THE FUTURE GENERAL PRACTITIONER/ FAMILY DOCTOR IN EUROPE –
A SPECIALIST

A Challenge for the UEMO
Dr Christina Fabian, President, the European Union of General Practitioners 2002-2006

Approximately 400 000 General Practitioners/Family Doctors from 21 countries in Europe are now represented in the UEMO via their national medical organisations.
With the enlargement process in the European Union, the profession in more and more countries will join the various European medical groupings, and the number of doctors represented will thus increase dramatically.

Not only is there a need for the medical profession to work nationally to improve and influence health care to guarantee the best quality of care for the patients and make the conditions to provide such care available to physicians – there is also a need to do the same work on the European level.

The main purpose of our work in the UEMO is to facilitate migration for doctors in Europe. The demand from patients to choose where they want to be treated in Europe is increasing – and the physicians fully support that demand.

THE GENERAL PRACTITIONER- A SPECIALIST!

In an increasing number of countries, general practitioners are specialists in Family Medicine. In some countries general practice is considered a specialty today. In 1994 the UEMO held a Consensus Conference on Specific training in general practice, where a decision was taken to recommend three years of training before a physician could work as a general practitioner in accordance with the so-called Title IV of Directive 93/16/ EEC. Last year – seven years later! – the European Parliament finally accepted this recommendation from the UEMO, and the Directive was amended and will be valid from 2006.

Title IV of the Directive, concerning general practice, has been in force since 1986.
The provisions of this Title were adopted with the objective of creating a new category of medical training and qualification having a special character. Thus, general practice is in a special category of automatic recognition for doctors migrating among the EU Member States, subject to specific rules, which differ from the rules that apply to the medical specialties.

In the 16 years since Title IV was created, there has been a great deal of change and development with regard to general practice. Health care has become increasingly specialized, and the general practitioners are facing a great demand from patients and colleagues to acquire the broad and extensive competence needed to care adequately and with high quality for their patients, especially with regard to those chronic diseases and symptoms which do not require treatment by a practitioner in a more narrow specialty field. .

It has been said that the General Practitioner cares for the same patients but deals with different diseases, while the other specialists are taking care of the same diseases but different patients.

The UEMO is convinced of the need for general practitioners to be fully established as a medical specialist on an equal footing with other specialists and has this year initiated discussions with the aim of achieving this. In some countries, general practitioners are already specialists in Family Medicine, equal to other specialists. Some of the EU applicant countries in the European Enlargement process already have the specialty of family medicine.

In countries where Family doctors are specialists, 90 % of unselected patients are taken care of by their Family doctor. Often these doctors work in group practices, with a team of nurses, physiotherapists, occupational therapists etc, and with certain medical equipment available to see to the basic medical examination and treatment of their patients.

There are many reasons for continuing the development of a competent general practitioner to a future specialist in General Practice/Family Medicine. Some of the most salient of them are given below:

THE STRUCTURE OF HEALTH CARE has changed. In many European countries, e.g. in Sweden 30 % of hospital beds have disappeared, and the patients meant to be cared for in the Primary Health Care system.

New and more effective methods of treatment have made the time in hospital for patients shorter and we have more and more possibilities to treat patients outside the hospital.

Ten years ago most terminal patients spent the last days of their lives in hospital and died there, but today an increasing number of patients, where possible, want to experience the end of life in their own home or in a nursing home. It is a natural task for the general practitioner to care for her or his patients from birth to the end of life. Palliative care at the end of life is an important task for the general practitioner and a doctor competent to meet this challenge is needed.

The increasing number of elderly people who need and demand health care in the field of medicine will be a great challenge for the profession.

THE INFORMED AND EMPOWERED PATIENT

There is also a wish from patients to receive care close to their homes if possible.

Patients’ rights are more clearly recognized and evident than ever before and are supported by doctors. A well informed patient needs and wants a competent doctor. Such patients want a specialised doctor both in general practice and in hospital. A great deal of information is available for patients today, and even more will be available tomorrow. A specialisation in general practice/family medicine is necessary to live up to the demands of the patients of today and tomorrow.

TEAM WORK

The future doctor and general practitioner will increasingly work in a team in cooperation with other health professionals. The doctor is the natural leader of this team and will increasingly assume the role of an expert in his/her field. The need for a specialist in general practice/family medicine is obvious.

RECRUITEMENT OF FUTURE GENERAL PRACTITIONERS

In some countries there is a lack of doctors, in others there is a surplus. The recruitment of doctors wanting to work in general practice is a most important task for the national medical organizations and also for the UEMO.

I am convinced that the future doctors working in general practice want to become specialists, on an equal footing with other medical specialists. More and more countries see the need for ever more competent general practitioners with a period of specific training equal to that of the other specialists to empower GPs to the greatest possible extent to meet the needs of patients in primary health care. There is also a need for the other specialists to care for patients outside hospital and as often as possible to care for patients as a consultant at the health centre or nearby.

WONCA-EUROPE

The scientific society of general practitioners/family doctors of Europe has recently adopted a very important document: THE EUROPEAN DEFINITION OF GENERAL PRACTICE/FAMILY MEDICINE. The discipline and specialty of general practice/family medicine are defined as an ACADEMIC AND SCIENTIFIC DISCIPLINE, WITH ITS OWN EDUCATIONAL CONTENT, RESEARCH, EVIDENCE BASE AND CLINICAL ACTIVITY, AND A CLINICAL SPECIALTY ORIENTED TO PRIMARY CARE.

The specialists in General practice / family medicine are described as specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness.

In the document there is also a description of the core competencies of the General practitioner/ Family doctor.

TITLE IV GENERAL PRACTITIONER OR SPECIALIST IN GENERAL PRACTICE/FAMILY MEDICINE

To qualify and work as a Title IV general practitioner, a physician must undergo 3 years of specific training after basic medical training. To qualify and work as a specialist in Family Medicine requires a training time equal to that for other specialists, often 5 years.

Our discussion in the UEMO will continue: Do we want an A and a B level of General practitioners in the future? Do young doctors want to work as a Title IV doctor? Or do they want the same status as other colleagues-specialists working in health care?

This discussion is one of the most important on the Agenda of the UEMO for the nearest future.

OTHER ITEMS ON THE AGENDA OF THE UEMO

PREVENTIVE ACTIVITIES

The European Union has launched a Public Health Plan for 2001-2006 with the overall aim of contributing to the improvement of public health, preventing human illness and disease, and obviating sources of danger to health.

As general practitioners work in the front line of health care, and meet the patients in different situations in life, they have an important role in prevention.

The need to provide counselling to the patients, who naturally have a great deal of the responsibility for their own health, must be made obvious to the health policy makers in the different countries so that they organize and finance primary health care in such a way that doctors can take responsibility for effective preventive services and health promotion .

During the consultation between the patient and the doctor there must be enough time for primary, secondary or tertiary preventive advice and activities.

In the cooperation between the European Medical Organisations we have launched a common working group on Prevention.

Tobacco still is the single most important risk factor in Western Europe. As general practitioners we have many opportunities in our meetings with patients to influence their habits and help them quit smoking. The UEMO will continue to work against tobacco and is cooperating with the World Health Organisation and its European Regional Office in this important work.

COOPERATION BETWEEN THE EUROPEAN MEDICAL ORGANISATIONS

The voice of the doctor must be heard when there are discussions of health care, professional development, and of efforts to guarantee the highest quality of care for the patients. If we can have one voice for the medical profession in Europe in as many situations as possible, it is an advantage for the furtherance of these important topics. The European medical organizations have started a cooperation between the Standing committee of European Doctors (CPME) and the independent associated craft organizations ,the European Union of Medical Specialists (UEMS), the European Union of General practitioners (UEMO), the Permanent Working Group of European Junior Doctors (PWG), the European Association of Senior Hospital Physicians (AEMH), the European Federation of Salaried Doctors (FEMS), the International Conference of Orders (CIO), the European Medical Students´ Association (EMSA), as well as the World Medical Association, whose national member associations include many European countries.

THE UEMO SWEDISH PRESIDENCY, 2002-2006

The Swedish Presidency looks forward with enthusiasm to its work during the coming 5 years. We want to influence European health policy to guarantee the patients of Europe the highest quality of primary health care, a care performed by specialised general practitioners on an equal level with other specialists.