Sport, on a proposal from the Commission of Human Resources of the National Health System, adopted prior to the report of the Professional Forum provided for in Article 35.3.b) of Law 16/2003, 28 of In order to be published in the "Official Gazette of the State", it will establish the accreditation requirements which, in general, must comply with the centres or units for the Health Sciences Specialist training.

2. The Quality Agency of the National Health System will coordinate the audits, reports and proposals necessary to accredit the schools and teaching units and to evaluate the operation and quality of the training system, for which it can to seek the collaboration of the quality agencies of the autonomous communities and the inspection services of these communities.

3. It is up to the Ministry of Health and Consumer Affairs, at the request of the institution holding the institution, to report on the teaching committee of the institution and the Health Department of the Autonomous Community, and in accordance with the reports and proposals to be refers to the above paragraph, to resolve requests for accreditation of schools and teaching units.

The accreditation will specify, in any case, the number of accredited teaching places.

4. The revocation, in whole or in part, of the accreditation granted shall be carried out, where appropriate, by the same procedure, heard by the centre concerned and its teaching committee.

Article 27. Teaching commissions.

1. In each health centre or, where appropriate, teaching units, accredited for the training of specialists, there will be a teaching commission whose task will be to organise training, monitor its practical implementation and monitor compliance with the requirements of the objectives that are specified in the programs.

The teaching commission will also have the functions of facilitating the integration of training activities and residents with the care and ordinary activities of the centre, and the planning of their professional activity in the center together with the management organs of the latter.

2. The autonomous communities, within the general criteria set by the Human Resources Commission of the National Health System, will determine the functional dependency, composition and functions of the teaching commissions. In any case, the teaching committees shall be represented by the tutors of the training and the residents.

Article 28. National Specialty Commissions.

1. For each of the Specialties in Health Sciences, and as an advisory body to the Ministries of Education, Culture and Sport, and Health and Consumer Affairs in the field of the corresponding specialty, a National Commission designated by the Ministry of Health Sciences will be set up. the Ministry of Health and Consumer Affairs with the following composition:

(a) Two vowels proposed by the Ministry of Education, Culture and Sport, one at least of which must be provided with the status of tutor of the training in the relevant specialty.

b) Four vowels from among the specialists of recognized prestige proposed by the Human Resources Commission of the National Health System.

c) Two vowels representing legally constituted state-wide scientific entities and societies in the field of the specialty.

d) Two vowels representing the training specialists, chosen by them in the form that is determined to be regulated.

e) A vowel representing the corresponding collegial organization. If the craft can be completed by a number of graduates, the appointment of the representative shall be made by common agreement by the corresponding corporations.

2. In the case of multidisciplinary specialities, the Government may extend the number of vowels provided for in subparagraph (b) of the previous paragraph, in order to ensure the appropriate representation of the various graduates who have access to the corresponding craft.

3. All members of the committee, except those referred to in paragraph 1 (d), shall be in possession of the relevant specialist title.

4. The members of the commission referred to in paragraphs (a), (b), (c) and (e) of paragraph 1 of this Article shall be appointed for a period of four years, and may be appointed only for another period of equal duration.

However, they shall cease in their duties when so agreed by the department or commission that proposed them or the corporation or corporation they represent.

5. The terms of reference of the members of the committee referred to in paragraph 1 (d) of this Article shall be two years.

6. The Ministry of Health and Consumer Affairs shall, on a reasoned and previously heard basis, agree to the cessation of all or part of the members of the Ministry of Health and Consumer when the commission fails to perform its duties properly.

7. Each committee shall elect, from among its members, the President and the Vice-Chair.

8. Regulations will determine the functions of the National Speciality Commissions, which in any case will develop, within the common criteria that, if necessary, determine the National Council of Specialties in Health Sciences, the following:

a) The elaboration of the training program of the specialty.

b) The establishment of the assessment criteria for training specialists.

(c) The establishment of the criteria for assessment in the case of new specialisation provided for in Article 23.

d) The proposal to create specific training areas.

e) The establishment of criteria for the assessment of teaching and training units.

f) The report on programmes and criteria relating to the continuing training of professionals, especially those relating to the accreditation and advanced accreditation of professionals in specific functional areas within field of the craft.

g) The participation in the design of the integral plans within the scope of the corresponding specialty.

(h) Those expressly stated in this law or determined in the regulatory provisions laid down in their development.

Article 29. Specific Training Area Committees.

When there is a Specific Training Area, the Commission or National Speciality Commissions or Specialties in which the area is constituted will appoint an Area Committee composed of six specialists.

The Committee shall develop the functions which are regulated and, in any case, those for the proposal of the contents of the training programme and those for the evaluation of the specialists who aspire to obtain the corresponding Specific Training Area Diploma.

Article 30. National Council of Specialties in Health Sciences.

1. The National Council of Specialties in Health Sciences will have the following composition:

a) The Presidents of the National Commissions of each Specialty in Health Sciences.

(b) Two specialists for each of the university degrees who have direct access to any major health sciences, chosen for a period of two years, one by the members of the National Commissions, have the title in question, and the other by the collegial organization of the members.

c) Two representatives from the Ministry of Education, Culture and Sport.

d) Two representatives of the Ministry of Health and Consumer Affairs.

e) Two representatives of the autonomous communities designated by the Human Resources Commission of the National Health System.

2. The National Board of Specialties in Health Sciences shall elect, from among its members, the President and the Vice-President.

3. The Council shall function in plenary or in the committees and working groups which the Council itself decides to constitute. In any case, the following shall be provided:

(a) The Permanent Commission, which will have the functions that the Council plenary delegates to it.

(b) A Commission Delegated Commission for each of the qualifications or groupings of specialties to be determined.

4. The Council shall adopt its own rules of procedure, which shall be in accordance with the provisions of Law No 30/1992, the Legal System of Public Administrations and the Common Administrative Procedure. However, the vote of each of the members of the Council shall be weighted according to the specific composition of the Council, taking into account the proportionality criteria for the number of specialists represented.

5. It is up to the Council to coordinate the action of the National Specialties Committees, the promotion of research and technical and methodological innovations in the field of health, and higher assistance and technical and scientific advice to the Ministry of Health and Consumer Affairs on specialised health training.

6. The Council shall elect, from among its members, four members of the Professional Consultative Commission.

Article 31. Technical support and secretariat of committees.

1. It is up to the accredited health centres for the training of specialists, in respect of the teaching committees set up in them, and the Ministry of Health and Consumer Affairs, in respect of the National Commissions and the National Council of Specialties in Health Sciences, to facilitate the technical and administrative support that is necessary for its operation.

2. The duties of the Registrar, with a voice but without a vote, of the collegiate bodies referred to in the preceding paragraph and of the committees and working groups which, if any, are constituted, shall be carried out by the person appointed by the Directorate of the Centre or the Ministry of Health and Consumer Affairs, as appropriate.

Article 32. Records.

1. The National Register of Training Specialists shall be registered when they begin their specialized training and the results of their annual and final evaluations shall be recorded.

2. The National Register of Health Sciences Specialists shall include all professionals who obtain a specialist's degree, as well as those who have approved or recognized a degree obtained abroad.

In the National Register of Specialist Training Diploma Specialists, all specialists who obtain it or who see the same professional effects as a diploma or diploma obtained in the foreign.

The records indicated shall be public as regards the identity of the persons concerned, the title or diploma they hold and the dates of their obtaining, recognition or approval.

3. In the register of accredited centres for the training of specialists, all accredited centres shall be registered to provide such training.

This record will have a public character.

4. The records referred to in this Article shall be managed by the Ministry of Health and Consumer Affairs, except as provided for in the first subparagraph of paragraph 2, which shall be managed by the Ministry of Education, Culture and Sport, and shall be integrated into the Health Information System of the National Health System, which shall make public the aggregated and integrated data thereof, as well as those resulting from its statistical treatment, in accordance with the general principles established by the Interterritorial Council of the National Health System.

CHAPTER IV

Continuous training

Article 33. General principles.

1. Continuing training is the process of active and permanent teaching and learning to which healthcare professionals are entitled and required, which begins at the end of undergraduate or specialization studies and is intended for to update and improve the knowledge, skills and attitudes of healthcare professionals in the face of scientific and technological developments and demands and needs, both social and the health system itself.

2. They are objectives of continuing training:

(a) Ensure the updating of the knowledge of professionals and the continuous improvement of their qualifications, as well as encouraging them in their daily work and increasing their professional motivation.

b) Potentially the ability of professionals to perform a balanced assessment of the use of health resources in relation to the individual, social and collective benefit that may be derived from such use.

c) Generalize knowledge, by professionals, of the scientific, technical, ethical, legal, social and economic aspects of the healthcare system.

d) To improve the perception of their social role in the professionals themselves, as individual agents in a general health care system and the ethical requirements that this entails.

e) Enabling the establishment of communication tools among healthcare professionals.

Article 34. Continuing Training Commission.

1. In order to harmonise the exercise of the functions which public health authorities and other institutions and bodies have in the field of continuing training, and to coordinate the actions carried out in this field, constitutes the Commission for Continuing Training of Health Professions.

2. They will be part of the Commission on Continuing Training of the Health Professions in the Public Administrations present in the Interterritorial Council of the National Health System.

Without prejudice to the provisions of the previous paragraph, the Commission shall also incorporate representation of professional colleges, universities, the National Council of Specialties in Health Sciences and the scientific societies, in the manner in which they are regulated.

3. The Commission for Continuing Training of the Health professions shall elect its President and approve its rules of procedure. Its operating system shall be adapted to the requirements laid down for the bodies in Chapter II of Title II of Law No 30/1992 of 26 November 1992 on the Legal Regime of Public Administrations and the Common Administrative Procedure, without prejudice to the powers of the Autonomous Communities.

The Ministry of Health and Consumer Affairs shall provide the technical and administrative support necessary for the functioning of the Commission, and shall appoint its Secretary, who shall have a voice but shall not vote in the meetings of the latter.

4. The Continuing Training Commission shall carry out the following tasks:

(a) The detection, analysis, study and assessment of the needs of professionals and the health system in the field of continuing training, in accordance with the proposals of the competent bodies of the communities autonomous, scientific and, where appropriate, professional organisations represented in the Professional Consultative Commission.

(b) The proposal for the adoption of programmes or for the development of activities and actions of continuous training of a priority and common character for the health system as a whole.

(c) The proposal for the adoption of measures that are deemed necessary to plan, harmonise and coordinate the action of the various actors in the field of continuing training of healthcare professionals.

(d) Study, report and proposal for the establishment of procedures, criteria and requirements for the accreditation of continuing training centres and activities.

e) Study, report and proposal for the establishment of procedures, criteria and requirements for the accreditation and advanced accreditation of professionals in a specific functional area of a profession or specialty, as a result of the development of accredited continuing training activities.

Article 35. Accreditation of centres, activities and professionals.

1. The Ministry of Health and Consumer Affairs and the competent bodies of the autonomous communities, within the scope of their respective powers, may accredit activities and programmes of action in the field of continuing training of professionals health care, as well as, on a global basis, centres in which they are provided.

The accreditation, which must necessarily be carried out in accordance with the requirements, procedure and criteria laid down in accordance with Article 34.4.d), shall have effects throughout the national territory, whichever is the Public administration that issued the accreditation.

2. At any time, public administrations will be able to audit and evaluate the centres and continuing training activities that they have accredited.

3. Only institutions and continuing training activities which are accredited in accordance with this Article may be eligible for support from public funds.

As from the entry into force of this law, only continuing training activities that would have been accredited may be taken into consideration in the health professionals ' career. The activities of continuing training of healthcare professionals prior to the entry into force of the law and which have not been accredited shall be considered by the committees responsible for assessing the merits of such effects.

4. The Ministry of Health and Consumer Affairs and the competent bodies of the Autonomous Communities may delegate the functions of management and accreditation of continuing training, including the issue of individual certifications, in other corporations or public law institutions, in accordance with the provisions of this law and the rules in each applicable case.

The continuing training accreditation bodies should, in any case, be independent of the bodies responsible for the provision of training activities accredited by those bodies.

5. The credentials of the professionals and their reviews will not replace the training, knowledge and skills procedures, which will be necessary to determine the promotion and recruitment mechanisms.

Article 36. Diplomas of Accreditation and Diplomas of Advanced Accreditation.

1. Public health authorities may issue Accreditation and Advanced Accreditation Diplomas to certify the level of training achieved by a professional in a specific functional area of a particular profession or craft, depending on the accredited continuing training activities developed by the person concerned in the relevant functional area.

Accreditation Diplomas and Advanced Accreditation Diplomas, which must be issued necessarily in accordance with the requirements, procedure and criteria laid down in accordance with Article 34.4.e), shall be effects throughout the national territory, regardless of the public administration that issued the diploma.

2. Public health administrations shall establish the records necessary for the registration of the Advanced Accreditation and Accreditation Diplomas that they issue. Such records shall be of a public nature as regards the identity of the person concerned, the diploma or diplomas he holds and the date of obtaining them.

3. The Accreditation Diplomas and Advanced Accreditation Diplomas will be valued as merit in the systems for the provision of places where this is provided for in the relevant regulations.

TITLE III

From professional development and recognition

Article 37. General rules.

1. The system of recognition of the professional development of healthcare professionals referred to in Articles 6 and 7 of this Law, consisting of the public recognition, expressed and individually, of the development reached by a healthcare professional in terms of knowledge, experience in the care, teaching and research tasks, as well as in the fulfillment of the health objectives and researchers of the organization in which they provide their services.

2. Without prejudice to the powers and functions for which the corresponding official title is to be provided, the recognition of professional development shall be public and with express attribution of the degree attained by each professional in the exercise of the whole of functions that are your own.

3. Professionals who are established or provide their services within the territory of the State may voluntarily access the professional development system.

Article 38. Professional development.

1. Health administrations shall, for their own establishments and establishments, regulate the recognition of professional development, within the following general principles:

a) Recognition will be articulated in four degrees.

Health administrations, however, may establish an initial degree, prior to the above. The creation of this initial grade shall entail approval in accordance with the provisions of Article 39 of this Law.

(b) obtaining first grade, and access to the superiors, will require a favourable assessment of the merits of the person concerned, in relation to their knowledge, skills, accredited continuing training, teaching activity and research. The evaluation shall also take into account the results of the interest of the person concerned, the quality of the care and the performance of the indicators that have been established for their assessment, as well as their involvement in management. (a) clinical practice defined in Article 10 of this Law.

c) To obtain the first degree, it will be necessary to accredit five years of professional exercise. The assessment for access to higher grades may be requested at least five years from the previous positive assessment. In the event of a negative assessment, the professional may request a further evaluation after two years from the latter.

d) The evaluation will be carried out by a specific committee created in each institution or institution. The committee shall be composed, for the most part, by professionals of the same health profession as the assessed, and the participation of representatives of the service or unit of membership of the assessed professional, as well as of the external evaluators appointed by quality agencies or scientific societies in their field of competence.

e) Professionals shall be entitled to publicly record the degree of professional development they have recognised.

f) Within each health service, these general criteria of the professional development system, and their impact on the career, will be accommodated and adapted to the organizational, health and organizational conditions and characteristics. health service or individual health care facilities, without detriment to the rights already established.

2. Private health centres where there are health professionals who provide services for an employed person shall, in so far as the capacity of each centre so permits, establish procedures for the recognition of professional development. and the race for them, which will be in line with the criteria set out in this title.

The procedures referred to in the preceding paragraph shall be supervised, in their implementation and development, by the relevant Health Administration.

At each center, the evaluation documentation of the professionals of each service or unit must be kept.

3. Health professionals who carry out their activities exclusively through their own professional exercise may voluntarily access the procedures for the recognition of professional development in the form in which they are determines by the relevant Health Administration. In any case, such professionals shall be required to exceed the same assessments as they are for those who provide services for hire or reward in healthcare facilities.

Article 39. Approval of the recognition of professional development.

The Interterritorial Council of the National Health System, on a proposal from the Commission on Human Resources and heard by the Professional Consultative Commission, will establish the general principles and criteria for the approval of the recognition of professional development throughout the National Health System, especially with regard to the names of different grades, the systems of assessment of merit, the composition of the evaluation committees and the mutual recognition of the degrees reached by the professionals of the various health services.

TITLE IV

From the private exercise of health professions

Article 40. General modalities and principles of private practice.

1. In the field of private health, healthcare professionals may be able to carry out their own or other activities.

2. The provision of self-employed or other services may be carried out by means of any of the contractual forms provided for in the legal order.

3. Private health care services shall be equipped with control elements that ensure the levels of professional quality and assessment established in this law in accordance with the following principles:

(a) Right to exercise the appropriate professional activity to the qualification and category of each professional.

b) Respect for the technical and scientific autonomy of healthcare professionals.

c) Stable recruitment framework, motivation for greater efficiency and incentives for professional performance.

d) Participation in the management and organization of the center or unit to which it belongs.

e) Right and duty of continuous training.

f) Evaluation of professional competence and quality of service provided.

g) Ensure professional civil liability either through an insurance institution or through other financial institutions authorised to grant guarantees or guarantees.

h) Free competition and transparency of the procurement system.

i) Freedom of prescription, taking into account the requirements of scientific knowledge and the observance of the law.

Article 41. Provision of services for an employed person.

1. Healthcare professionals who provide their activity in private health care facilities or services have the right to be informed of their tasks, tasks and tasks, as well as the objectives assigned to their unit and health centre and of the systems established for the assessment of compliance with these systems.

2. Such health professionals are obliged to pursue the profession, or to develop all the tasks assigned to them, with loyalty, effectiveness and compliance with the technical, scientific, professional, ethical and deontological that are applicable.

3. They are also required to keep the knowledge and skills necessary for the proper exercise of the profession or for the development of the functions corresponding to their qualifications duly updated.

4. The regular assessment of competences and the quality control systems provided for in this law will be applied in private institutions employing health professionals through the provision of services for an employed person. The system of professional development shall be articulated in these centres in accordance with the provisions of Title III of this Law.

Article 42. Provision of own-account services.

1. In order to guarantee the official qualification of professionals and specialists, the quality and safety of the equipment and facilities, and the subjection to the professional discipline and the other requirements and guarantees that are determined in this law, all contracts for the provision of health services, as well as their amendments, to be concluded between healthcare professionals, between professionals and health centres or between professionals and insurance entities operating the disease class, be formalized in writing.

2. Healthcare professionals who exercise exclusively through the provision of self-employed services may voluntarily access the system of professional development in the form provided for in Title III of this Law.

Article 43. Records of professionals.

Health centres and insurance entities operating the disease class referred to in Articles 41 and 42 shall establish and keep up to date a record of the health professionals with whom they maintain contracts for the provision of self-employed or employed persons.

As provided for in Article 5.2 of this Law, such registration shall be public in respect of the name, title, specialty and, where applicable, category and function of the professional.

The general criteria and minimum requirements for these registers will be established by the autonomous communities within the principles to be determined by the Interterritorial Council of the National Health System, which will be able to integration of the same to the Health Information System of the National Health System.

Article 44. Advertising for private professional practice.

1. The advertising of the services and services offered to the public by healthcare professionals must strictly respect the scientific basis of the activities and prescriptions, and will be objective, prudent and truthful, so as not to raise false hopes or spread unfounded concepts.

2. Healthcare professionals may provide the media, or express directly in them, information about their professional activities, provided that the information provided is true, discreet, prudent and manifest easily understandable for the social collective to which it is addressed.

3. Unauthorised medical activities or products, or on which there is no evidence of their beneficial effects on the human being, shall not be the subject of advertising, the advertising of products and services of a creative nature shall be prohibited. and of the miracle products.

4. Failure to comply and, where appropriate, the appropriate sanction, as provided for in the foregoing paragraphs shall be required in accordance with Law 14/1986, General of Health, and, in so far as they are applicable, with Laws 26/1984, General for the Defense of the Consumers and Users, and 34/1988, General Advertising.

Article 45. Safety and quality in the private professional exercise.

1. Professional consultations shall comply with the requirements for authorisation and accreditation which, taking into account the specific characteristics of these consultations, shall determine the competent bodies of the Autonomous Communities.

2. Security and quality guarantees are applicable to all private health activities, regardless of the funding of the benefits they are offering at any time.

It is for the public health administrations, in respect of professionals and centers established in their geographical scope, to ensure that the guarantees referred to in the previous paragraph are met, for which they may to seek the collaboration of quality agencies or equivalent bodies, or of professional associations in the case of professional consultations on the terms that are regulated in law.

Article 46. Liability coverage.

Healthcare professionals in the field of private healthcare, as well as legal entities or private entities that provide any kind of health services, are obliged to to subscribe to the appropriate liability insurance, a guarantee or other financial guarantee covering compensation which may be derived from any damage to persons caused by the provision of such assistance or services.

The autonomous communities, within the scope of their respective competences, will determine the essential conditions of insurance, with the participation of professionals and other agents of the sector.

In the case of collegiate professions, professional colleges may take the necessary steps to facilitate their collegial compliance with this obligation.

TITLE V

From the involvement of professionals

Article 47. Professional Consultative Commission.

1. The Professional Consultative Commission is the body for the participation of professionals in the health system and in the development, planning and management of health professions.

2. With regard to professional development, the tasks of the Commission shall cover the fields of training, the system of recognition and the assessment of skills.

Article 48. Composition and membership.

1. The Professional Consultative Commission has the following composition:

(a) Four representatives of the National Council of Specialties in Health Sciences, appointed by the Council itself.

(b) Two representatives of each of the health professions referred to in Article 6.2 (a) and (b) and Article 7.2 (a) of this Act, designated by the corresponding General Councils of Colleges.

(c) A representative of each of the health professions referred to in Article 6.2 (c) and (d) of this law, designated by the corresponding General Councils of Colleges.

(d) A representative of the health professions referred to in Article 6.3 of this Law, appointed by common accord of the General Councils of Colleges or the National Colleges of the relevant professions.

(e) a representative of the health professions referred to in Article 7.2 (b) to (g) of this law, appointed by common accord of the General Councils of Colleges or the National Colleges of the corresponding professions.

(f) A representative of the health professions referred to in the second paragraph of Article 2.3 of this Act, appointed by common accord of the General Councils of Colleges or, failing that, the organizations

g) A representative of the set of health professionals referred to in Article 3.2 (a) of this law, designated by common agreement by the scientific organizations and official Colleges of the same.

(h) A representative of the health care professional as referred to in Article 3.2.b) of this law, designated by common agreement by the scientific organizations thereof.

i) Four healthcare professionals with recognized prestige in the care field, designated by the Human Resources Commission of the National Health System.

j) Two healthcare professionals of recognized prestige in the care field, designated by associations and entities that operate in private healthcare.

2. The members of the Professional Consultative Commission shall be appointed for a period of four years, and may be reappointed only for another term of the same duration.

However, the members of the Commission shall cease their duties when the bodies, corporations or associations that have agreed to their appointment agree.

3. The Professional Consultative Commission is attached to the Ministry of Health and Consumer Affairs, which will provide the necessary technical and administrative support for its proper functioning.

Article 49. Operating system.

1. The Professional Consultative Commission shall adopt its own rules of procedure, which shall be in accordance with the provisions governing the operation of the bodies in accordance with Law No 30/1992, the Legal Regime of the General Administration and the Common Administrative Procedure.

2. The Commission shall elect, from among its members, the President and the Vice-Chair.

3. The duties of the Secretary of the Commission, with a voice but no vote at their meetings, shall be performed by the official designated by the Ministry of Health and Consumer Affairs.

4. The Commission shall operate in plenary and in the committees and working groups which the Commission itself decides to constitute.

5. The plenary session of the Commission shall meet at least twice a year.

Article 50. Functions.

The Professional Consultative Commission will develop advisory functions in all areas of development and professional management, and in particular the following:

(a) Those that correspond as an organ of support to the Human Resources Commission of the National Health System in the fields of professional development referred to in Article 40 of the Law on Cohesion and Quality of the National System Health and the provisions of this law.

(b) The preparation, with reports or proposals, where appropriate, of the various scientific organizations and societies, of the annual report on the state of health professions, which should include an analysis of the situation of those professions.

(c) General proposals, which shall be included, where appropriate, in the report provided for in the preceding paragraph, on the organisation, the arrangements for the provision of services and the management of the health professions, addressed to the Interterritorial Council of the National Health System, to the Ministry of Health and Consumer Affairs and to the Autonomous Communities.

(d) Mediation and a proposal for a solution in the conflicts of competences between the different health professions.

Additional disposition first. Special employment relationship of residence.

1. The special employment relationship of residence is applicable to those who receive training in order to obtain a degree of specialist in Health Sciences, provided that such training is carried out by the residence system provided for in Article 20. of this law, in institutions, public or private, accredited to provide such training.

Residents will have the consideration of temporary work staff of the health service or center in which they receive the training, and they will have to develop the professional exercise and the care and training activities of the training programs are derived.

2. The Government shall, by means of royal decree, regulate the special employment relationship of residence, in accordance with the rules of the European Community which are applicable and establishing, in addition to the peculiarities of its working day and breaks, the cases of termination of contracts where the assessments laid down are not exceeded, the procedures for the review of the assessments granted, the maximum duration of the contracts according to the duration of each of the corresponding training programmes, and the exceptional scenarios for their possible extension where there are cases, not attributable to the person concerned, of suspension of the employment relationship.

3. The special employment relationship of residence shall also apply in those cases of training in Specific Training Areas which, in accordance with Article 25, are developed by the residence system provided for in Article 20. of this law.

Additional provision second. Reservation of denominations.

Only the names of specialist titles, those of the Diploma of Specific Training Areas, those of the Diplomas of Accreditation and Accreditation may be used in the public and private professional exercise. Advanced, and those of the degrees of professional development, when such diplomas, diplomas or degrees have been obtained, approved or recognized in accordance with the provisions of this law and the other applicable rules.

Other denominations may not be used which, because of their significance, may lead to confusion with those names.

Additional provision third. Training of health specialists in places of the Military Health Network.

1. The Ministry of Defense shall be responsible for the proposal provided for in Article 22.2 of this Law in respect of the number of Health Sciences specialists to be formed annually in accredited centers of the Military Health Network.

2. Access to training in the places referred to in this additional provision shall be regulated by the Ministry of Defence and, without prejudice to the fulfilment of the other requirements laid down in Article 20.3 of this Law, the special employment relationship of residence to the military personnel forming in them.

Additional provision fourth. Remuneration effects of the professional development system.

The effects on the structure of the remuneration and the amount of remuneration could be derived from the recognition of degrees of professional development will be negotiated in each case with the trade union organisations which, on the basis of the provisions of the applicable rules, as appropriate.

Additional provision fifth. Application of this law to health professions.

Without prejudice to Articles 2, 4.2, 6 and 7, the rest of the provisions of this Act shall apply only to the graduates provided for in those Articles when they provide their professional services in healthcare facilities. integrated into the National Health System or when they develop their professional, self-employed or other exercise in the private health sector.

Additional provision sixth. Exclusions to the application of this law for public safety reasons.

For reasons of public safety, the principles set out in paragraphs (d) and (e) of Article 5.1 of this Law may not apply, nor shall it be of a public nature to register the register provided for in Article 5.2.

Additional provision seventh. Character of healthcare professionals.

1. This law shall be without prejudice to the nature of the health professionals of the Technical Health Assistants and other professionals who, without having the academic title referred to in Article 2, are enabled by law or regulation to exercise any of the professions provided for in that provision.

2. They will have a role of health professionals in Food Science and Technology when such graduates develop their professional activity in healthcare facilities integrated into the National Health System or when they develop their professional, self-employed or self-employed, in the private health sector.

Additional disposition octave. Regime of infringements and penalties.

Public health authorities and professional bodies governed by public law, within the scope of their respective powers, shall ensure that the exercise of the health professions is carried out in accordance with the provided for in this law and in the other applicable rules.

For these purposes, the infringements of the provisions of this law are subject to the regime of infringements and penalties laid down in Chapter VI of Title I of Law 14/1986 of 25 April, General of Health, without prejudice to their case, civil, criminal, statutory and deontological responsibilities, as provided for in the current legal order.

Additional provision ninth. Assessment of professional development in research healthcare facilities.

In the health centres of research, the system of evaluation of the professional development of the healthcare professionals referred to in this law will be adapted to the specific characteristics of the health professionals, evaluating, others, the quality and relevance of scientific work according to results, organizational involvement and leadership capacity in the direction of projects and training of research personnel.

Additional provision 10th. Address of health centres.

Health administrations shall establish the requirements and procedures for the selection, appointment or recruitment of management staff of health centres and establishments that are dependent on them.

Likewise, the health authorities shall establish the mechanisms for evaluating the performance of the management functions and the results obtained, an evaluation which shall be carried out on a regular basis and which may be assumed, in their case, the confirmation or removal of the person concerned in such managerial functions.

First transient disposition. Progressive implementation of Article 22.2 of this Law.

The new test model for access to the specialised healthcare training provided for in Article 22.2 of this Law will be introduced progressively during the eight years after the entry into force of this rule.

Second transient disposition. Implementation of the professional development system.

The health authorities shall determine the time limits and periods for the implementation of the system of professional development provided for in Title III, within the general criterion that within four years of the entry into force of the the procedures for its implementation must have been initiated in all the health professions provided for in Articles 6 and 7.

Transitional provision third. Definition and structuring of health professions and occupational health professionals.

1. The criteria for defining and structuring health professions and occupational health professionals within the scope of Articles 2 and 3 of this Law shall be maintained as long as the reform or adaptation of the health professions is carried out. cyclical modalities referred to in Article 88 of the Organic Law 6/2001 of 21 December 2001 for the adequacy of the European Higher Education Area.

Once this reform or adaptation has been produced, the criteria for defining the health professions and the health professionals in vocational training and their structuring will be modified to bring them into line with the which is provided for in the same.

2. The Government will reorder the functions of the various departments of the General Administration of the State in the field of specialized health training, when this is advisable to adapt it to what the standards of the European Community in relation to the requirements for access to professional activities.

Transitional disposition fourth. Health specialties whose training system is not the place of residence.

Within five years of the date of entry into force of this law, the Government shall amend, abolish or adapt its system of training as provided for in Article 20 in the case of health specialties whose training is not performs by the residence system.

Transient disposition fifth. Creation of new degrees of Health Sciences Specialist.

When, in accordance with the provisions of Article 16 of this Law, new official titles of specialists in Health Sciences are established, the Government will take appropriate measures to enable access to the new title of professionals who have provided services in the field of the new specialty and comply with the requirements that they regulate.

You will also take appropriate measures for the initial constitution of the corresponding National Specialty Commission.

Transitional disposition sixth. Constitution of collegiate bodies.

As the collegiate bodies referred to in Articles 27 to 30 of this Law are constituted, the functions assigned to them shall be performed by the commissions and councils existing before the the entry into force of this rule.

Single repeal provision. Repeal of rules.

1. All provisions of equal or lower rank shall be repealed as set out in this Act.

2. The Law 24/1982 of 16 June on specialized health practices and teaching is repealed, which will be effective when the royal decree on the special employment relationship that is provided for in the provision comes into force. First of this law.

Final disposition first. Competence title.

1. This law is approved in accordance with the exclusive powers assigned to the State in its article 149.1.1. and 16. the Constitution, and its precepts are the basis of health.

2. Except as provided for in Chapter III of Title II of this Law, the third and third transitional provisions of Title II of this Law, which are approved in use of the powers assigned to the State by the State, are exempted from the provisions of this Law. Article 149.1.30. of the Constitution for the regulation of conditions for obtaining, issuing and approval of professional qualifications.

3. Articles 8.2 and 20.3.f) and the first provision of this law, which are approved under the exclusive powers conferred on the State by Article 149.1.7. of the Constitution, are exempted from the provisions of paragraph 1 above. for the establishment of labour law.

4. The provisions of the foregoing paragraphs shall be without prejudice to the provisions of the Foral Regime of Navarra.

Final disposition second. Reports on funding.

The interministerial collegiate body provided for in the final provision of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, will inform preceptively those matters arising from the application of this law.

Without prejudice to the financial responsibility of the Autonomous Communities in accordance with the provisions of Law 21/2001 of 27 December 2001, and in accordance with the principle of institutional loyalty in the terms of Article 2 (1) (e) of The Organic Law 8/1980, of 22 September, of Financing of the Autonomous Communities, the report prepared will be presented by the collegiate body to the Interterritorial Council of the National System of Health. For its part, the Ministry of Finance will move this report to the Fiscal and Financial Policy Council, in order to carry out its analysis, in the context of this principle of institutional loyalty, and, if necessary, propose the necessary measures for ensure financial balance.

Final disposition third. Entry into force.

This law will enter into force on the day following its publication in the "Official State Gazette".

Therefore, I command all Spaniards, individuals and authorities, to keep and keep this law.

Madrid, 21 November 2003.

JOHN CARLOS R.

The President of the Government,

JOSÉ MARÍA AZNAR LÓPEZ