Health care reform and general practice:
are we providing the right care to
the right people in the right way?
First
electronic version 1989
of clinical
guidelines for general
practice
“The future of our professional discipline will depend on our ability to work together in the
service of humanity.”
Monty Kent Hughes, 1st WONCA president, 1972
World Organization of Family Doctors
• Supports high quality clinical care, education and training, research, and leadership
development
• Supports development of new colleges and societies of family medicine/general practice around the world
• The global voice of general practice and family doctors at the World Health Organization
500,000 family doctors/GPs in 131 countries 2 billion consultations each year
Health care reform and general practice:
how do we provide the right care to the right people in the
right way?
Can health care transform the world?
• 7 billion people
• 1 billion with no access to health care services
• Bryan Stevenson, equal justice advocate (TED)
• “You judge the character of a society, not by how they treat their rich and the
powerful and the privileged, but by how they treat the poor, the condemned, the incarcerated.”
Challenges for 21
stcentury health professionals
• Tackling the challenges of inequity:
- inequity of access to health care
- inequity of outcomes of health care - being socially accountable
• How do we work together to ensure that high quality health care is available to all people in every nation of the world,
including those who are disadvantaged and marginalised?
1948
The world’s governments declared health to be a fundamental human right
““““without distinction of race, religion, political belief, economic or social
condition.””””
The Declaration of Alma Ata
1978
The Declaration of Alma-Ata was adopted at the International Conference on Primary Health
Care in Almaty, now in Kazakhstan
Extracts from the declaration
• “A main social target of governments,
international organizations and the whole world community in the coming decades should be the attainment by all peoples of the world by the
year 2000 of a level of health that will permit them to lead a socially and economically
productive life.”
• “Primary health care is the key to attaining this target as part of development in the spirit of
social justice.”
“We, heads of State and Government, have
gathered at United Nations Headquarters in New York from 6 to 8 September 2000, at the dawn of a new millennium.”
Millennium Development Goals
Millennium Development Goals
What’’’’s Missing?
Tackle chronic disease Strengthen primary care
Social determinants of health Health systems financing Universal health coverage
WHO World Health Report
In 2008 the World Health Report was devoted to the reinvigoration of primary health care
Strong primary care is the only way we will …
• effectively contain rising health care costs,
especially through support for preventive care, health promotion and improvements in chronic disease management and the management of co-morbidities
• effectively manage the health care needs of the increasing proportion of elderly people in our
nations
• effectively tackle the epidemics of both
communicable and non-communicable diseases
Strong primary care is the only way we will …
• tackle the workforce shortages affecting health care provision across the world, especially
through supporting teamwork between primary care professionals
• effectively address the continuing rise in mental health problems affecting our populations
• ensure that high quality health care is available to all people in each country, including those who may be disadvantaged
Why is family medicine important?
Barbara Starfield (1932-2011)
• Provided us with the evidence to show that a greater emphasis on primary care can be
expected to:
• Lower the cost of care
• Improve health through access to more appropriate services
• Reduce the inequities in a population’s health
Barbara’s last message for general practice
• “Here are the three challenges I think you should focus on:
• “How do we develop primary care research to address the challenges of care for people
with comorbidities?
• “How do we truly adopt patient-centredness into general practice?
• “How do we use the information from primary care to improve population health?”
“I love family medicine”
Dr Margaret Chan Director-General
WHO
Messages from Dr Chan
• Strive for universal coverage
• The importance of infusing, honestly and
meaningfully, the caring dimension of health care
• Not necessarily the “best care”, but the
“most appropriate care”
• Focus on healthy life expectancy rather than longevity alone
• Before looking at ways to cut health
spending, look at ways to improve efficiency
So what are our greatest challenges to providing the right care to the right
people in the right way?
• Training a general practice workforce of doctors and nurses and other health
workers to meet each nation’s needs
• The existing primary care workforce –
“don’t leave anyone behind”
• Our peers in other medical specialties
• Encouraging students & recent graduates
• Providing appropriately resourced clinics
• Community perceptions
Are we training the right people in the right way?
• Health workers are central to tackling health inequities
• And so are the universities and other institutions where we are instructed to heal, treat and serve our communities
This poses challenges for the education of the next generation
of doctors
• 1910 – Flexner Report – challenge to
become more scientific and effective in the training of medical students
• 2010 – Global consensus report on social accountability of medical schools
http://healthsocialaccountability.org/
2010 Global consensus report
• Improve quality, equity, relevance and effectiveness of health care delivery
• Equip medical graduates “with a range of competencies consistent with the evolution of the communities they serve, the health system in which they work and the
expectations of citizens.”
Qualities of socially accountable medical education
• Equity (especially of access to services)
• Quality (satisfy both professional and community standards
• Relevance (tackle most important and locally relevant problems first)
• Cultural competency (remove barriers)
• Efficiency (greatest impact with available resources)
• Partnerships (with all key stakeholders)
Partnership Pentagon
Dr Iona Heath, Past President, Royal College of GPs
“I believe that general practice is a force for good throughout the world.”
Our individual responsibilities as general practitioners …
• To be an advocate for social justice and human rights
• To contribute towards ensuring equity of access to health care – “a fair go”
• To speak out for what is right
• To stand up for freedom and justice and peace
• To care for the health of our planet as well as the health of our patients
Why should we do all this?
• If as doctors, with our privileged
position in society, and our access to pretty much the entire population in our communities, don’t do these things,
who will?
Dr Albert Schweitzer Nobel Peace Prize
1952
• “I don’t know what your destiny will be, but one thing I do know.
• “The only ones among you who will be really happy are those who have sought and found how to serve.”
Features of general practice
1. First-contact care
2. Comprehensiveness 3. Continuity of care
4. Coordination 5. Prevention
6. Person-centeredness 7. Family-orientation
8. Community-orientation
WONCA Rural Medical Education
Guidebook
“The typical picture of the family physician and, the rural doctor in particular, is the
rugged male.”
Dr Susan Phillips
Queen’s University, Canada.
Developing gender and cultural awareness for rural practice
GLOBAL STANDARDS FOR
POSTGRADUATE FAMILY MEDICINE EDUCATION
First Family Medicine Training Program in the world to receive accreditation against the
WONCA Global Standards Shanghai Medical College
of Fudan University
General practice has the power
to transform the world
University of Turku – 19/05/14
Always remember, no matter where and how you choose to work as a general practitioner…
• Our important work will continue
• Never forget that we are privileged to work as GPs and to work with our local
communities
• Never forget that through our work each of us makes a positive difference in the lives of our patients every single day
