WONCA News October 2024

VOL 50 | NUMBER 6

NEWS

2024

O C T O B E R

WONCA PRESIDENT ASSOCIATE PROFESSOR KAREN FLEGG (AUSTRALIA) EMAIL: PRESIDENT@WONCA.NET PRESIDENT-ELECT DR VIVIANA MARTINEZ BIANCHI (US/ARGENTINA) WONCA IMMEDIATE PAST PRESIDENT DR ANNA STAVDAL (NORWAY) EXECUTIVE MEMBER AT LARGE & HONORARY TREASURER DR STEVE MOWLE (UK)

CONTENT FROM THE PRESIDENT

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MONTEGUT SCHOLARS REPORTS

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APR CONFERENCE UBUNTU

NORTH AMERICA CONVENING

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WORLD PATIENT SAFETY DAY

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WONCA EXECUTIVE MEETING WITH WHO

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WONCA CONFERENCES

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PAST PRESIDENTS CHINA MISSION

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REGIONAL PRESIDENT, WONCA ASIA PACIFIC DR. BRIAN CHANG (TAIWAN)

WICC MEETING

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REGIONAL PRESIDENT, WONCA EAST MEDITERRANEAN DR ABDULAZIZ MAHMOOD NASSER AL-MAHREZI (OMAN)

77TH WHO SEARO MEETING IN NEW DELHI

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FAMILY MEDICINE PARADIGMS IN INDIA

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GERIATRICS TRAINING PROGRAM

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GERIATRICS TRAINING PROGRAM

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PIERRE PLUYE SHOLARSHIP

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EXECUTIVE MEMBER AT LARGE ADJ PROFESSOR KAREN PRICE (AUSTRALIA) EXECUTIVE MEMBER AT LARGE & WHO LIAISON DR MARÍA PILAR ASTIER PEÑA (SPAIN) REGIONAL PRESIDENT, WONCA AFRICA DR JANE FRANCES NAMATOVU (UGANDA)

REGIONAL PRESIDENT, WONCA EUROPE PROF SHLOMO VINKER (ISRAEL) REGIONAL PRESIDENT, WONCA IBEROAMERICANACIMF DR DORA PATRICIA BERNAL OCAMPO (COLOMBIA) REGIONAL PRESIDENT, WONCA NORTH AMERICA DR VICTOR K NG (CANADA) REGIONAL PRESIDENT, WONCA SOUTH ASIA DR KANAPATHIPILLAI SRI RANJAN (SRI LANKA) YOUNG DOCTORS' REPRESENTATIVE DR CHAN YUEN CHING CHERYL (HONG KONG) WONCA CHIEF EXECUTIVE OFFICER DR HARRIS LYGIDAKIS WONCA WORLD SECRETARIAT WORLD ORGANIZATION OF FAMILY DOCTORS AVENUE DES ARTS 7-8 1210 BRUSSELS BELGIUM EMAIL: SECRETARIAT@WONCA.NET PHONE: +32 (0) 2 329 00 75 WONCA EDITOR DIARMUID HAYES EMAIL: COMMUNICATIONS@WONCA.NET

FROM THE PRESIDENT O C T O B E R

2 0 2 4 WONCA RURAL CONFERENCE IN CAPE TOWN

A/PROF KAREN FLEGG WONCA PRESIDENT

In September, the WONCA World Rural conference “Ubuntu” was held in conjunction with The Network Towards Unity for Health (TUFH) in Cape Town, South Africa. The conference was marked by the huge diversity of attendees from around the world. There was a holistic approach presented alongside data and outstanding innovation of programs and workshops.

Innovation included one day during the conference spent “on the move” visiting services in and around Cape Town.

The word “Ubuntu” meaning “I am because you are” was an appropriate theme, with attendees connecting over much that we had in common as rural practitioners and realizing that “you are” is the most important thing.

WATCH CONFERENCE VIDEO

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The WONCA Iberoamericana region President, Prof Dora Bernal, a rural doctor from Cali in Colombia, had the honour of presenting the John MacLeod Oration. It is the first woman and the first person from the rural Americana to deliver this Oration in honour of one of the founders of our Working Party on Rural Practice. She shared some of her work and that of colleagues from across South America in a video of six countries that kept the engagement of the audience and inspired us all.

The conference was preceded by our WONCA Rural Council and Assembly meetings.

Photo: Dora Bernal, President WONCA Iberoamericana region, with WONCA President and Bruce Chater, chair, WONCA Working Party on Rural Practice

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POST CONFERENCE IN WESTERN CAPE REGION

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After the conference I joined the post conference tour - these regularly occur after WONCA rural conferences and generally as did this one enable us to visit various teaching and clinical sites in rural settings at some distance from the conference venue.

My group was ably led by Ian Couper, Stellenbosch University (past chair of the WONCA Working Party on Rural Practice) and Dehran Swart, Health Teaching Platform Manager, University Cape Town.

A second group was led by Lindsay-Michelle Meyer, Stellenbosch University, and Steve Reid, University of Cape Town.

Medical facilities visited were Worcester regional Hospital, Knysna Hospital, Harry Comay Hospital, Mossel Bay Hospital. Dr Andries Brink and Dr Francois Potgieter, at Knysna Hospital, explained the high TB burden, 20% HIV rates in pregnant women, and the mental health burden since COVID resulting in substance abuse.

It’s hard to pick between many memorable moments, but I think meeting medical students on year-long rural placements and hearing the eloquence with which they spoke about the fantastic learning experiences they were having confirmed to me the universal value (in a multitude of countries) of extended rural placements for medical students.

At the Inkcubeko Youth and Science Centre, Jo Scott-Jones of New Zealand and Ricardo Caravantes of Guatemala tested out some of the fascinating exhibits designed to help kids get interested in science.

Photos: 1. Group listening to explanations at Knysna Hospital during the tour.

2. Students at Mossel Bay Hospital (left to right): Heinco Botha, Tanya Heyns, MeganRose Redmond, and Ane Ungerer with Dehran Swart (group leader).

3. Jo Scott-Jones (New Zealand).

4. Ricardo Caravantes (Guatemala).

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We also spoke to health workers at SAHARA, which provides support groups and free medications for harmful substance use (alcohol, nicotine, drugs) in eight community clinics in George and the surrounding areas.

We visited one of their pop-up stations, part of SAHARA’s "My Journey" program for adolescents and young people, providing sexual-reproductive health screening, information, referrals, and HIV testing and counseling.

SAHARA SOUTH AFRICA WEBSITE Photo: WONCA President in one group at a popup clinic in Thembalethu, Geroge – an initiative of the SAHARA organisation

WONCA EUROPE MEETS IN DUBLIN After this fantastic time with colleagues in South Africa, I traveled to Dublin, Ireland, for the WONCA Europe conference. For me, it’s always meaningful visiting the country of many of my ancestors, and this visit was no exception. There were 2,600 participants from 77 countries, listening to 10 keynote speakers and attending many more workshops and presentations.

The WONCA Europe Executive Board and the Council met before the conference, and this will be reported on the WONCA Europe website.

Photo: WONCA Europe board during WONCA Europe Council meeting

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A personal highlight in Dublin was being able to pay tribute to past president of WONCA, Prof Michael Boland, at the inauguration of an award made by the Irish College of GPs and named in his honor. I was joined onstage by other WONCA World past presidents who were present at the meeting, including Michael Kidd, Amanda Howe, and Anna Stavdal. My tribute to Michael Boland, who was WONCA President from 2001-2004, can be read here. Indeed, his career was stellar, and he is missed.

A/PROF KAREN FLEGG WONCA PRESIDENT

WONCA President with Past Presidents Anna Stavdal, Amanda Howe, and Michael Kidd, paying tribute to Prof Michael Boland (1948-2020) at the WONCA Europe Conference in Dublin Convention Centre.

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WONCA AT UBUNTU 2024

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WONCA wishes to formally acknowledge the generous sponsorship of the American Board of Family Medicine Foundation (ABFM-F) through the Montegut Global Scholars Program.

This program fosters international education, research and collaboration in the specialty of family medicine by providing a scholarship for one family doctor selected from each of the seven WONCA regions to attend the WONCA regional or world conference.

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D R J A C Q U E L I N E J A V I E R - C A T U B I G

Montegut Scholar 2024

I am very fortunate to be chosen as one of the recipients of this year’s Montegut Global Scholarship Fund awarded by the American Board of Family Medicine Foundation. With this grant, I was able to attend the WONCA Asia Pacific Region (APR) Conference, which provided an avenue for me to gain valuable insights and connect with the international healthcare community.

PRE-CONFERENCE EXPERIENCE One of my main motivators in attending this conference was to expand my perspective and gain knowledge from seasoned and expert physicians from all over the world.

First on the list, I joined a pre-conference activity which was a learning visit to a Family Medicine practice site. The learning visit had a limited number of participants, and I was very happy to secure a spot. Our venue was the National University Polyclinics (NUP) in Bukit Panjang in the Western Region of Singapore.

efore our clinic tour, a short introduction about NUP was given. The NUP is the primary care arm of Singapore’s foremost academic health system, the National University Health System (NUHS). The NUHS is one of three public healthcare clusters in Singapore. I learned that almost 80% of Singapore’s healthcare is subsidized by the government, regardless of income and/or tax bracket, and that medicines are subsidized by Medisave, thus essentially bringing the cost to a minimum or nil.

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Singapore is also working to integrate all healthcare clusters into a unified health system under the One Healthier Singapore initiative. I was amazed at how fast they established the polyclinics—they did it in just under two years. As of this writing, the Western Region has 7 active polyclinics, with 3 upcoming clinics still being completed.

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On the first day of the conference, Mr. Ong Ye Kung, the Minister for Health of Singapore, was our guest speaker. I was taken aback when he mentioned that he recently visited the Philippines and learned that my country’s Department of Health launched BUCAS (Bagong Urgent Care and Ambulatory Services) Center. “A BUCAS Center is an intermediate health facility that aims to bridge the gap between primary care

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facilities (rural or city health centers) and higher-level health institutions (tertiary hospitals) by providing urgent health care services (minor surgeries and other ancillary services).” So BUCAS is basically like a “supercenter,” the equivalent of polyclinics in Singapore or what it aims to be.

I am currently working as a Medical Officer in Southern Philippines Medical Center (SPMC), a tertiary public hospital in Davao City, Mindanao, which serves the poorest of the poor in the southern region of the Philippines. Under SPMC, I am deployed as a family physician to Marilog District Hospital, a BUCAS Center located 2 hours away from the city proper. In the past two months of working there, I believe that we were able to meet our goal of decongesting our tertiary hospitals by providing healthcare services directly in the community. By doing so, we cut back on costs and manage resources effectively. The waiting time of patients had also been reportedly reduced, which translated to better health outcomes.

IMPACT ON MY WORK The theme for this year’s conference is Art and Science of Family Medicine. One of the more controversial topics discussed was the use of Artificial Intelligence (AI) in healthcare.

Prof. Enrico Coiera from Macquarie University presented scenarios wherein AI has caused patient safety issues, such as “hallucinating” or introducing confabulated information. However, he proposed that AIaugmented clinical decision-making is better than that of the same person unassisted by AI. “If we are not accelerating our thinking and response to this tsunami of change, we are falling behind.” He then discussed the National Policy Roadmap, including recommendations that focused on safety, quality, ethics, and security of using artificial intelligence.

Another plenary discussion was given by Dr. Danielle Martin of the University of Toronto, wherein she presented the Primary Care paradox: “efforts to improve the parts may not necessarily improve the whole,” referring to her experience and learning from cancer care in Ontario, with patients ending up frustrated and helpless because of too much specialization and the lack of coordination of care. She emphasized that relationships can be used as tools for change in primary healthcare.

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The workshops on research were of particular interest to me. I attended the first workshop on Designing Research For Busy Primary Care Practices. This provided tips for researchers and clinicians alike. One of the best practices that was shared, showed how we can maximize the data at our fingertips by using the very data we generate from electronic health records. This is helpful especially to our resident doctors who are looking for research topics.

The other research workshop I attended the next day was on Primary Care Innovations and Research. There was a short introduction but I appreciated the workshops more as we got more time to listen to everyone’s answer.

I was glad to see familiar faces from my first international conference last year. So honored and humbled to be sitting and standing with some of the giants of primary care in Asia Pacific and to be learning from their experience and perspective. An added bonus was witnessing our very own Dr. Karin Estepa-Garcia, immediate past president of the Philippine Academy of Family Physicians, conferred as the Five Star Family Doctor Awardee for 2024.

PERSONAL REFLECTIONS Seeing the best of what Singapore has to offer has been an exhilarating experience for me. Singapore is indeed an eye candy. It has rekindled my passion for the arts and architecture. From its superb transportation system, enormous green spaces, bustling sights and sounds, multicultural society surrounded by great food — it was just sensory overload.

I hope that my attendance at WONCA. APR inspires our junior doctors to realize that it is possible to enjoy and explore research and academe beyond the conventional pathways of clinics and hospitals. We have so much untapped research potential in the Philippines, and I hope this small win of getting a grant motivates our young researchers to pursue their studies for the betterment of the Filipino family. Plus, one gets to travel for free!

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Montegut Scholar 2024 I feel really lucky to be selected as one of the recipients of this year’s Montegut Global Scholarship Fund awarded by the American Board of Family Medicine Foundation. This grant gave me the opportunity to attend virtually the WONCA rural conference held in conjunction with the organization Towards Unity For Health tagged Ubuntu 2024. Aside missing the beautiful scenery of Cape Town where the conference took place, I enjoyed every moment of the conference.

My interest in rural health arose while working in two rural facilities in Ekiti State, Nigeria and now in Federal Medical Centre Abeokuta (FMCA).

Family Medicine Department of FMCA serves as the primary care unit of the facility and provides primary care services for patients from rural communities in Ogun State, Nigeria. My goals of attending the conference were to gain ideas on innovative ways to enhance health care services to these rural dwellers and to have more insights on how to improve the rural posting experience of our family medicine postgraduate trainees.

TUFH PRE-CONFERENCE I attended the TUFH pre-conference, which was a panel discussion on social accountability. The panelists were Sairu Philip, Firdouza Waggie, Jessiklecia Josinalva de Siqueira, and others. They emphasized the importance of Social Accountability in building equity for rural health. This was my first time learning what social accountability is all about. I got to know about the great work the organization is doing in partnership with health institutions across the globe.

TUFH’s mission is to focus on the globe’s most vulnerable communities, who usually live insecurely on the fringes of society, in fear and without access to a reasonable level of essential services, including health services.

Dr Meredith del Pilar-Labarda presented the Topic; Social Innovation in Health; Catalyst for connecting people, place, and policy towards community wellness. She cited examples of social innovations from the Philippines, including: the use of humancentered design approaches to deliver essential health services in three rural areas during the COVID-19 pandemic, application of human-centered design for local telephone systems in southern Luzon, Philippines, introduction of modules on Social Innovation into their medical curriculum, community engagement, selfmonitoring strategy, and others. This was an eye-opener as I learned how the use of social innovation can enhance health care for rural dwellers.

Another keynote speaker, Dr Malin Fors, presented the topic Geographical Narcissism.

This is a term she used to explain the ruralurban interaction she encountered while working in Norway. Rural health workers are often talked down to by their urban counterparts, who ask why they left the cities to practice in rural areas and when they will return. This can have a profound psychological effect on rural health workers, who may feel less valued than their urban colleagues.

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The third keynote presentation was on promoting an inter-professional and collaborative approach to health service delivery by Prof Shenuka Singh from the University of KwaZulu Natal. She emphasized the need for continuing educational support for students and inter-professional education, which will give health professionals the opportunity to learn from one another and better understand the perspectives of others. I loved when she explained that a siloed approach to teaching, as currently practiced in most places, will produce an ill-prepared and ill-equipped medical graduate.

The last keynote speaker, Prof Tefera Lema Belachew, addressed the need for universities training health workers to adopt a paradigm shift towards redirecting their education to serve society and respond to the needs on the ground. He stressed the interrelatedness of global and local health and stated the need for community engagement in managing noncommunicable diseases. He emphasized that community engagement is critical for achieving sustainable development, citing the Community Based Engagement (CBE) model currently practiced in Ethiopia as an example.

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OTHER INSPIRING MOMENTS JOHN MCLEOD ORATION The oration honored significant contributions to advancing health for all rural populations. Attendees from the Virgin Islands, Iberoamerica, and New Zealand shared inspiring stories of the incredible work being done by Family Physicians in these areas. They showed exceptional dedication despite the limitations posed by difficult terrains, lack of internet connection, and water shortages.

VIRTUAL NETWORKING I had the opportunity to meet Tiffany Maycook, Khalid Muhammed, Nilufer Demiral, Yilmaz Adelina, and Rajan Ghimire. I plan to collaborate with Tiffany on research focusing on elderly care and lifestyle and with Khalid, a medical student from Sudan who is working on a topic related to climate change.

MY REFLECTIONS AND ACTION POINTS Ubuntu 2024 was a great conference with excellent delivery of its theme: People, Place, Policy for Community Wellness. I hope to utilize all I learned to make a positive impact on my patients and younger colleagues in postgraduate Family Medicine training. My action points are: To adopt the concept of Geographical Narcissism to explore the mindset of young family physicians practicing in Nigeria towards those who have migrated to developed countries.

To initiate a discussion on the need for inclusion of social accountability in the postgraduate family medicine curriculum among family physicians and trainees in my institution.

To collaborate with Tiffany Maycook and Khalid Muhammad on research projects focusing on elderly care and climate change.

To contact the Social Innovation for Health Initiative Hub in Nigeria for more information about the group’s activities.

VIDEO DOCUMENTARY: A JOURNEY THROUGH IBERO-AMERICA TO EXPLORE THE WORK OF FAMILY DOCTORS IN RURAL AREAS.

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WONCA NORTH AMERICA

INAUGURAL CONVENING

DR. TANIA WHITBY-BEST

President-Elect, WONCA North America Region

DR. VICTOR NG

President, WONCA North America Region

The inaugural World Organization of National Colleges Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) North America convening event was a resounding success, beginning with a business meeting attended

by Canadian, American, and Caribbean representatives aimed at charting the team’s path forward. The meeting facilitated inperson interactions, networking among the member organization leaders, and charting a course forward for our region. Additionally, we celebrated the awardees for the North America five-star doctor and Montegut scholar awards for 2024, highlighting their significant contributions.

The business meeting was immediately followed by the inaugural convening chaired

by WONCA North America President Dr Victor Ng. Introductions by Dr Ng, Dr Vivianna Martinez-Bianchi (WONCA President-elect), and Shawn Martin (AAFP CEO and EVP) emphasized a shared commitment to the mission of WONCA to enhance global health by strengthening family medicine and primary healthcare.

The keynote speaker, Dr Carlos Gonzales, delivered an insightful presentation titled “Addressing Challenges: Primary Care, Rural Health, Native American Health, The Border”.

He provided a historical overview of primary care in the region, highlighting the urgent need for a primary-care-centered health system with strong connections to specialists.

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This message aligned closely with WONCA’s mission to improve the quality of life for people worldwide. Dr Gonzales also offered valuable perspectives on the health challenges faced along the USA borders, in rural and Native American communities, leaving us with important considerations for our ongoing efforts.

An engaging interactive exercise led by Dr David Polka (Canada), Dr Kim Yu (USA), and Dr Paula Henry (Trinidad and Tobago) highlighted the core values project from the North American perspective. Key values identified during this exercise include equity/social accountability, empathy/compassion, and professional autonomy. Participants were reminded of the adaptability required of family physicians and how establishing core values can help us navigate the daily challenges we face.

Dr Brunèe Dorsett (Bahamas), chair of WONCA Polaris (North America Young Doctors' Movement), provided an update on the remarkable initiatives undertaken by the group. Programmes such as the PolaRise mentorship programme, the PolarUs meetings, the empowerED podcast, and the Polaris newsletter are designed to inform, educate, support, and empower young family physicians as they embark on their careers in family medicine.

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Three breakout sessions were conducted, led by representatives and Board members of WONCA North America: Medical Education in North America (Drs Esther Johnston and Victor Ng) Impact of Climate Change on Clinical Care in North America (Drs Tania WhitbyBest and Kim Yu) Community Medicine: Family Doctors as Connectors and Advocates for Health (Drs Julie Wood and Vivianna MartinezBianchi) Feedback from participants indicated that these sessions were both informative and impactful. As highlighted in General Practice News (June 1948, p. 4), “the general practitioner should be the first line of defense for the patient—the medical ‘clearing house’. The family doctor practices the broadest specialty in medicine.”

Overall, the WONCA North America convening was a success. We hope that this will be the start of an annual WONCA North American event that will allow Canadian, American, and Caribbean members to continue connecting with each other and nurturing established relationships. It will also be a forum for us to share best practices, engage in collaborations on how we can support young doctors across our region, and contribute to strengthening family medicine.

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Improving Diagnosis for Patient Safety

PROF MARÍA PILAR ASTIER-PEÑA

WONCA liaison person to WHO On September 17, World Patient Safety Day will be celebrated, an event that since 2019 has been part of the World Health Organization (WHO)’s public health campaigns.

With the theme "Improving Diagnosis for Patient Safety" and the slogan "Right Diagnosis Safe Patients!" World Patient Safety Day 2024 highlights the importance of accurate and timely diagnosis for patient safety.

Although diagnostic errors — along with issues related to medication use — have some of the worst consequences for patients and professionals, they have not been the focus of attention until 2015 when the report "Improving Diagnosis in Health Care" was published.

In its announcement of World Patient Safety Day 2024, the WHO describes diagnostic error as a situation where the patient's health problem is not correctly or timely explained.

This includes the absence of a diagnosis, incorrect diagnoses, delays in diagnosis, and failures to communicate the diagnosis. The UN health agency highlights that diagnostic errors account for almost 16% of preventable harm in healthcare systems and estimates that most adults will face at least one diagnostic error in their lifetime.

The WHO notes that to improve the safety of the diagnostic process, action is needed on both systemic and cognitive factors.

Systemic factors involve organizational shortcomings that predispose to errors, such as poor communication between healthcare staff or between staff and patients, work overload, and deficiencies in teamwork.

Cognitive factors relate to the training and experience of professionals, their predisposition to cognitive biases, and other factors that increase the risk of human error in healthcare, such as fatigue and stress.

It is noteworthy that most diagnostic errors related to cognitive biases are not due to a lack of knowledge but to failures in gathering, verifying, integrating, and interpreting information.

Therefore, for family doctors, keeping information in the medical record up-to-date is essential for tailoring interventions to the patient's characteristics. The electronic health record allows all of a patient's health information to be included in a single support system regardless of where and when it is generated. A traceability of information that was previously unthinkable with paper records.

On the flip side, if the information is not reviewed, organized, and updated, medical records can become a maze of disconnected data that complicates decision-making and increases the risk of inappropriate interventions. It is crucial to eliminate inappropriate, erroneous, or outdated diagnoses from the medical record. This contributes to patient safety, just as regularly reviewing and adjusting pharmacological treatments does.

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A delayed or incorrect diagnosis, or the absence of a diagnosis, generally leads to a worse prognosis, can prolong illness, and sometimes cause disability or even premature death. Failures in the diagnostic process are accompanied by delays in starting appropriate treatment and can lead to providing the patient with unnecessary or harmful treatment, which also has psychological and economic repercussions.

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THE ROLE OF FAMILY DOCTORS IN THE SAFE DIAGNOSIS PROCESS Family doctors play a critical role in ensuring a safer diagnosis process in primary care.

Their contributions to patient safety in diagnosis include the following key areas: 1. COMPREHENSIVE HEALTHCARE Family doctors often have a long-term relationship with patients, allowing them to understand the patient’s medical history, lifestyle, and psychosocial factors. This deep understanding enables more accurate clinical judgments and timely diagnosis as they can consider the full context of a patient's health. For example, knowing a patient's family history of heart disease, a family doctor might promptly recognize subtle symptoms of cardiovascular issues, leading to earlier diagnosis and intervention.

2. EARLY DETECTION AND PREVENTION Family doctors serve as the first point of contact for patients, making them essential in detecting early signs of disease. By performing routine screenings and physical exams, they can identify risk factors and symptoms that might otherwise go unnoticed. For example, implementation of regular screening programas such as colon cancer or blood pressure checks in patients at risk of hypertension and cardiovascular diseases help prevent serious complications.

This comprehensive approach helps prevent diagnostic errors, such as misdiagnosing depression for fatigue or vice versa. For example, recognizing that a patient's physical symptoms (e.g., fatigue, headaches) might be linked to underlying depression or anxiety, the family doctor can avoid unnecessary medical interventions and provide appropriate mental health care.

5. PATIENT COMMUNICATION AND SHARED DECISION-MAKING Family doctors often have well-established relationships with their patients, fostering better communication. Clear explanations and discussions of symptoms, treatment options, and diagnostic tests reduce misunderstanding and ensure patients are active participants in their care. For example, a family doctor explains the pros and cons of various diagnostic tests (e.g., MRI, CT scan) and involves the patient in deciding the most appropriate steps, ensuring that diagnostic tests are both necessary and understood.

3. CONTINUITY OF CARE AND MONITORING Family doctors provide continuous care, which allows for the tracking of symptoms over time. This helps in diagnosing conditions that evolve slowly or present with ambiguous symptoms. Continuity also aids in adjusting treatment plans when conditions change or new information arises.

For example: In chronic conditions like diabetes, family doctors monitor long-term health changes and ensure timely adjustments in treatment plans to avoid complications.

4. COMPREHENSIVE PHYSICAL AND MENTAL HEALTH ASSESSMENTS Family doctors are trained to assess both physical and mental health, which is crucial as many conditions have overlapping or psychosomatic symptoms

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WONCA NEWS 7. ERROR PREVENTION THROUGH DIAGNOSTIC STEWARDSHIP By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients. They use clinical judgment to determine which tests and procedures are truly necessary. For example, a family doctor may avoid ordering an unnecessary MRI for a patient with back pain when conservative management is sufficient, preventing the patient from exposure to potentially invasive procedures.

8. ADDRESSING COGNITIVE BIASES By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients. They use clinical judgment to determine which tests and procedures are truly necessary. For example, a family doctor may avoid ordering an unnecessary MRI for a patient with back pain when conservative management is sufficient, preventing the patient from exposure to potentially invasive procedures.

9. FOSTERING A SAFE ENVIRONMENT FOR OPEN COMMUNICATION By avoiding over-testing or unnecessary interventions, family doctors help prevent overdiagnosis and unnecessary treatments that can harm patients. They use clinical judgment to determine which tests and procedures are truly necessary. For example, a family doctor may avoid ordering an unnecessary MRI for a patient with back pain when conservative management is sufficient, preventing the patient from exposure to potentially invasive procedures.

6. COORDINATING WITH SPECIALISTS When conditions require specialist referral, family doctors play a key role in referring patients, providing essential background information, and coordinating care. This helps ensure that specialists receive a clear picture of the patient’s health, reducing the risk of fragmented care and diagnostic errors. For example, a family doctor identifies potential early signs of cancer and coordinates with an oncologist, sharing detailed medical history and test results for more accurate diagnosis and treatment planning.

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In summary, family doctors contribute to safer diagnostic processes by combining their clinical expertise, patient-centered care, and preventive approaches. Their ability to build trust, ensure continuity, and balance clinical judgment with patient input makes them a vital part of the effort to reduce diagnostic errors in primary care.

WORLD FAMILY DOCTOR DAY A Campaign Created by

19.May.2025 THEME ANNOUNCEMENT COMING SOON BLOOD CLOT SURVEY Dear family doctors, World Thrombosis Day kindly ask for your support in sharing an important upcoming survey focused on women’s education and awareness of blood clot risks during pregnancy and postpartum. The survey is available in 11 languages, making it accessible to a broad audience.

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Their goal is to reach as many women who are pregnant or have recently given birth as possible. By sharing this survey, you will help us gather valuable insights that can improve education and prevention efforts worldwide.

Thank you for your continued support in promoting women's health.

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WONCA EXECUTIVE MEETS WHO LONDON

London, 29 September 2024.

At the end of September 2024, WONCA World Executive Committee held a face-to-face meeting at the Royal College of GPs in London. This venue was chosen because not only is it the cheapest city for us all to reach in in terms of airfares, it also has the lowest carbon footprint especially when the president is already in Europe.

This Executive meeting was remarkable in that Dr John Fogarty, primary care leader the WHO and our liaison person in the WHO, attended the meeting for half a day. I believe that is a first for WONCA Executive and we must thank John for making the effort to come to London.

The WONCA Region Presidents, each gave a short presentation on the activities in the region with the WHO. A summary of these is as follows: AFRICA REGION President Jane Namatovu reported on engagements with WHO to enable them to understand the contextual issues in the region including a workshop to help improve the quality of care delivery in health facilities and the WHO AFRO regional meeting. There is ongoing advocacy for several activities including a project on three proposed WHO collaborating centres on PHC in the African region: at Stellenbosch University (South Africa), in Makerere (Uganda), and in Benin.

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Meetings are ongoing with Hyppolite Kalambay Ntembwa who has the PHC portfolio at WHO AFRO and recently a meeting with Constance Assohou-Luty who is responsible for collaborating centres at WHO AFRO. In Geneva, ongoing engagements are about the Special Programme on PHC which officially ended in August 2024 and the hope is that the MOU with WHO Geneva will be signed imminently. This needs support from WHO AFRO. We are preparing for the upcoming 2025 PHC conference. WONCA Africa still needs support from WHO through its country offices to support Family Medicine both in training and practice institutions.

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WE conducted a talk session in April 2024 with Dr Toni De Deu (Senior officer, WHO European Centre for Primary Health Care, Kazakhstan) and Candan Kedir (OECD). For the future, WE is looking to cooperate in various WHO projects and plans, bringing to these our expertise and that of our member organizations, special interest groups, and networks.

The MOU aims to foster cooperation between PAHO and these two WONCA regions, in areas of common interest including the prioritisation of primary care services. This involves promotion of the provision of primary care, and the central role of family doctors in developing and implementing specific programs. A project working with PAHO and University of New Mexico to examine the scope of practice of family medicine in the Americas is an exciting opportunity.

ASIA-PACIFIC REGION (APR) President Brian Chang (pictured ready to speak) noted that WPRO Director Piukala and he have met several times including on World Health Day this year. They have agreed on closer collaboration for the future, aiming to deliver the best healthcare for the people in this region. This year, Brian has received an invitation to the 75th Session of the WHO Regional Committee for the Western Pacific coming up, in October 2024. WONCA APR intends to share the WONCA statement on NCDs and deliver the concepts of the WONCA APR Singapore Declaration of Planetary Health.

EAST MEDITERRANEAN REGION (EMR) President Abdulaziz Almehrazi spoke of the WHO Regional Diploma Collaboration, launched in 2022. It is a collaborative effort between the WHO EMRO, WONCA EMR, and the Arab Board of Higher Specialisation. This diploma program is a 24 month program tailored for GPs in the EMR and Arab countries, equipping them with essential knowledge, skills, and competencies to provide comprehensive and high-quality health care. The curriculum is designed in alignment with the standards set by globally recognized bodies including WONCA. Initially, 35 tutors underwent a Train the Trainers program and 129 students from nine countries were selected for the course. Now Abdulaziz believes that we need governments to empower family physicians and to increase the resources for training of family physicians in the region.

EUROPE REGION (WE) President Shlomo Vinker noted that WONCA Europe (WE) was represented in the 73rd session of the WHO Regional Committee for Europe. At this meeting, Prof Zalika Klemenc Ketiš delivered a statement “Shortage of European primary care workforce”, co-signed by a significant number of other European NGOs with an interest in this topic. Other activities include: Prof Mehmet Ungan, WE Immediate Past President, joined the WHO Europe short guide on the Therapeutic Patient Education (TPE) project; two WHO officers were keynote speakers in the WONCA Europe 2024 conference in Dublin - Dr Tomas Zapata-Lopez Yomas, Workforce Health Unit, WHO Europe).and Dr Pavlos Theodorakis, Senior Health Policy Advisor.

IBEROAMERICANA-CIMF REGION AND NORTH AMERICA REGION Our respective region presidents, Dora Bernal and Victor Ng and their teams, have worked hard on a Memorandum of understanding (MOU) for improving primary healthcare through strengthening family and community medicine in health systems of the Americas.

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An invitation for WONCA IberoamericanaCIMF and WONCA North America to attend the PAHO council meetings this year is an important development.

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WONCA NEWS Enhancing workforce development and growth through improved clinical decision-making tools, alignment with the ICPC-3, and the development of standardised postgraduate family and community medicine programs for health workers.

An invitation for WONCA IberoamericanaCIMF and WONCA North America to attend the PAHO council meetings this year is an important development.

SOUTH ASIA REGION (SAR) President K Sri Ranjan notes that our SAR region has made connections with WHO at a regional level by attending WHO SEARO meetings held in New Delhi last year. This year, Sri Ranjan has been able to strengthen these connections. Also, in Sri Lanka, we are engaged with ministry of health and WHO, in the primary care strengthening program.

THE WHO-WONCA WORKPLAN Our WONCA executive liaison person, Maria Pilar Astier Peña, made a presentation on the "WHO-WONCA Work Plan 2025-2027". This focuses on supporting WHO's efforts to strengthen Universal Health Coverage (UHC) by promoting strong primary care with family medicine values and by improving access to quality essential health services

and enhancing patient safety in primary care setting. ​Key action areas are: Supporting the development of comprehensive primary care services which involves defining essential materials and human resources, providing detailed feedback, and offering guidance for adapting the primary care services package to different health systems in the world.

Fostering patient safety improvements through contributions to the Global Patient Safety Action Plan 2021-2030 focus on primary care, providing expert recommendations and advocating for patient safety through global awareness and promotional efforts in primary care facilities.

Dr Fogarty updated us on projects of the WHO in which WONCA input and collaboration would be of value. We hope to have input to training programs under the Integrated Management in Primary and Acute Care Training (IMPACT) initiative, alignment of clinical tools with international standards, and curriculum development for family medicine.

All agreed it was a valuable half day enabling Dr Fogarty to meet and get to know the WONCA World leadership team.

Our seven region presidents continued their hard work by considering the aspects of WONCA’s Strategic Plan that can be worked on in their regions.

Thank you to my WONCA World Executive team and the WONCA secretariat (who also presented on their area of work) for two days of strong action and hard work on WONCA’s behalf.

PROF MARÍA PILAR ASTIER-PEÑA

WONCA liaison person to WHO

A/PROF KAREN FLEGG

WONCA President

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SAVE THE DATES

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WONCA Conferences 2024 23 - 26 OCTOBER 2024

WONCA Iberoamerican - CIMF Region Conference 2024 PAMANA CITY, PANAMA

WONCA Conferences 2025 04 - 06 APRIL 2025

WONCA South Asia Region Conference 2025 BENGALURU, INDIA

24 - 27 APRIL 2025

WONCA Asia Pacific Region Conference 2025 BUSAN, SOUTH KOREA

17 - 21 SEPTEMBER 2025

WONCA World Conference 2025 LISBON, PORTUGAL

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PAST PRESIDENTS ON CHINA MISSION Past Presidents Donald Li and Anna Stavdal represented WONCA at the annual conference of the Chinese Society of General Practice in Harbin on September 7-8. In her keynote speech, Anna Stavdal discussed the core concepts of Primary Care and Primary Healthcare, emphasizing how Family Medicine and its generalist approach are essential for delivering high-quality, personcentered care.

Following the conference, the team participated in an academic exchange at Beijing University First Hospital’s Department of Family Medicine, joined by former APR President Meng-Chi Li. Key topics included WONCA Accreditation, the Hong Kong Primary Healthcare Policy Blueprint, challenges in diagnosing diseases in Primary Care, and the relationship between research and clinical practice. Donald Li and Anna Stavdal also met with representatives from the Chinese Medical Association.

Additionally, Anna Stavdal engaged in an academic exchange at Harbin University’s Department of Family Medicine, visited a Community Health Center, and toured Harbin University Hospital. Discussions revisited WONCA Accreditation, alongside dialogues on core values, principles, and safeguarding the foundation of Family Medicine as a discipline.

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WONCA INTERNATIONAL CLASSIFICATIONS COMMITEE (WICC)

WICC MEETING IN NEWCASTLE The WONCA International Classification Committee (WICC) is a working party created in 1972 to discuss and develop tools that organize and collect information in the context of family medicine and primary health care. WICC met in Newcastle (UK) between September 22 and 24, 2024. The meeting was hosted by Nick Booth, a longstanding and active member of the group.

There were 23 participants from 14 countries, including Australia, Belgium, Brazil, France, Japan, the Netherlands, and Norway.

The main topics discussed were the implementation and updating of ICPC-3, the communication of the group's activities, training initiatives in classification and data collection. Traditionally, the group organizes a time when various guests or members give presentations related to the Committee’s work. At this meeting, presentations were given by the EDGE AI Hub Project, PRIMIS (University of Nottingham), EAVESii (Strathclyde University) and INTEGO (University of Leuven).

One of the meeting highlights was the presentation of reports from different countries about how they use classifications in primary care locally and prospects for the future. With the availability of Large Language Model tools, there will certainly be advances in the area of data structures and analysis in the primary health care context.

Family doctors need to be attentive and active in order to be able to influence decisions about the choice of tools for the benefit of health teams and patients.

PROF GUSTAVO GUSSO

Chair, WICC

FEATURED DOCTOR

Dr Gustavo Gusso (Brazil) is a family doctor in Brazil and chair of the WONCA International Classification Committee (WICC).

We were pleased to have Prof Gustavo Gusso visit the WONCA secretariat last week on his way to attend a meeting of the WONCA International Classifications Committee (WICC) in Newcastle, UK.

WATCH:

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REFLECTIONS ON THE 77TH WHO SEARO MEETING IN NEW DELHI

DR ROSHNI JHAN GANGULY

Organising Secretary WONCA South Asia Region Conference 2025

The 77th session of the WHO South-East Asia Regional Committee (SEARO), held from October 7–9, 2024, in New Delhi, was a remarkable convergence of health ministers, policymakers, and representatives from across the region. As the WHO representative from WONCA, this experience allowed me to witness first-hand the power of regional collaboration in addressing complex public health challenges.

The ministerial roundtable on building adolescent-responsive health systems was particularly impactful for me. Adolescents are often left behind in healthcare discussions, yet they represent the future of our region. The conversations reinforced the need to address their unique health challenges, especially mental health and reproductive health, with empathy and actionable policies.

The energy in the room was palpable from the opening session, where Mr. J. P. Nadda, Health Minister of India, assumed the role of Chairperson, with co-chairs from Bhutan and Timor-Leste. The presence of Ms. Saima Wazed, our Regional Director, added grace and dignity to the event, reinforcing the importance of strong leadership in fostering health diplomacy.

One of the most significant moments was the adoption of resolutions related to expanding the South-East Asia Regional Health Emergency Fund (SEARHEF) and enhancing universal health coverage (UHC). These are critical steps toward strengthening our region’s capacity to respond to emergencies and provide equitable healthcare access. The focus on sustainable financing also resonated deeply with me, as I believe financial resilience is fundamental for health systems to thrive.

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The meeting also highlighted progress in traditional medicine, vector-borne disease control, and mental health services. As someone passionate about the intersection of mental health and public health, I was encouraged by the collective commitment to the Paro Declaration on people-centered mental health care.

For me, a key takeaway was the growing emphasis on digital health and AI-driven solutions, which aligns with my vision for the future of healthcare. These innovations, when used responsibly, can revolutionize healthcare delivery and bridge gaps in access. I am excited about the opportunities this opens up for our region, and I look forward to working on these initiatives through WONCA’s eHealth Working Party and the Working party for Policy and Advocacy.

This session reaffirmed my belief that collaboration across borders, supported by strong leadership and sustainable policies, is essential to achieving health goals. I left the meeting inspired by the collective determination of member states and committed to contributing meaningfully toward a healthier and more resilient SouthEast Asia.

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FAMILY MEDICINE PARADIGMS IN INDIA: A STRATEGIC IMPERATIVE amily Medicine in India is rapidly evolving as an essential pillar of the nation's healthcare system. With its focus on comprehensive, continuous, and coordinated care, Family Medicine is uniquely positioned to address the diverse and complex health needs of India's vast and varied population. As the country faces an increasing burden of noncommunicable diseases (NCDs), mental health issues, and an aging population, the role of Family Medicine has never been more critical.

In recent positive developments, in 2019 the National Medical Commission (NMC) Act was passed by the Parliament of India, which mandated the inclusion of family medicine in the mainstream medical education system.

Also, the Government of India has written to state governments to incorporate family medicine programs within the National Health Mission. The government has also offered funds to start MD/DNB Family Medicine Training Programs and to train state medical officers in family medicine.

However, the integration of Family Medicine into the broader healthcare framework has been challenging. Despite its proven benefits, there remains a significant gap in the number of trained family physicians, as well as in the recognition and support for the specialty within the health system. This gap is particularly evident in rural and underserved areas where access to quality primary care is limited.

Against this backdrop, the WONCA South Asia Region (SAR) Family Medicine Conference in 2025 in India holds tremendous significance.

This conference will provide a platform for family physicians, healthcare policymakers, and stakeholders from across the region to come together and discuss the future of Family Medicine in South Asia. It will facilitate the exchange of best practices, innovative models of care, and strategies for overcoming challenges unique to the region.

It will also attract policymakers who could be influenced, leading to better integration of Family Medicine into healthcare policies.

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Hosting the WONCA SAR conference in India is not just a matter of prestige, but a strategic imperative. It will spotlight the country's commitment to strengthening primary care and provide an opportunity to showcase the advancements being made in Family Medicine. Moreover, it will serve as a catalyst for policy change, encouraging the government and health institutions to invest more in this crucial specialty.

In conclusion, the WONCA SAR Family Medicine Conference 2025 in India is poised to be a landmark event. It will not only reinforce the importance of Family Medicine in the region but also contribute significantly to the global discourse on primary care. By bringing together experts from across South Asia, this conference will help chart a course for a more robust, resilient, and equitable healthcare system in India and beyond.

DR ROSHNI JHAN GANGULY

Organising Secretary WONCA South Asia Region Conference 2025

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GERIATRICS TRAINING PROGRAM WONCA AGEING & HEALTH SIG The need for improved training and skills development in care of our older patients has been identified as one of the goals of the WONCA Ageing & Health SIG. Globally, within medical schools, training at both undergraduate and postgraduate levels in geriatrics is significantly lacking due to competing needs with other disciplines. We are happy to inform you that we are now able to offer an internationally accredited and certified e-learning program in geriatrics.

The courses will be developed for three main regions of the world; however, anyone from anywhere can participate in any course as the content is available for offline learning.

WONCA’s association with the IAGG FGE will allow us to provide substantial input into the topics to be presented, and for those of us who are experts in a particular field to be presenters, as well as opportunities for trainees or early-career doctors to present cases.

WONCA has entered into an agreement with the International Association of Gerontology and Geriatrics (IAGG) & Federation of Geriatric Education (FGE), who have for a number of years been offering the e-TRIGGER program. The online “E-TRaining In Gerontology & GERiatrics” (IAGG-FGE.org) is conducted over 12 months. The course is accredited by the European Accreditation Council for CME for 60 CEUs. The Health Professionals Council of South Africa, via the South African Academy of Family Physicians (the South African WONCA member organisation), has awarded the course 60 hours of CME credits. It is hoped that in other regions of the world, where accredited training is needed to maintain registration, the credits will be recognised.

The first course, which is in the Africa, Middle East & Europe Region, will commence on 26 September from 2PM – 5PM Paris time.

Below is an outline of the topics to be presented:

Fees for the course, as a member of the WONCA Ageing and Health SIG, have been substantially discounted with costs ranging from CHF 30 for doctors practicing in lowincome countries, CHF 60 for those practicing in middle-income countries, and CHF 120 for those from high-income countries. Residents, registrars, and trainees will be entitled to a further 50% discount on these fees, and a certain number of scholarships are available.

These fees are available to the first 10 applicants from the Ageing & Health SIG. To join the Ageing & Health SIG, please click here.

New generation of adults: September 26, 2024 Cardiovascular diseases: October 24, 2024 Neurology: November 21, 2024 Nutrition and metabolic disorders: December 19, 2024 Dementia: January 23, 2025 Mobility disorders: February 20, 2025 Long term care: March 20, 2025 Mental Health: April 20, 2025 Pulmonary diseases: May 22, 2025 Teamwork in geriatric medicine: June 20, 2025 End-of-life issues: July 24, 2025 Aging in a changing world: August 21, 2025

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To register for the course, please click here.

If you would like to apply for a scholarship or make further enquiries, please send an email to contact_iagg@hset.org, informing them that you are a member of WONCA.

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