Contact EURACT

E-mail

Phone
(32) 16 33 74 64

FAX
(32) 16 33 74 80

Euract Council News

Library Documents

Euract Council met in Cracow, Poland in March 1999, the meeting being organised by Dr Adam Windack There have been some changes in the organisation. After years of dedicated service, Dr Ivar Østergaard (honorary secretary) and Dr Mårten Kvist (honorary treasurer) have retired as office bearers, although still represented on council. Dr Adam Windack (Poland) is now honorary secretary and Dr Athanasios Simeonidis (Greece) is the honorary treasurer. Professor Dr Jan Heyrman (Belgium) remains president, and other executive board members are Dr Justin Allen (UK), and Dr Igor Swab (Slovenia). New representatives to council have been appointed from the Ukraine and Russia, accepted at the last meeting. At this meeting applications from Malta and Bosnia were accepted in principle, bringing the total number of countries represented in Euract to 31

Future courses and meetings

The Greek new teachers course planned for April has failed this year for a number of reasons, but it is still proposed to run an annual new trainers course.
Mallorca: 21st May 1999 (in the European Society meeting) - General meeting of EURACT
Leuven, Belgium: 23rd-27th August 1999 - Using Evidence Based Medicine - Finding answers to clinical problems
Bled, Slovenia, 7th-11th September 1999 -Teaching Management of Chronic Diseases
Zagreb, Croatia, 20th -24th October 1999 - EURACT Council
Riom, France, November (final date to be announced) - Course organisers course

General Practice in Europe and the EU Directive

This very important issue was debated at some length. There are a number of concerns about the implementation of the European directive, and in particular about delays in introducing much needed amendments. Many countries now exceed the requirements specified in title 4 of the directive and organisations in some countries are dealing with the frustrations of the current low standard of training required by introducing a new qualification of specialist in family medicine and seeking to list this under title 3, the specialist section of the Doctors' Directive. This potential double standard poses problems for the unity of the discipline. General practice education and political organisations bodies as a whole threw their weight behind the recommendations of the UEMO consensus conference in 1995, which recommended major improvements so the requirements of title 4 of the Doctors Directive. These suggestions were largely adopted by the Advisory Committee On Medical Training (ACMT) and recommended to the European Commission, but no action has been forthcoming.

The discipline of general practice needs to consider these matters with some urgency and adopt a common position on the future development of general practice vocational training in Europe. EURACT Council took the lead on this and has produced the following policy statement.

EURACT Position on Specific Training in Europe

The qualification to become a general practitioner / family doctor in Europe should continue to be through a common training programme. It should only be awarded after an agreed period of postgraduate study following undergraduate education and internship. This unified training programme is currently defined in Title 4 of the EU Directive. The reasons for this single path way to qualification are that the standards of qualification to be a general practitioner should be uniform, the quality of training consistent, and standards for patients guaranteed. A single entry standard is also administratively more simple.

However the current period of training demanded by the Directive is too short and the standard of entry consequently too low if only the minimum training period is applied. In particular the length spent in a general practice setting is insufficient to equip the modern general practitioner for the wide variety of tasks now expected. Evidence for this can be drawn from the fact that most states now exceed the minimum requirements of Title 4. Frustrations have arisen however, as they can only insist on these higher standards in training programmes for their own health systems. Further evidence for the need to raise the standard can be drawn from the production of the Consensus statement by UEMO in 1995, after a wide consultation exercise with experts from all over Europe. This suggested that lengthening the programme, and shifting its emphasis to a primary care setting is urgently required. Furthermore it must be recognised that the primary care physician has an increasing role with many more tasks in the evolution of health care in Europe; this has been emphasised by WHO in its statement on the development of family medicine in Europe. Finally there is the persisting illogicality of the locus of the major part of the training being an institutional setting, when the job itself is carried out in the community. The need for improvement in the training for general practice on a European level is now becoming urgent.

The creation of new professional development programmes for qualified general practitioners, in order to develop the discipline further, is to be encouraged. It also will encourage an academic career progression for newly qualified general practitioners. However the use of the word "specialist" for such qualifications can cause confusion, and listing them in a separate Title in the Directive will cause further confusion and runs the risk of splitting the discipline. In particular such qualifications should not be used to impede free movement by recognizing and using Title 4 qualifications only for incoming doctors. Finally urgent work is required to determine the competencies needed for the single entry standard for general practice in Europe, and the competencies and training that are needed for any further qualifications. It is urgent for the development of training and the protection of patients that Directives on the training programmes of all doctors move away from the current time based definitions and towards definitions of skills and competencies required.

The status of general practice/family medicine as a discipline is a major cause of concern, both in universities and in other areas of national and international health care systems. This lack of status has driven many of the moves to register newer and longer training programmes as "specialists", in order to defend the place and increase the status of general practice. Although understandable in the national context, this causes problems for the discipline internationally. The key here is to work together to improve the status of general practice / family medicine as an academic discipline throughout Europe.

Conclusions

EURACT Council recommends that:-

• the training programme and qualifications needed to work as a general practitioner in Europe should remain unified in one Title of the European Directive.
• the current training standard required as a minimum in Title 4 of the Directive is too low and requires amending urgently, at least in line with the UEMO Consensus statement
• initiatives to develop general practice further by developing higher professional development courses should be encouraged. However this should not be at the expense of improving the entry standard as a general practitioner. The training programmes for such higher qualifications should be listed in the same Title as the entry qualification.
• efforts throughout Europe must be made to increase the status of general practice as an academic discipline.
• further work is urgently needed to determine the range of tasks and the skills and competencies needed to be acquired during vocational training for general practice to meet the health care needs of the citizens of Europe.