Presidents' Letter - History of FM/GP in Europe and WONCA Europe

History depends on how you write, and how much you are able to include. It is said to be written by survivors. I made it in a chronological order without any comment. I know that we need our history especially when teaching residents. Moreover in order to have a future you need to know where you are coming from.

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Leaders of the GP/FM Organizations in Europe since 1959:

Presidents of Societas Internationalis Medicinae Generalis (SIMG), European Society of GP/FM (ESGP/FM) and finally WONCA-Europe since 1995.

1961-1970 DR. DR. FRITZ GEIGER
1988-1991 DR. LOTTE NEWMAN O.B.E
1994-1995 DR. FONS SIPS
2004-2010 PROF. DR. IGOR SVAB
2010-2013 DR. TONY MATHIE
2016-2019 DR. ANNA STAVDAL

In 1995 the organization became a region in WONCA, and was renamed as WONCA Europe. The names of all Presidents since 1959 are on the medallion of the president which is transferred in between the Presidents during the handover ceremony. Let's have a look at GP/FM history in WHO region Europe.

Back to 70 years

Infant mortality, maternal mortality, short life expectancy, communicable diseases and environmental problems were those major topics and were the agenda for research in general medicine, Minor talks but no idea about family medicine and its content. Very little research on the importance of primary care, no idea of patient rights, gender balance, equity. Starting to describe the need for a skilled-equipped physician type. No academic family medicine in practice anywhere. No international FM/GP organization, a few local, weak national activities driven by other disciplines and unfortunately quite some by the industry. Public Health (PH)-FM/GP integration is not existing, borders, role definitions were not set, PH suppressed development of the academic FM.

Back to ancient times in Europe;

460-377 BC. Schools of Medicine (Asclepion) in Kos (Istankoy) & in Knidos (Datca). The “generalist” and “specialist” approaches were born in a 7 miles diameter special and beautiful area in the southern east edge of modern Greece (Kos) and in the south-west edge of Anatolia, Asia minor, modern Turkey (Datca) which is one of those favorite areas of many touristic sailors in Mediterranean Sea today.
School of Hippocrates  is the oldest in history for the “generalist” approach in medicine. Knowing your own history is mostly useful for shaping a better future. Although WONCA Europe is a 25 years old young adult, our discipline has a history more than all specialties, and we have a future to live probably more than all. These two schools are clearly at the origin of the (prevailing) biological and biopsychosocial models. In KOS the doctors were approaching the patient while in Knidos to the diseases and organs.

Milestones of Family Medicine/General Practice in Europe

11th century medical schools appear in modern Italy Bologna, France Montpellier, and London. The 18th century, between the French and Industrial Revolutions, the term “family doctor” (médico de cabecera): a practitioner providing care in the patient’s home by standing at the head (cabecera) of the patient’s bed or vaccinating or treating nails. This term was thus associated with that of “general practitioner”. Rare books, light of science, were coming from the east at that time. Avicenna’ El-Kanun fi't-Tıb/Canon medicinae, was there in 1021 and has been a textbook 400 YEARS in medical education/ in Europe. The 19th century in America and Europe was the “age of the general practitioner”: a key professional for individuals, families and the community.

20th century GP declined, medical specialities inclined in medical schools. Majority of the physicians were specialists unlike before.

  • 1910 - Flexner report in USA changed medical education (milestone for medical education, prevention & PH)
  • 1911 - UK, “panel system” working men could choose a GP from a "panel" of local doctors, free, government funded health care. Almost first health coverege..
  • 1923 - Francis Peabody (over specialization and need for FDs)
  • 1947 - Foundation of American Academy of General Practice as the first scientific society of family physicians, influenced the world & Europe
  • 1947 - 1955 General Medicine Speciality Program in Turkey, 1961 - Reform in Health, GP definition & tasks  by a Law, 1963 GP is a team leader in TR,
  • 1948 - Foundation of NHS in the UK
  • 1952 - Foundation of RCGP
  • 1959 - the "Societas  Internationalis  Medicinae  Generalis", Vienna, European 1st GP  organisation.
  • 1960 - The speciality of Family Medicine appeared in the 1960s and spread to various countries in the 1970s
  • 1960 - (Former) Yugoslavia, Vocational training was successful, and still has a very strong tradition in countries separated from each other.
  • 1961 - Reform in Health in some countries, in Turkey the GP definition & tasks defined  by a Law,
  • 1961 - The Ecology of Medical Care in NEJM (by White at al; organization of health care, medical education, and research)
  • 1963 - Edinburgh, Scotland –first ever “GP related department chair” in Europe., Prof R. Scott
  • 1963 - GP is a team leader in Turkey in PHC teams actively working all around country
  • 1965 - 1st report on Vocational training in RCGP, 1977 Parliament approved, 1982 started
  • 1966 - Millis, Folsom & Willard Reports-concerns on rapid decline in nr of GPs, a  fragmentation, an authority division)
  • 1967 -  UEMO (in 2009 had an official status)
  • 1969 - Recognition of Family Medicine Specialization in the USA, a wind came to Europe.
  • 1969 - Foundation of American Board of Family Medicine
  • 1971 -  European General Practice “Research” Workshop (EGPRW) 1974 bylaws change.
  • 1972 -  WONCA first “Global” GP/FM Society began “officially” at the 5th World Conference on GP in “Melbourne” !
  • 1974 -  Leeuwenhorst (The Definition clearly described the tasks)
  • 1978 -  The WHO (Alma-Ata, 1978) defines PHC as the preferred area of work of FPs in “teams” and for a “specific community”.
  • 1979 - UK Mandatory GP training 2 years hospital and 1 year training with a certified GP trainer
  • 1986 - EC made specific training for GP/FM mandatory in all member states
  • 1987 - ICPC (International Classification of Primary Care) was published as a tool to order the domain of family practice.
  • 1991 - EQUIP (Quality)- later WONCA Europe Network
  • 1991 - Publication date of the registration for EJGP as the journal of the Dutch College
  • 1992 - EURACT (Education-Academicians), later WONCA Europe Network
  • 1992 - 1st WONCA Europe Conference, Barcelona Spain
  • 1993 - Directive 93/16/EEC defined “minimal acceptable length” of specific training in FM/GP !
  • 1994 - Ontario Conference WHO/WONCA working paper making medical education and medical practice more relevant to people's needs; the Contribution of the Family Doctor by WONCA !
  • 1995 - EJGP, the official journal of WONCA Europe
  • 1995 - EUROPREV - Network of WONCA Europe
  • 1995 - WONCA Region Europe-ESGP/FM European Society of General Practice/Family Medicine  (WONCA Europe) Sociedad Europea de Medicina de Familia (SEMF), Strasbourg, France, EU Parliament, Bylaws approved Jun 1995; By laws most recently amended Oct 2015, Istanbul (Turkey). Stichting WONCA Europe founded 2007, as a legal entity registered in accordance with Dutch law
  • 1997 - EURIPA Network of WONCA Europe.
  • 1998 - ICPC Coding system an international standard presentation, was published by the WONCA, maintained by the Wonca International Classification Committee (WICC), of which the author has been a member since 1998. It has been translated in 22 languages, accepted by the World Health Organization (WHO) as a member of the Family of International Classifications (WHO/FIC), widely used for the routine collection of data on EoC (The Netherlands, Japan, Poland, Malta, Serbia) and also in encounter studies (Australia, Norway, Denmark, The Netherlands), and it is now supported by large empirical databases.
  • 1998 - “Memorandum of Understanding” for Collaborative Activities for the period 1998 - 2001' between Wonca and WHO was formulated by signed by Charles Boelen
  • 1999 - First Joint meeting of WONCA Europe Networks EGPRW, EQuiP & EURACT in Majorca and second in Tampere 2001.
  • 2002 - WONCA EUROPE declaration in Noordwijk (NL) in March 2002. A consent declaration described both theFM/GP discipline and occupational duties as well as the core competencies required by family physicians. The Family Physician Tree, published by WONCA, identified 12 central characteristics that define discipline, that is, 12 abilities that every specialist family doctor needed to master, revised 2005, 2011 by (EURACT).
  • 2003 - EGPRW; with a bylaws change the name changed from Workshop EGPRW (W) to EGPRN (N) Network in  Ankara..
  • 2004 - Vasco da Gama Movement- VdGM Network
  • 2005 -  European Educational Agenda- WONCA Europe (by Euract)
  • 2005 - European Primary Care Forum (EFPC)
  • 2005 - Directive 2005/36/CE article 28 & Annex 5.1.4, minimum 3 years, 6 months at least in PC, at least 50% practice in GP.
  • 2010 - The Research Agenda for GP/FM and PHC in Europe-WONCA Europe (by EGPRN)
  • 2010 - The EJGP is registered officially to WONCA Europe (Journal passed to WONCA Europe from the Dutch College registered for Benelux countries )
  • 2012 - The EJGP accepted for inclusion in the Science Citation Index Expanded and Current Contents/Clinical Medicine, beginning with the first issue of 2009. The journal was listed in the 2011 Journal Citation Reports with an Impact Factor. ans became the fourteenth journal in the new subject category ‘Primary health care’. 2019 IP became considerably high, above 2.4.
  • 2015 - VdGM is 6th  Network of WONCA Europe, and 4th NW having a seat in WE Executive, the bylaws changed in Istanbul.
  • 2018 - WONCA signed a MoU again (after 1998) with the WHO for collaboration, and WONCA is a NSA.
  • 2018 - European Training Requirements for GP/FM specialist training (EURACT)
  • 2019 - European Teaching Agenda on Quality and Safety in FM-WONCA-Europe  (EQuiP&EURACT)
  • 2020 - First full virtual conference for a WONCA Region, Europe  organized by DEGAM