Multi Country Study Visits


Multi Country Study Visit organised for the WHO headquarters in Geneva

November 2009

The European Forum for Primary Care has organized in close collaboration with the WHO (Geneva) a study visit to Ghent (Belgium) and London (the United Kingdom) for the WHO's Site-Based Learning Programme. The aim of the programme was to disseminate the principles of the World Health Report 2008: Primary Care Now More Than Ever by visiting "best practices" in primary care to WHO participants. Besides the exchange and dissemination of experience and knowledge the objectives of this activity were:
- To increase awareness of the participants about the importance of Community Oriented Primary Health Care.
- To strengthen local health care providers in their skills to implement a people-centred Primary Care approach.
- Demonstrate the principles of people-centred primary care in the appropriate health systems context, Community Oriented Primary Care
- To provide practical experiences on which case-studies can be based on

Details of the Programme
The main focus of the Site-Based Learning Programme was on people-centred primary care. The programme lasted six days, starting in Ghent on Sunday the 29th of November. During the week a total of ten participants visited primary care practices in Ghent and London. In Ghent the participants were hosted by the chairman of the EFPC, Prof. Dr. Jan De Maeseneer. In London Michael Sobanja, special advisor of the EFPC, gave an introduction into the primary health care system in the U.K. During the visits of the primary care practices, the participants did not only observe different activities in primary care, but participants were also able to interact with patients/ citizens. The programme ended in Belgium with a conclusion meeting in Brussels. For the detailed schedule of the programme click here.
To get an impression of the meeting with the Bromley by Bow Weight Management & Exercise Programme in London watch the videos.

Evaluation by the participants

The overall impression of the participants was that the length of the programme was in line with their expectations and what is feasible within their own work- responsibilities back home. From the perspective of the programme it was not possible to make it shorter as there is a need to get acquainted with the group and the subject which leads to a better understanding of the topic towards the end of the week.

The overall content was evaluated as good. The site visits have confronted the participants with interesting aspects of health system development and in particular for primary care. The experts involved were of high level and gave information that was new for the participants.

A gap in the programme was the lack of preparation before entering the Site Based Learning Programme (SBLP). The participants were not at all familiar with the principles of the WHR 2008 so did not know what they could expect from the programme content wise. The time allocated to present the key-principles was clearly insufficient and could only function as a rehearsal of information picked up already prior to the SBLP. In the normal set-up the SBLP will be part of a larger training framework where participants have already been confronted with the principles of the WHR 2008 through workshops and e-learning modules.

The introduction to the Belgian health care system and the position of Primary Care was a bit short and fast. This could have been more expanded, using time that was allocated to the presentation of the different research programmes that run at the University of Ghent. These presentations were too much in detail, where an overview would have been sufficient.
There might be a need to give more attention to the link of Primary Care with Secondary Care. Showing the working relations between Primary Care teams and hospital specialists.

The observation of consultations at the Botermarkt were evaluated as very valuable. A different set-up by having one person doing the consultations and another being in the conference room for commenting the consultations, could have facilitated the continuation of the programme. The involvement of other professionals within the practice visits would be an improvement of the programme. The visit to the other group practice was evaluated as interesting. The flexibility in providing those practice visits that are requested by the participants was welcomed very much.
The possibilities for discussion were limited due to fact that the programme was rather tight. Room for discussion can be increased by limiting the research presentations and limiting the round tour through the neighbourhood of Ledeberg.

In particularly the represnatatives of the NHS Alliance were praised about their clear presentation about the UK Primary Care system.
It would have been interesting to see and hear the practical involvement of the Primary Care Trusts (PCT's) in the whole system of Primary Care. It was clearly explained, even several times by NHS Alliance and within the site visits, and also the term commissioning was introduced but it would have been good to speak with somebody practising commissioning for a PCT.

The practice visits at the Caversham group, joining the professionals during their consultations with patients, were evaluated as very positive.
The practice visits in Bromley by Bow were limited by being introduced to several programmes running in the centre. Participants did not give a specific opinion about this part of the programme but the impression they gave was that this wasn't really applicable for them in their home country. The introduction of the weight management programme (see above for the video recording) was evaluated as best.
At the Caversham group there were many possibilities to discuss plenary or face to face issues concerning their system to provide Primary Care in Kentish Town. This was evaluated as very positive, in particularly the coffee break in the morning where participants could meet with professionals of the practice in a very open sphere. Tthe discussion with Dr. Iona Heath, president of the Royal College of General Practitioners, was much appreciated.

The conclusion meeting at the end of the programme was held on the Friday evening (which was more logic within the current programme) and was seen as helpful to evaluate and discuss the programme. The everyday feedback sessions were not evaluated very well as they had the impression that everything to be said had already said during the day and so the feedback session were overdone and making the day unnecessary long.