Policy bite: Member organisations – building and valuing their role

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Amanda Howe, WONCA President writes:

After a busy period for WONCA, I spent most of June in the UK, reacquainting myself with my university, patients, and family. The days were long, and the news was bad – including the state of the National Health Service (NHS), where much discussion ranged over the sustainability of what has been a wonderful model of care for 70 years.

The NHS is a taxation based system, with care being free at the point of use, and a comprehensive primary care service based on patient registration. It provides universal health coverage that is accessible, affordable, covering a full range of preventive, as well as curative and ongoing care across the life range.

The problems have arisen in three areas – the first is reduced funding from the government with the introduction of an ‘internal market’ model. This has had very variable success in raising alternative funding, and much time being spent on entrepreneurial and managerial aspects rather than clinical care. There is also instability in the workforce, particularly in rural and disadvantaged urban areas; and the service is struggling to meet the increasing needs of an ageing population, especially because funding has also been reduced in the social care sector.
The GP workforce has been particularly hardhit, with the historical model of small business ownership proving difficult to sustain, as younger doctors often do not want the commitment of buying into a practice. Vacancies exist all over the UK, and the speciality has dipped in popularity.

I mention this in this policy bite, because this situation is replicated in many countries I now know. All family doctors need to be alert throughout their careers to how best to foresee and forestall the recurrent problems of underinvestment in primary health care; and specifically in our speciality. This is not something we can deliver as am individual doctor, and is one of the reasons we need a professional organisation which can influence these things at a national level.

Our UK member, the Royal College of GPs, has been valiantly championing family doctors in their efforts to secure a better situation. Their GP Forward View campaign has won ministerial attention with a five year plan for reinvestment, though big challenges still remain to secure delivery on these political promises. In recent years the RCGP has also asked for a campaign to improve the career image of general practice in medical schools (see the ‘By Choice not by Chance’ report, chaired by our own WONCA Working Party on Education chair, Prof Val Wass). They have contributed expert input to efforts to plan the workforce, and stop the uncontrolled number of hospital specialist post expansions; and also tried to ensure that the training and standard of family doctors is supported across their working lifetime.

At our Warsaw executive, Dr Henry Lawson, the Africa region President, reminded us of a document written by Prof Michael Kidd (WONCA Immediate Past President) on the role of professional member organisations (MOs) – this includes support, political influence, standard setting, leadership of new initiatives for benefit of members and their patients, and providing education and evidence base. Building such an organisation has inevitable challenges, including decisions on eligibility for membership, and governance and finance decisions which underpin the ongoing function of the MO. The early years of an MO usually see a few visionary and committed people come together to create a new body, but the maturing group will need structures that address these different challenges – supporting members in their careers, leading speciality training and accreditation, academic leadership, and political leadership.

This is what WONCA does with and through its MOs. This is what is needed in all health services – a strong and credible professional voice for family doctors, that is heard by governments, funders, and other health professionals – and that is valued and supported by the impacts we have on our patients’ health and lives.

Thank you to all our member organisations for your hard work.