The G.P. and the European Union

Dr Jan Bergen
Former Vice-President, European Union of Medical Practitioners (UEMO)

During the last and present year, UEMO and its member organisations have made and will continue to make great effort to have the European Parliament amend the doctor's directive 93/16 to include a minimum of three years' specific training for general practice after the basic diploma. This is reason for me to examine this subject and explore some of the underlying questions and opportunities in this respect. The European Union (EU) has become more and more active in the field of healthcare in recent years. This involvement can only increase after the ratification of the new Amsterdam Treaty by all EU Member States. More 'Europe' will have consequences for general practitioners (GP): there may be some threats, but certainly opportunities as well. That is why it is important that the European interest group of GPs not only has its say, but furthermore is heard and read and, where possible, exerts its influence on all the grounds GPs are, and should be, interested in. When we look at the present situation, we have the doctor's directive (93/1 6) that ensures a high level of education and training for doctors, GPs and other medical specialists. 

The directive, and therefore its protecting and stimulating function, is threatened on two counts, firstly, by the Brussels bureaucrats, as the ongoing discussion in the SLIM project proves. For Brussels it is too costly to maintain all the committees for all the different professionals in the so-called sectoral directives, committees with three members for each country, whereby half of them are always absent because of the continuous personnel changes. They want to get rid of the sectoral directives, which I believe is happening. The second threat is coming from the enlargement of the EU. The timespan in which Eastern European nations will be able to organise and train themselves to the high level of education and specific training, as laid down in the present directive, is unknown once they have become members. For these countries, either the transition period must be very long, or we will have a general system for all countries, or there will be a variety of systems for a certain number of years. What does UEMO think about this issue? Does Brussels know UEMO's opinion?  Is Brussels informed after all? Is the reference book, a wonderful and potent public relations item, widely circulated among all the Brussels stakeholders? Is the Comite Permanent informed?There are at present eight EU action programmes in the field of health (since 1996, cancer; drugs, health promotion, Acquired Immunodeficiency Syndrome (AIDS) and other contagious dis eases, and health control, and since 1997, rare illnesses, injuries and pollution-caused diseases). UEMO has sent a position paper on the European programme against cancer. What about the other ones? An opinion on paper could be sent. The opinion of the GP should be there on the Brussels table. The same can be said about the communication of the European Committee on the development of public health policy in the European Community (UEMO no 98/070) or about the development in the discussion on the 'completing of the single market in pharmaceuticals'. What do we want? Does the European Commission know what we want?Another place where we should be seen and heard is the

"Matters concerning the free traffic of doctors... are principally only dealt with by the committee for legal affairs and civilian right"

European Parliament. The Committee for the Environment, Health Care and Consumer Protection deals with health matters. Matters concerning the free traffic of doctors (directive 93/16) are principally only dealt with by the committee for legal affairs and civilian rights. Seventy-seven members in all! Do they know about UEMO, and more importantly, the GP view on a number of questions? About 25 Members of the European Parliament (MEP) are doctors. There is only one GP among them, Dr Mendonca from Portugal. Is the so-called informal but influential Health Forum Group Intergroup of MEPs informed of our views? In June 1999 there are elections for the European Parliament. We have to prepare for the outcome. All 77 members should be sent a copy of this reference book.Another branch of the EU is the European Commission. The Directorates-General V, especially the Luxembourg-based directorate F (healthcare), and XV should all be aware of our opinions and wishes, even when it is only in writing. Is UEMO known by the European Health Alliance, an influential Brussels-based organisation of primarily non-governmental organisations? They reportedly do not know about UEMO, but are said to be very willing to exchange information with GPs because of their important position and role in healthcare.

I think we should reconsider our position in relation to Brussels. There is now not a consistent association with the European institutions. In the present context, there seems to be no well-outlined strategy. I believe we should consider making plans as to how to associate with Brussels. We should think about our goals and the means to achieve them. We must indicate how to communicate with all relevant stakeholders,like the European Commission,European Parliament,our own national civil servants based in Brussels,The Comite Permanent and the Brussels-based non governmental organisations.We should also indicate to them GP's opinions regarding participating systematically in projects.Furthermore,we should pay attention to the amelioration of internal UEMO communication,for instance,the creation of some kind of an internal and maybe also external newsletter and an Internet site,which preparations have been made for. I am well aware of the fact that the consequences of what I am writing about will cost us dearly in attention and work. I also believe that UEMO, as it is now, cannot do and achieve what I have described as desirable. I believe we should have permanent eyes and cars in Brussels, reporting to our Presidency with suggestions and ideas. Having our own eyes and ears in Brussels can be realised either by hiring hours with a consultant in Brussels, possibly combined with a small permanent UEMO secretariat in Brussels. I seriously wonder whether a modem international European interest group can permit itself not to have a central secretariat permanently based in one place: as the UEMO is founded with a certain European Community dimension, it should have a natural place in Brussels. Inventing the wheel every four years is a bit old-fashioned, so to speak. We would not be lonely in Brussels. The Comite Permanent and UEMO have their permanent secretariats there. The British Medical Association (BMA) also has an office in Brussels. Sharing offices and premises is a possibility. Of course this costs money, but the secretariat in the Presidency country also costs money. That could become much less in the case of a permanent Brussels secretariat as well. I urge the plenum to deliberate on these ideas and proposals. Let us start thinking and moving forward.