ICHPO Edinburgh 2013
Priorities for primary care in Europe: a
multi-disciplinary approach
Diederik Aarendonk
EFPC Coördinator
Created in 2005
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The European Forum for Primary Care
is situated at the NIVEL institute in the
Netherlands.
Multi-professional Advisory Board with
members from Belgium, UK, Italy,
Sweden, France, Slovenia, Turkey,
Norway, Greece, Portugal, Romania,
Hungary, Latvia, Spain, Macedonia,
Austria and the Netherlands.
Membership network
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Membership
(100 institutional & 50 individual members)
Members from the 3 levels: Policy, Research &
Practice
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Membership is multi-professional
The main objectives
• To provide information to and share the
information between the members
• Advocacy for Primary Care towards
policymakers and politicians
• Support to the development of research
and establishment of a research agenda
Why this Forum?
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Dissemination of expertise and knowledge on
Primary Care systems
Support to members for implementation
To show the key principles of the World Health
Report 2008: “Primary Health Care Now More
Than Ever”!!
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universal coverage (focus of the WHR 2010)
service delivery
public policy
leadership
And its relevance in relation to the WHO/Europe
emphasis on Health System initiated at the
Tallinn 2008 Ministerial conference on "Health
Systems, Health and Wealth”
Function of Primary Care in the
health care system
Navigation: “Tom Tom of the care”:
Searching for the appropriate level of care
that is needed:
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Encouraging informal care/self-care, when
possible
Providing care when needed,
Referring to medical specialist care when
necessary
Results of consultation by
GP / Primary Care team
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82 %:
9 %:
2 %:
2 %:
3 %:
treated by GP / Primary Care team
referral to specialist
X Ray
laboratory
therapy at secondary
care level
2 %: other
Demand & Supply
Population Health Management
Vulnerable elderly (65+) in
Almere-Haven
Expected demand for care:
Diabetes Mellitus (Wijkscan.com)
The patient perspective
as a starting point
for service delivery!
Includes the following values:
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Accessibility
Continuity of care
Coordination of care
Comprehensiveness of services
!! Integrated and Community Oriented
Primary Care including Interprofessional
Collaboration
Quality of primary care: messages for
the third millenium
Problem versus goal oriented care
o Absence of disease as defined by the health care
system versus Maximum desirable and
achievable quality and/or quantity of life as
defined by each individual
o Eradication of disease , prevention of death
versus assistance in achieving a maximum
individual health potential
Resulting in the need for patient/client/citizen
orientation and involvement
and even one step further:
 Patient/client/citizen involvement in the set-up of
Primary Care provision
Quality of primary care: messages for
the third millenium
Community Oriented Primary Care
Organisational developments
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Multiprofessional teams: integration of care is more easy.
Integrated
Population based
Healthcare
Organisations
Multi
professional
healthcare
centre
Mono
professional
care
organisation
Solists
Clinical leadership and
Operational management
More care
standards
Selfmanagement
and prevention
Scope of integrated
care
Soloist
Caregroups
Caregroups
Small
group
Anno 2011
with
extra’s
practice
Primary Care
organisations
that deliver
integrated
care
Big Primary Care
organisations
that deliver
integrated care
with backoffice
Primary Care centres
in the south of the Netherlands
are uniting
Ref: Teamwork in primary care: perspectives of general practitioners and community nurses in
Lithuania; Jaruseviciene et al. BMC Family Practice 2013, 14:118
Activities of the Forum:
• Alliance of Community Oriented Primary Care
services (ACOPC) as a Working Group of the EFPC
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Members:
• Catalonia
• Walloon
• Flanders
• Netherlands
• UK
• Portugal
• France
Core member of the International federation of
Community Health Centres (IFCHC)
Improving health and primary health
care around the world
through Community Health Centres
Learn more at: www.ifchc2013.org
Objectives
The core goals of the IFCHC are
• to foster global collaboration in communityoriented primary health care and
• to expand access to Community Health
Centres as the optimal way to achieve the
World Health Organization’s vision for
equitable access to primary health care for all.
Global Partners
• Canadian Association of Community Health
Centres
• Twitter: @CACHC_ACCSC
• Community Health Australia
• Twitter: @CHCAustralia
• European Forum for Primary Care
• Twitter: @PrimaryCare4um
• US National Association of Community Health
Centers
• Twitter: @NACHC
Primary care developments in Europe
At policy making level
Page 6: "Also in the context of the demographic challenges
and the pressure on age-related expenditure, reforms of
healthcare systems should be undertaken to ensure
cost-effectiveness and sustainability, assessing the
performance of these systems against the twin aim of a
more efficient use of public resources and access to high
quality healthcare."
Annual Growth Survey 2013; Communication from the
Commission; Brussels, 28.11.2012, COM(2012) 750 final
Investing in sustainable health systems combines
innovative reforms aimed at improving costefficiency
and reconciling fiscal consolidation targets with the
continued provision of sufficient levels of public services.
Page 5: "using financial incentives to encourage patients to
register with a general practitioner (GP) or family doctor
and using a referral system to define a cost-effective
path of care: from GP, to outpatient specialist, to
hospital, to emergency care, while encouraging patients
to have less recourse to unnecessary care and
emergency services"
Suggested measures for Investing in Sustainable Health
Systems two clear recommendations for Member States:
• Reducing the unnecessary use of specialists and hospital
care
• Improving primary healthcare services
“Investing in Health - Key Messages”, ; European Commission,
DG Health and Consumers; February 2013
“Efficiency gains can be made by, for example, reducing
unnecessary hospitalization and use of specialists,
strengthening primary care, encouraging the use of less
expensive equivalent (generic) drugs, and using health
technology assessment to evaluate the cost-effectiveness
of health technologies as a basis for decision making.”
“Investment in Health a priority in the Social Investment Package”
by Ms Paola Testori Coggi, Director General for Health and
Consumers, European Commission; Health-EU newsletter 106
Health 2020 –reaching higher and broader:
• Going upstream to address root causes such as social
determinants
• Invest in public health, primary care, health protection and
promotion, and disease prevention
• Making the case for whole-of-government and whole-ofsociety approaches
• Offering a framework for integrated and coherent
interventions
Health 2020: a new European policy framework for health and
well-being; Zsuzsanna Jakab, WHO Regional Director for
Europe, 20 March 2013, Riga, Latvia
Prof Alan Maynard, University of York:
“the re-distribution of income & power of Health
Professionals is key to create solutions for the future”
Representatives from Greek and Irish ministries of health:
emphasizing the need to invest in Primary Care.
Observatory:
Accessibility of vulnerable groups is key, Primary Care is
key!
WHO Oslo conference 17-18 April 2013, Health Systems in Times
of Global Economic Crisis
Primary care was associated with better population health;
lower rates of unnecessary hospitalizations; and
relatively lower socioeconomic inequality,
Overall health expenditures were higher in countries with
stronger primary care structures, perhaps because
maintaining strong primary care structures is costly and
promotes developments such as decentralization of
services delivery.
Comprehensive primary care was also associated with
slower growth in health care spending.
Evidence grows that strong primary care in Europe is
conducive to reaching important health system goals.
Europe’s Strong Primary Care Systems Are Linked To Better
Population Health, But Also To Higher Health Spending.
Kringos DS, Boerma WGW, Van der Zee J, Groenewegen PP;
doi: 10.1377/hlthaff.2012.1242 Health Affairs April 2013 vol.
32 no. 4, pp. 686-694.
Page 67: “There is some evidence that Quality and
Outcomes Framework has not resulted in better access
to care or interpersonal elements of care, may have
negative effect on inequalities as it encourages linear
care pathways and a ‘one solution fits all’ approach, and
is not sufficiently responsive to local needs. It has also
tended to measure treatment procedures rather than
clinical outcomes. It seems that QOF may have reduced
inequalities in measured outputs, but this has not
translated into a reduction of inequalities in the health
outcomes experienced by patients.”
Working for Health Equity: The Role of Health Professionals
Matilda Allen, Jessica Allen, Sue Hogarth and Michael Marmot;
UCL Institute of Health Equity, Department of Epidemiology &
Public Health, University College London; March 2013
Conclusion (1):
Europe is a natural laboratory for learning about health
policies and health systems.
With diverse systems to finance, provide, and govern
health care across the 27 member states of the
European Union and the wider European region there are
many opportunities for international comparative
analyses and natural experiments.
Health systems and policy research in Europe: Horizon 2020
Kieran Walshe, Martin McKee, Mark McCarthy, Peter
Groenewegen, Johan Hansen, Josep Figueras, Walter Ricciardi
The Lancet, Early Online Publication, 18 March 2013
Conclusion (2):
In this respect Primary Care gets a lot of attention and is
seen by Policy Makers as well as Researchers as an area
with enormous potential.
It is up to the Primary Care professionals to make the case
In order to achieve this, the different professional groups
should share their interests and strive together for a
strong Primary Care movement!
European Forum for Primary Care!
www.euprimarycare.org
Activities of the Forum:
• Website & Two weekly Newsflash
• Position Papers in development
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PC and Interprofessional Education
Impact of continuity on quality of care within
Primary Care – the perspective of preferences of citizens
• Conferences/workshops
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"Balancing the Primary Care and Secondary Care
provision for more integration and better health
outcomes!“ 9/10 September 2013 Istanbul, Turkey
Barcelona, 1/2 Sept 2014, 5th EFPC biannual conf.
• Advocacy (EU, National Governments, WHO)
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EC Expert Panel on effective ways of investing in health
EC Consultations on Health topics like NCD’s & aging
• Multi Country Study Visits
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Visits to Primary Care innovations based on WHR ‘08
Advocacy
(EU)
European Commission Expert Panel on
effective ways of investing in health
• EFPC Chairman Prof Jan De Maeseneer member of
the expert panel
• Mandate 2: Definition of a frame of reference in
relation to primary care with a special emphasis on
financing systems and referral systems
1. Provide a definition of primary healthcare and
community-based care
2. Identify main investigation lines to analyze financing
of primary care and integrated care
3. Pronounce itself on the role of effective referral
systems in ensuring integration between all levels of
the health system and provision of best possible
care closest to home.
Advocacy
(EU)
European Commission Consultations on Health
topics like NCD’s & aging in the framework of
Healthy Aging
• EU project ProFouND is to embed evidence based fall
prevention programs for senior citizens at risk of falls
by using effective training programs and ICT-support
solutions in as many countries in Europe
www.profound.eu.com
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EFPC invited to EU-level stakeholder group to
provide multi-professional Primary Care expertise
The Future of Primary Care in Europe V
“Twinning Population Health and
Primary Care”
V bi-annual EFPC conference
1/2 September
EFPC at the Web
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www.euprimarycare.org
Webbased database on European Primary Care
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LinkedIn discussion group “Primary Care
Forum” Currently 3500 members from all
over the world
Twitter: (@PrimaryCare4um) 570 followers,
rapidly growing
Facebook-page: Primary Care Forum