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Council meeting - Vilnius, Lithuania, May 2003 Report of the Meeting

Council Reports Contents

Wednesday 7 May 2003

Pre-Council Executive Board Meeting

The Executive Board met just before the Council Meeting and discussed the following issues:

• Web-site development needs further support. Sakis should try to involve Dolores more as well as other Council members.
• Since the last EB meeting in London there is no progress on further review of VT & CME in Europe. Agnes will distribute the questionnaire to the second informant. The names will be provided by the Council Members.
• There is a new question in the country reports – “What have I done for EURACT?” During the first session of the Council meeting, after the discussion in small groups of four people, everybody will report on the issue to the plenary.
• Adam Windak has finished his first term as an Honorary Secretary of EURACT. EB will propose to the Council his candidature for the second term.
• Corrections of the members' booklet were done by Igor. This should be incorporated to the new version, which will be sent to all newly approved members.
• The concept for EURACT rolling course should be developed further during the ongoing meeting.
• There is a delay in work on the Assessment course, mainly due to the illness of Leslie Southgate's husband. Justin Allen will explore chance for any progress.
• The document on HPE from the conference in Utrecht is available. No further action was undertaken. Jan Heyrman will lead the discussion on this topic during one of the sessions of this meeting.
• Implementation of the New Definition document should be monitored. Adam Windak will distribute the questionnaire and will lead the discussion on this issue.
• EB will propose to the Council to co-opt Bernardina Wanrooij till the end of 2003.
• The Spring Council meeting in 2004 will be held in Portugal. The place of autumn 2004 meeting is unclear at the moment. This must be clarified during the Vilnius meeting.
• EB will propose changes in membership fees as it was developed in London. The Council has to consider it. However the final decision will belong to the General Meeting in Ljubljana.
• There is no response to Justin Allen's letter to the EQuiP and EGPRW presidents, proposing closer collaboration of the three networks. We are still waiting for it. Justin Allen will write a letter to UEMO explaining that we are available to work on any educational issue.
• Jan Heyrman will lead the discussion on the Educational Agenda, followed by small group work. The aim to finish the document in Leicester seems to be unrealistic. Clear deadlines should be agreed on at the end of the second session.
• The Meeting with Lithuanian colleagues has the following agenda: welcome speeches, Justin Allen's and Jan Heyrman's presentations on New Definition, presentation by Lithuanian colleagues followed by the group discussions. Visits to the practices at the end of the program.
• The place and time of the EURACT General Meeting will be announced in the Congress Program.
• Provisional program for Leicester meeting to be held on 10-13 September 2003 is as follows. Wednesday – practice visits, Thursday – English Conference at 10.30 (Yonah Yaphe, Margus Lember and Paula Vainiomäki will present work of BME, VT and CPD committees of EURACT, then the groups will work together with English EURACT members. On Friday there will be time for the rest of the Council Meeting and social program. Accommodation will be in university student rooms.
• Adam Windak will be the contact person for Filipe Gomez to finalize the arrangements for Portugal Council meeting.

Session 1: Country Reports

Dr. Justin Allen, President of the EURACT, welcomed all the Council members and thanked the Lithuanian Representative – dr. Egle Žebiene for organization of the meeting. Dr. Žebiene introduced prof. Bunijar Orgil from Mongolia who joined the meeting as an observer. Prof. Orgil introduced himself and described the health care system in his country. He attended the meeting in the framework of the East-East Program. After his presentation the Council divided into small groups of 4 persons to discuss the country reports. After half an hour the Council met again for plenary discussion limited to the issue: “What have I done for EURACT?”. The Council Members described their work on the national level. In general most of these activities promote the role of the organization. Often the courses were organized under the “umbrella” of EURACT. Quite often local relationships with other networks representations were established. Many participants stressed that they tried to keep working relationships with the national associations or colleges and departments of the universities. In many cases the above actions were aimed to increase membership, which were not always successful. The group considered the reasons why EURACT not always is regarded as a “Centre of excellence” for GP education. Several solutions were discussed, e.g. organization of our own congress, although it was regarded as too ambitious at the moment. The problem of the benefit package for members was raised again. The issue of national meetings of EURACT members was also mentioned. Many members regarded this proposal as a good idea. Some members asked for the electronic version of the report to be used for further local distribution. The idea of the e-mail list of local members of EURACT was also raised. The above was seen by the Council as a potential list of choice for Council Members.

• Review of the activities from Dublin – the EB has already reflected on this. The only missing point is the update of the membership booklet. It was already done by prof. Švab. There were no further questions to the report from Dublin, which was approved by the Council.
• WONCA Europe Executive Board met in Belgrade and reflected on several issues. They discussed the European conferences. The last one in London produced a significant deficit. WONCA Europe seeks a more effective strategy. The EB established a constitutional working party to solve the problems put forward by the Nordic Colleges and other networks in Europe. The report of the working party clearly endorses our current position, which satisfies us. There is a new category for organizations in collaboration (Euripa, Europreve etc.), which can collaborate with WONCA Europe mainly on the basis of special projects.
• The EB discussed the issue of extension of the boundaries of Europe. More countries, especially former Soviet Union countries, want to join WONCA and its network organizations. This results also in some practical problems like extension of our Council and EURACT has to be prepared for it.
• UEMO wanted to move general practice from title IV to title III as for other specialties to improve the status. UEMO produced the discussion document with a thesis that cannot be fully supported by EURACT. Especially we cannot support the request for 5 years of VT all over Europe. Fixed length of training is not a good solution. It should be competence-based rather than time-based. Council stressed that we should not leave this issue to UEMO alone. We should be involved in the process. Any individual comments on the discussion paper are welcomed and should be sent to the President, who will contact UEMO. The President will keep the Council informed about progress.
• The Honorary Treasurer presented the financial report. This is a provisional report since many Council members are bringing fees collected in the countries to the current meeting. The current budget predicts to spend more money on the web-site development. The report shows a rather good and stable financial situation of EURACT. The turnover is growing and the savings stay on the same level. A full report is available as Annex 3.
• The East-East Project has supported the current meeting by coverage of expenses of Central and Eastern European participants. This is due to the seminar organized parallelly to the meeting. This is a potential resource for future meeting organizers, however it can be used only if the meeting takes place in one of the CEE countries. This is also an example of successful support from outside. Similar opportunities should be sought by future organizers also from other sources. Another consequence is that 6000 Euro is available to support the travel expenses for Leicester.
• According to the WHO database many countries in Europe have crossed the boundaries of categories for current fees. However the Executive Board has several proposals to solve the situation. The following changes have been proposed: 1) Raise the threshold for the lowest fee to 10,000 EURO of GDP, 2) Increase the lowest fee from 5 to 10 EURO, 3) Raise the threshold for 20 EURO fee to 15,000 EURO of GDP, 4) Increase the regular membership fee for countries with GDP over 15,000 EURO to 50 EURO per year. This will result in a new regrouping of the countries and would better reflect changing realities in Europe. Other proposals were also discussed. However after serious consideration the Council decided to support the EB proposal, which was approved as a consensus of the Council and will be presented in this form to the General Meeting in Ljubljana for final approval.
• The CPD and VT overview was done with only one informant. The Council does not want to postpone the publication on the web-site. The second informant review will be done as well. The Council members will be asked to review the existing data and to provide the names and addresses of the second informants in their countries.
• Dr. Adam Windak has completed his first term as Honorary Secretary of EURACT. On behalf of the Executive Board dr. Justin Allen has proposed his candidature for the second term. There were no other applicants. The Council elected Dr. Windak for the post of Honorary Secretary for next three years.
• The formal election in Portugal was completed and Dr. Filipe Gomes was elected the Portuguese representative. The Council approved him as a new Council member.
• There is a big group of GPs interested in joining EURACT in Cyprus. EURACT waits for their applications and then relevant election procedure will be started. There is development of family medicine in Latvia and Bulgaria but no contact with WONCA Europe or EURACT. There are some contacts in Serbia and Montenegro and we can expect new members in the future.
• EURACT seeks for more effective way of collaboration with other networks. The President wrote a letter to EQuiP and EGPRN presidents proposing future collaboration and the meeting in Lubljana to discuss this issue further. EURACT still waits for their answer.
• The Council decided to co-opt dr. Bernardina Wanrooij till the end of 2003.
• Following number of applications of new members have been presented to the Council: Slovenia – 1, UK – 1, Lithuania – 3, Bosnia & Herzegovina – 2, Germany – 5, Greece – 13, Turkey – 6, Portugal – 16, Italy – 7, Spain – 1, Norway – 1. New members were approved.
• A new group was formulated to support further development of the EURACT Web-site. Dr. Roar Maagaard and Dr. Francesco Carelli will join Dr. Athanasios Simeonidis and Dr. Dolores Fores in the work on the web-site.
  

Session 3: Implementation of the New Definition

The session started with a short, structured overview of the New Definition implementation process. A short questionnaire was filled in by Council members. Results will be used to plan further work in this field. After the work with the questionnaires, plenary discussion, lead by dr. Adam Windak took place. Several problems were raised and local solutions were presented. Dr. Justin Allen informed us that there is no copyright for the document. Every GP organization or publisher is welcomed to translate it and publish in any European language. It was stressed that translations into other languages are needed to reach a large part of the profession. Dr. Gomes said that according to many Portuguese colleagues the document is too -repetitive. That it is why a shorter version was published in Portugal. In Spain the translation was put on the web-site. In Belgium translation was done together by representatives of the university departments and GP associations. As a result of this work the Belgium core group was created. In Italy the document was partly translated and published for discussion. Further action will depend on the reaction to the first article. Dr. Margus Lember said that in Estonia translation and distribution are not sufficient. It can be of value if further discussion will follow publication. In Poland many parts of the document were used to influence new legislation. In Portugal the document was given to the politicians who declared that they would use it. Dr. Rothenbühler said that in Switzerland bureaucrats do not understand the document. It is useful for doctors but decision makers expect something more. According to him it can be used on a local basis. In the UK the document was used for the new syllabus and in some political contexts. Although most ordinary doctors are not aware of the existence of the document, politicians regard this document as useful evidence. Prof. Bernard Gay said that the profession should pay more attention to the scientific value and not to the political aspects of the New Definition. However according to the majority Council members it can be used in both dimensions. In Switzerland the first reaction of specialists was anger. They believe that they do more or less the same kind of work as described in the document. Prof. Jan Heyrman said that in Belgium specialist are especially angry because of the advocacy role and follow up done by GPs. There was general feeling that we can't prevent this kind of reaction in other places as well. Dr. Justin Allen said that maybe we are missing the opportunity to link the document to CPD, as the BME and VT perspectives were originally seen. According to him this should be changed. Dr. Egle Žebiene said that in Lithuania the structure of the document is too difficult for ordinary doctors, but it is used as an example of a well-organized study of the subject. In order to promote the content of the document to ordinary doctors, it was put on the list of useful literature in Ireland. It was done mainly in the educational context. In Albania the document is applied in teaching and presented at national conferences. Lectures on the New Definition take place mainly during VT. Dr. Muharem Zildic said that in Bosnia the New Definition could help general practice at the university level achieve independence. At the end it was agreed that New Definition has at least three different functions. 1) It creates a background for educational, research and the quality assurance agenda. 2) It is a strategic document for further development of the discipline. 3) It can be used as a tool for political influence in many places.

Session 4: Committee meeting

During this session BME, VT, CPD and Member Service committees worked separately. The reports are available as Annex 4.

Session 5: Educational Agenda I

Prof. Jan Heyrman introduced the framework for future work. The structure of the document was discussed. Six core competencies should form the core of the document and can be described both in text and with tables, followed by the literature selection. The issue of support from external experts was discussed. Several comments were made on the process of work on the document. Many members stressed the need to identify the general purpose of the document. The group decided to work on six chapters related to the core competencies. Work on chapters 2 and 3 is postponed till Leicester. The Council split into 3 groups, each working on two competencies subchapters. Distribution of Council members to the groups as is follows:

Friday 9 May 2003

Session 6: Educational Agenda II

At the beginning three groups continued the work from the previous day. At the end of the session the Council met at a plenary meeting and three groups reported to the Council on the progress achieved. It was agreed that groups should continue and exchange the information between the group members and keep Prof. Jan Heyrman informed. The need for unique layout was stressed. The concept of the existing headings with the text in it followed by the tables was presented. An alternative proposal for headings was presented by Dr. Yonah Yaphe. The Council accepted it. It was agreed that he will produce a new template and will send it to the principal authors of the six chapters (Jan Heyrman, Igor Švab, Yonah Yaphe). Short reports of the group chairmen are attached as Annex 5.

Session 7: Seminar with Lithuanian colleagues

The rest of the day was devoted to the seminar with Lithuanian teachers of general practice. At the beginning the EURACT document on the New Definition and Core Competencies was presented by prof. Jan Heyrman and dr. Justin Allen. Lithuanian colleagues presented their achievements in the field of education of family physicians. After the plenary meeting the group split into three small subgroups to discuss problems of BME, VT and CPD. The seminar concluded with a visit to Lithuanian general practices, where participants had an opportunity to familiarize themselves with basic arrangements for family medicine in Lithuania.

Saturday 10 May 2003

Session 8: “5 minutes 1 slide”

• Vocational Training (Dr. Margus Lember). The committee is preparing the workshop for the Ljubljana Congress and wants to make the overview of the assessment, which will be presented during the WONCA.
• CPD group (Prof. Paula Vainiomäki). The group feels responsible for the implementation of the document on CME&QA. There is a plan for distribution, which includes national colleges, university departments and national authorities responsible for authorization. The CPD group asks national representatives to sent relevant addresses in their countries to Agnes by May 31. The booklets will be also distributed by national representatives. The Hon. Treasurer will support mailing.
• BME (Dr. Yonah Yaphe). The group invites all Council members to the workshop on BME, which will be held during the WONCA Congress in Ljubljana on Friday afternoon. A second project currently conducted by the group is lead by dr. Stefan Wilm who is going to develop a checklist for BME course organizers.
• New educational website. Dr. Yonah Yaphe presented the address: http://YAPHE.ESMARTWEB.COM – of a free website with freely available teaching materials.
• PASSWORD Protected, Members Only, website (Prof. Jan Heyrman and Dr. Francesco Carelli). This completely new idea is seen as a strong incentive for membership. On this part of the website some confidential or incomplete information and overviews could be presented. This could also be used for administrative purposes. Other advantages were also presented. Some disadvantages were discussed as well (a lot of administrative work, some extra costs of developments etc.). Dr. Francesco Carelli stressed that it would help to keep EURACT members together. This is going to be discussed by EB. A more detailed discussion paper is needed.
• MERCHANDISING (Dr. Filipe Gomes). The idea of EURACT Diploma was introduced. According to the author it would be an easy task. Two signatures would be needed. The expiry date would be protected by a sticker, provided yearly when a member pays the annual fee. Other ideas would be a membership card and pin. Some technical difficulties were discussed. In some countries it would be seen as a waste of time and money. This issue must be explored further.
• Workshops at the Ljubljana Conference on the EURACT Course in Turkey (Thursday, 19 June, 2003, 15.15 – 16.15, Dr. Okay Basak). The development of the course in Turkey since October 2000 will be presented. Altogether there have been seven courses with 168 participants in total. The structure of the course is the same as before. The aim of workshop is describing the structure and methods of the course. Some Council members stressed that the goal of the workshop should be defined more precisely. However EURACT Council is strongly interested in the results.
• Rolling course (Dr. Egle Žebiene). The idea of a rolling course to be organized in 2004 by Member Service committee and a general structure for the course was presented. The course is aimed at groups of 4 teachers from 6 countries, who can repeat the course in their own countries. The first pilot course will be organized in Krakow for Poland, Slovakia, Lithuania, Estonia, Czech Republic and Hungary. This is going to be reproducible in other countries. Leonardo da Vinci (Dr. Adam Windak) The basic framework of the European project “Towards Development of the European Network of Postgraduate and Continuous Education for Family Physicians”, was presented. The project seeks the most effective method for training of trainers. Another part of this project is aimed at Development of distance learning programs for family physicians. Existing examples of similar programs in Europe have been listed. EURACT is very interested in the project and further ways for mutual collaboration will be sought.
  

Session 9: Higher Professional Education

There is a booklet presenting the results of HPE conference. We decided that we will produce a statement on this issue. The first problem is a proper name for the process. Two possible proposals are Higher Specialist Training or Higher Professional Development Program. Examples of such a program could be:

• research/QA
• palliative/mental care
• diabetes/COPD/prevention
• etc.

A lifelong learning scheme was presented and discussed by the group. The possibility of rearrangement of current VT was presented, which could also include HPE and the last 5 years. Possible ways of development of the EURACT statement document were discussed. Invitation of external experts and exchange of information with other centres of excellence were discussed as well. Content of the document that needs to be based on the concept of HPE was considered. Examples from different countries were presented. Further plan of the work was discussed. One possibility is to create the Task Force to reflect on this issue. Another solution is to develop a short discussion paper and work further on it during future meetings. This option was approved and further work will take place in Leicester.

Session 10: EURACT progress review

• Review of the Action Plan developed in 2001 during the Barcelona meeting. There were seven items listed and discussed. The issue of the introduction of new members was discussed. It was proposed to have a mentor who can guide new members during the first Council meeting. Another idea was to respond to every e-mail giving the signal that the message was received. No firm decision was taken. There is a need to update the mailing list. Jan will ask Agnes to do this. An offer to members and organizations in collaboration was discussed. Sponsorship of the participation in two courses was presented as an example. Other ideas are web-site information and a rolling course. Membership fee for WONCA direct members should be reduced by half. We forgot about this rule. we need to accept it, but we are not responsible for checking it. Members of EURACT must prove that they are direct members of WONCA and are entitled for 50% reduction of the membership fee. The issue of first two years fee was raised, but a majority of the Council did not want to change it. Collaboration with other networks is based mainly on national contacts. The CPD document was an example of collaboration on the central level of two organizations. Reports from our meetings are sent to presidents of these organizations. Further collaboration should be based on the projects. Another organization, which should be on our target, is UEMO, however EB thinks that most of the contacts should go through WONCA Europe. There is nothing against direct contacts, which should take place where needed. It seems that EURACT has completed all the projects started in the past.

Future meetings

Ljubljana	June 18-21, 2003	General Meeting of EURACT is marked in the program of the Congress There are also sessions marked as EURACT sessions
Leicester	September 10-13, 2003	Autumn 2003 Council Meeting
Madeira Island	April 21-25, 2004	Spring 2004 Council Meeting
Amsterdam	June 1-4, 2004	EURACT sessions are not secured yet, but there is such a possibility – perhaps it would be time to present an Educational Agenda
Denmark	Autumn 2004	to be confirmed in Leicester (to clarify position of Czech & Slovak meeting)

• The Honorary Treasurer summarized the meeting. EURACT continues to be very productive group. A lot of projects are coming to completion. Special thanks were addressed to Dr. Egle Žebiene who made wonderful arrangements for the meeting.
  

Summary of EURACT Council and EB decisions – Vilnius 2003

• Agnes will distribute the questionnaire on VT and CPD to the second informants. Names to be provided by Council members.
• Members' booklet will be sent to all newly accepted members of EURACT.
• Next Council meeting will be held in Leicester on 10-13 September 2003.
• Comments on the UEMO document should be sent to the President, who will contact UEMO.
• Travel reimbursement budget for Leicester meeting is 6000 EURO.
• New membership fees to be valid since 2004 are approved by the Council and will be presented to the General Meeting for final approval.
• CPD and VT overview to be published on the web.
• Dr. Adam Windak elected Honorary Secretary of EURACT for next three years.
• Dr. Filipe Gomes is approved as a new Council member.
• Dr. Bernardina Wanrooij co-opted as a Council member till the end of 2003.
• Dr. Roar Maagaard, Dr. Francesco Carelli and Dr. Dolores Fores will support Dr. Athanasios Simeonidis in the work on the web-site.
• Work on the Educational Agenda will be continued according to the developed plan.
• The pilot rolling course will be held in Cracow in Spring 2004.
• The schedule for Council meetings till the end of 2004 is nearly ready.