On the value of the international perspective in supporting primary care

AHoweAmanda Howe is Professor of Primary Care at the University of East Anglia in Norwich, England, and President-Elect of the World Organization of Family Doctors

 

I am heading for the explicitly international perspective of the ‘Clinical Academic Careers’ meeting in Dublin tomorrow, which is part of this year’s SAPC conference. I'll be commenting in my capacity as President-Elect of the World Organization of Family Doctors (WONCA). Let’s leave aside my sense of irony and grief that I shall be doing this as a little Englander whose country thinks it can manage alone – and will probably have to....I am writing this as a citizen of the world, where the professional networks of doctors, researchers, and scientists can span borders and bring fruitful ideas to deliver better care for our peoples. And I shall bring with me a blank sheet elevator conversation  ……

So let’s speak truth to power – if your country is buying into the W.H.O. goal of universal health coverage, and has decided an important and cost-effective part of that needs strengthening of its primary health care system, have you persuaded them yet that their medical schools will now need departments of family medicine? And if you have (good start!) then how many academic trainees will they qualify a year – how will they know they are ‘good enough’? -and how will they ensure they stay and grow the discipline for the longer term?

The arguments within the clinical academic community are well rehearsed, and this has been the mission of SAPC and those who sail with her for many years. Medical practice needs an evidence base to improve its outputs – so some doctors from each of the specialities need time, head space, financial and technical support to deliver research: and to do that, they need academic as well as clinical training. They also need a career structure that allows them to develop and perform as researchers as well as clinicians – this needs equity of terms and conditions, no good paying people half the annual salary because they only do 50% clinical, and also if they become less eligible in the job market because they ‘stepped off’ part of the clinical ladder. And they need equivalent status – so young doctors see an academic track as something positive, and will choose it and use it.

So, Minister – lets look at some of the examples at SAPC16 – built–in opportunities to do a Masters or PhD during postgraduate general practice training; opportunities to be bought out of clinical practice to develop as a researcher during your early – and later? – career: and, more widely, if you train a cadre of academics early on, they can be the leaders and the innovators within your reformed health service.  WONCA has some standards to help you set up excellent family medicine training – which includes developing competencies in data collection and analysis; and we also have some standards for your universities, to ensure their research is community focused and socially accountable.

I know there are challenges – funding for population and community based research is often less forthcoming from commercial partners: the hospital specialities don’t want to see income diverted from their training schemes; people who train up to postgraduate level then leave the country and don’t return. But most medical specialities now rely on their public health and primary care academic colleagues to help them with their clinical and research work – because, guess what, most people are not in hospital most of the time, so any data on interventions and longer term outcomes can only really be gathered in the community setting. And if you value your academics and create a strong career structure for them in the public sector they are less likely to migrate. The developed countries also have a responsibility to support countries with newer academic developments, and to partner in a way that speeds up development but does not encourage the ‘brain drain’  - we can discuss that too. But look at the role models – so many countries have started family medicine in their universities – 160 countries must be getting something out of this and you can talk to them about how they did it and how to go forward.

So good to see you in Dublin – we shall learn more there. And please don’t think that Brexit means we don’t value an international perspective – we need it more than ever.

Editor's note: This is the fifth in a series of 8 blogs about international collaboration in strengthening primary care research, ahead of the #SAPCASM2016 conference in Dublin, Ireland

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