Family Doctor Networks:the specific solution for improving health economics and

health service access and reducing hospital overload

Sustainable Development Goal on Health

Our greatest challenge : Universal Health Coverage

What is our biggest challenge?

Universal health coverage

How do we ensure access to health care for all people in the nation?

Represents over 600,000 family doctors in over 150 countries

World Organization of Family Doctors

WONCA brings the family doctors of the world together

Supports the highest standards of clinical care, education, training and research

Represents family medicine and general practice at the World Health Organization

WONCA Rio Statement on the contribution of family doctors to Universal Health Coverage

• The World Organization of Family Doctors (WONCA) calls for all countries to increase the number of family doctors in order to achieve high quality comprehensive primary care and universal health coverage.

• Effective strategies include: improving the skills of doctors already working in the community; recognising Family Medicine as a specialty and enhancing the academic basis of the discipline; strengthening the family medicine experience of all medical students; actively recruiting more medical graduates into more postgraduate family medicine training programs; giving all family doctors and members of their teams the resources to carry out their work, recognising their contribution, and ensuring their retention in the workforce – all in order to deliver excellent integrated cost-effective people-centred care.

Features of Family MedicineBarbara Starfield (1932-2011)

• Four main features:– First-contact access for each new need– Long-term person-focused (not disease-

focused) care– Comprehensive care for most health needs– Coordinated care when care must be sought

elsewhere– Barbara Starfield 1998

Features of family medicine

1. First-contact care2. Comprehensiveness3. Continuity of care4. Coordination 5. Prevention6. Person-centeredness7. Family-orientation8. Community-orientation

Why is family medicine important to improving health economics and

health service access and reducing hospital overload?

• Provided us with the evidence to show that a greater emphasis in a country on primary care and family medicine 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

“I love family medicine”

Dr Margaret ChanWHO Director-General

December 2013

Family medicine provides a way to …

• 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

Family medicine provides a way to …

• effectively tackle the epidemics of both communicable and non-communicable diseases

• tackle the workforce shortages affecting health care provision across the world, especially through supporting teamwork between primary care professionals

Family medicine provides a way to …

• 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 (universal health coverage)

WHO World Report on Ageing and Health (2015)

http://www.who.int/ageing/events/world-report-2015-launch/en

/

• “Models of care will need to be reoriented towards prioritizing primary care and community-based care.

• “This encompasses a shift from inpatient care to

ambulatory and outpatient care, to more home-based interventions, community engagement and a fully integrated referral system.

• This is a core challenge for family medicine.

• “Problems that matter for older people, such as pressure ulcers, chronic pain and difficulties with hearing, seeing, walking or performing daily or social activities, are often overlooked by health professionals.

• “In primary health care, the clinical focus often remains

on detection and treatment of diseases; because these problems are not framed as diseases, health care providers may not be aware how to deal with them, and frequently lack guidance or training in recognizing and managing impairments and geriatric syndromes.”

• “This leads to older people disengaging from services, not adhering to treatment or not admitting themselves to primary health care clinics, based on the belief that there is no treatment available for their problems.

• “New approaches and clinical intervention models need to be introduced at primary health care level, if the aim is to prevent care dependence and maintain intrinsic capacity.”

• Fortunately, family medicine provides solutions.

• Our primary care workforce can deliver holistic care for older people.

• This includes the prevention and management of conditions, and often complex co-morbid conditions.

• The role that the members of primary care teams, including family doctors, have in caring for people and their families, within their communities, and throughout their life-course, positions primary health providers to identify functional decline as well as other complex problems that many older people face, and to manage these appropriately.

Partnership Pentagon

What are some of the major challenges?

• Training a family medicine workforce of doctors and nurses and other health workers to meet each nation’s needs

• The need to improve the skills of the existing primary care workforce

• Our peers in other medical specialties

What are some of the major challenges?

• Encouraging students and recent graduates to train in family medicine

• Providing appropriately resourced clinics

• Community perceptions

• The status of family medicine as a recognised medical specialty matters with equal opportunities for career advancement and salary

So what is happening around the world?

Brazil

• 200,000,000 people• 40,000 Family Health Teams• (family doctor +/- trainee, 2 nurses, 6

community health agents from local community)

• Each Family Health Team cares for 4,500 people• Responsible for everyone in their catchment

area

Cuba

• 11 million people• Universal health coverage based on primary

care model• 36,000 family doctors• 3,000 clinics in rural areas• Every person in the country knows their family

doctor, including those in urban areas and those in rural areas

China

• 1.35 billion people, 800,000,000 in rural areas

• Aim to train an additional 400,000 family doctors by 2020

• As China adopts new models of family medicine, this will influence developments in other parts of the world

Ethiopia

• 90,000,000 people• 13 new medical schools with innovative

community-based curriculum, soon to graduate 3,000 new doctors each year

• Commenced postgraduate specialty training in family medicine

• Aim to train 7,000 family doctors in next seven years

WONCA Rural Medical Education Guidebook

Australia• 24,000,000 people• 24,000 specialist family doctors, called GPs• Universal health insurance through taxation• 85% of population visit their family doctor each

year• Predominantly private family medicine with

government payments for services delivered• Mix of fee for service and pay for performance• No capitation model as yet

• Family medicine training of medical students mandatory

• Government-funded postgraduate specialty training of family doctors (1,200 each year)

• Incentives for team-based primary care• Special models in areas of need (eg Indigenous

health)

The Primary Health Care Performance Initiative seeks to help low- and middle-income countries build high-performing

primary health care systems

.

Indicators for primary health care

“I believe that family medicine is a force for good throughout the

world.”– Iona Heath

– Former president

Royal College of GPs