European General Practice Research Network (EGPRN)Abstracts from the EGPRN meeting in Leipzig, Germany, 12-16 October 2016. Theme: 'General practice/family medicine in a changing world'.

Introduction to the theme ‘General practice/family medicine in a changing world’

Societies and healthcare systems in Europe are facing many changes: ageing, migration, increasing morbidity, shortage of financial resources. All these changes will influence the future care and research in general practice.

The ‘theme’ contributions are related with the following subtopics:

General practice in a changing world (e.g. shortage of GPs, changing practice management)

Innovations for future care and research (e.g. ambient assisted living, European networking)

Primary care for patients suffering from chronic diseases

The international development of professional and academic general practice

The education and support of future general practitioners by innovative solutions

Nowadays health systems are confronted with important challenges: there is the demographical and epidemiological transition: with an important increase of multimorbidity. There are the scientific and technological developments and especially the increasing impact of ICT in care. There are important cultural developments, presenting a new type of ‘patient’ (active, informed and critical). There is an increasing social health gap, caused by social determinants of health. All these global problems are present in the waiting room of the provider at the primary care level. These challenges require new types of questions. The components of primary care can be organized around the following clusters: proactive or pre-care; reactive care; chronic care; community/population-oriented care and health system components of primary care. For each of these clusters, we can formulate relevant research questions at the nano-, micro-, meso-, and macro-level.

Four dimensions may guide the conceptual basis of our research:

Equity: e.g. research on access to care, including access to innovative care; financial accessibility; cultural accessibility;

Quality: looking at structure-process and outcome, and evaluating the ‘medical/technical evidence’, the ‘contextual evidence’ and the ‘policy evidence’. Importantly, especially in the context of multimorbidity, our research requires a paradigm-shift from disease-oriented care, towards goal-oriented care to assess to what extent our interventions contribute to the achievement of the individual goals of the patient regarding quantity and quality of life;

Cost-effectiveness: with a focus not only on ‘cost-reduction’ but on the creation of ‘added value’;

Sustainability: the ‘sustainable development goals’ invite us to take an intersectoral look at health, involving welfare, work and education. The study of ‘community oriented primary care’ (COPC) and its contribution to ‘social cohesion’ is one of the strategies to look at ‘sustainability’.

From these research dimensions, a magnitude of research designs can be developed. Nowadays, we need to look at key concepts that contribute to innovative care: interprofessional cooperation, the concept of ‘social accountability’, the relevance of the care (‘does care matter for the patient/population?’), the contribution of care to social justice.

That kind of research projects, continuously developed in interaction with the populations we serve, will help general practice/primary care to contribute to health systems based on relevance, equity, quality, person- and people-centeredness, sustainability and innovation.

On Saturday 15 October 2016, Prof Joachim Szecsenyi was the national keynote speaker at the 83th meeting of the EGPRN in Leipzig, Germany. He introduced the audience into the German healthcare system and current developments and challenges of the academic general practice in Germany. With this short paper, we want to report and comment this keynote session.

After a brief introduction into the German healthcare system (mandatory insurance, direct access to GPs and specialists, payment fee for service), Szecsenyi underlined the high workload of German GPs compared to other countries. On average, Koch et al., found a weekly work time of 51 hours and 243 patient contacts per week [1].

As a challenge of particular importance, he described current problems to maintain a sufficient GP workforce against the background of significant recruitment problems in general practice and an ageing population with increased demands on primary care supply [2,3]. There has been a dramatic shift in the GP–specialist ratio in the German ambulatory care in the last two decades. While the number of specialists increased by 57% between 1993 and 2012, the number of GPs decreased by 10% [4].

Subsequently, the role of the academic departments in strengthening general practice was emphasized. As a positive achievement of the last years it can be stated that, although funding is still insufficient in many cases, nearly every German medical faculty has a department or institute for general practice. The research output increased dramatically from 2000 to 2010 [5]. Furthermore, the GP associations are growing (e.g. German College of GPs (DEGAM)) and there is an increasing number of community-based GPs involved in innovative teaching and research. According to Szecsenyi, the current key tasks of the academic departments are attracting young physicians to the specialty, doing research on the core problems of the profession (e.g. reasons for encounter, prevention, chronic and end of life care, multimorbidity, prescribing, polypharmacy, patient safety, quality of care, shared decision making, risk communication, etc.); developing and evaluating new models of care (e.g. task shifting to assistants), and developing guidelines.

To attract upcoming physicians to general practice he recommended innovative teaching concepts, a longitudinal curriculum beginning with matriculation, less ‘badmouthing’ from colleagues, and community-based clerkships. In this context, he referred to an ongoing political debate in Germany on a mandatory three-month period in general practice during the last study year as well as mandatory final exams. Regarding the five-year vocational training after graduation, he emphasized the need for a well-structured and centrally organized pathway led by academic departments of general practice. Due to the success of Szecsenyi’s project ‘Verbundweiterbildung plus’ in Baden-Württemberg [6], in Germany the establishment of so-called ‘general practice competency centres’ on the level of the federal states is discussed.

Regarding the improvement of the patient care, Szecsenyi pointed out that there is still a lack of sound data and studies evaluating the effects of the special disease management programmes for patients with chronic diseases, which have been embedded in the German healthcare system in 2002 by federal law. As important concepts that might help to improve the care for patients with chronic diseases shortly, he highlighted the potential of telemedicine and regionally integrated medical care networks. Looking further ahead, the fields of ambient assisted living devices, nursing robots, and linked information systems in healthcare were identified as promising.

The keynote ended with a humorous reference to Star Trek and the comforting knowledge that even on a high-tech starship exploring strange new worlds a GP will be needed.