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40 YEARS OF EXPERIENCE LOOKING FORWARD INTO DE FUTURE
Taking over the Presidency of an Organisation with 40 years of background is no doubt a heavy responsibility. One has to know how to better take advantage from its experience in order to prepare the future. The Portuguese team takes over the Presidency of the UEMO with the main objective of reaching recognition of General Practice/Family Medicine as a full specialty in Europe . However, we are also aware that the definition of priorities, strategies and main actions are actively defined and pursued with the involvement of all members. Some trends will come out as the main themes for the years to come: • The value of highly qualified General Practitioners / Family Physicians General Practitioners/Family Physicians have large potential and different opportunities to develop their professional role. They will be asked to be responsible for the continuing care of many patients and for advising them about the resources in the health care system. Ideally, everyone should have the possibility to choose a personal General Practitioner/Family Physician and to keep with him/her a continuing relationship for as long as they wish. General Practitioner/Family Physician will play a leading role as the front line doctor (first contact for most of the problems and continuing relationship, based on an informed patients' choice). Responsibilities of the General Practitioner/Family Physician cover a wide range of tasks in the European countries and this raises the problem of quality and status of general practice in the different European countries. There are many theoretical definitions of General Practice/Family Medicine, however, the profession has a multiplicity of profiles in different countries. Apart the never ending epistemological discussion between generalism and specialism there are many advantages in promoting a wide dialogue between General Practitioners / Family Physicians and other specialists so that clarification could be brought upon their complementary roles and we could clearly establish the main technical specificities of General Practice/Family Medicine. General Practice/Family Medicine is becoming one of the more complex areas of medical practice. The risk of falling into poor practice must be lowered to a minimum level. General Practitioners/Family Physicians must deal effectively with undifferentiated problems, co-morbidity, polipharmacy, sophisticated biomedical and psycho-social phenomena, and psychosomatic problems and, at the same time, be attentive to opportunities for preventive interventions and health promotion. This requires high-level training programmes, continuing education and quality assurance activities. That is why we feel that specialist training is indeed a huge responsibility and cannot be considered less important than in other specialties, for it will affect the future of health care all over Europe . The recognition of General Practice/Family Medicine as a medical speciality is still under debate in a number of national medical organisations and academic bodies. It is important that UEMO is aware of this and defines and promotes strategies to obtain the full recognition of this important specialty. • Mobility of health care professionals and patients Free movement of doctors and other health care professions, due to mutual recognition of diplomas will raise more rigorous demands on the domain of Quality Assurance. Recognition of the specialty of General Practice/Family Medicine upon a European Directive will promote easier mobility of General Practitioners/Family Physicians. Abolition of borders all across the European territory, globalisation, and migration of populations looking for a better socio-economical status raises a new challenge to European health systems. Well prepared General Practitioners / Family Physicians have an important role to play in this new reality. • Empowerment and autonomy of citizens concerning personal and collective health matters; Promotion of patients' rights in Europe is nowadays a strong societal and political issue. This will raise questions such as greater freedom of choice, new ethical dilemmas, new sources for litigation (should mutual trust be not a dominant issue), self-care, self-medication, etc. Patients will take more responsibility for their own health. This requires more education and cautions, including the need to protect patients from an uncontrolled self-medication market. These are clearly subjects already approached by the UEMO and that need continuous attention in the future. • Increasing demand for cost-effectiveness and quality preserving the principle of universal access to health care; There is currently some tension around the "gate-keeper" concept existing, for instance, in the UK . Some medical associations in Germany , France and Belgium - where a tradition of free access to any specialist care has established itself for many years now - fear that General Practitioners/Family Physicians could be subject to misuse in order to ration specialist medical care merely for cost-containment reasons. However, the increasing labyrinth of medical technology and its social and economical associated costs will highlight the General Practitioners/Family Physicians' supportive and orientation role. This must be achieved through information and education, rather than by coercion. Facilitator mechanisms can probably help to meet the demand of universal access to quality and cost-effective care. Funding models and specific interests of the different health care players have shaped-up distinct organisational models where competition prevents co-operation. Discussion will continue related to sickness funds, health care sector quality levels and health care providers. However, it will be possible to work on innovative solutions that emphasises co-operation instead of competition. Well prepared and trained General Practitioners/Family Physicians are indispensable for cost-effectiveness in health care. • Information & communication technologies in healthcare Computerised health records, telemedicine and remote medicine, expert systems and data protection are all issues which will undoubtedly influence and shape-up the future General Practice. Different personal smart cards projects are under way in several European countries, along with a global project which led to the launching of the European health card project. UEMO has already done an important work in this area, but must take its approach further to a political level. The future role & strategy of the UEMO The definition of the future role and strategy of the UEMO is an essential task to be continuously reviewed, monitored and updated. The Portuguese Presidency highlights as essential: • Development of the status of General Practice in Europe , at all levels; • International co-operation within General Practice/Family Medicine organisations and with other medical organisations in Europe ; • Promotion of General Practice/Family Medicine in the undergraduate medical curriculum; • Full development and implementation - in accurate technical terms (job/tasks description) – of the core content for the European General Practitioner/Family Physician and its ethical, organisational, training, quality assurance and appropriate technology implications; • Development of specialist postgraduate training curriculum, in all European Union countries, recognition of the General Practice/Family Medicine specialty and updating of the European Directive on recognition of qualifications; Above all, we will work together for the future of our specialty and for the future of UEMO as a big family of friends. |