Domhnall MacAuley on WONCA Part II

Domhnall MacauleyThe picture screamed at me. It was of a ragged traveller child playing by a caravan at a halting site strewn with rubbish. It could have been from our practice. To travel half way around the world and be confronted by the failures of our local health care was humbling and embarrassing.  Millennium Development Goals, the theme of this WONCA conference begin at home. In her keynote address on children’s health, Catherine Law (UCL Institute of Child Health) focused on data from the UK, which might have been of limited relevance to the international audience but, she highlighted problems of importance to many developed countries: obesity, mental health, and injury. She emphasised the social class gradient., the long term sequelae and, how many of the social disadvantages are linked. The most striking message for me was the clustering of adversity. Some children have little chance.

Molecular biologists have dominated cancer care medicine but, as Frede Olesen (Univ Aarhus, Denmark) pointed out at the inaugural meeting of a special interest group that took place at the conference, cancer societies are increasingly looking to partnerships with primary care. His colleague Peter Vedsted (Univ Aarhus, Denmark) supplied the figures indicating a lifetime cancer risk of 35% and how, by 2020, there will be a 20% increase in cancer simply because of the demographics. With cancer, 90% present with symptoms first in primary care and 80% are cared for in primary care. But, it was not all positive news. One of the audience asked, in response to some of the data presented, why those patients with a personal doctor in a list system seemed to have worse outcomes. It may be, Frede Olesen responded, that a personal and close relationship with a doctor could inhibit patients presenting early, for fear of wasting their doctors time.

As cancer care integrates more with primary care, it will uncover more new and unanticipated challenges. Supportive and palliative care is likely to be a huge growth area in health care provision and the BMJ is particularly interested in attracting high quality research and educational articles, partner academic meetings and, indeed, is due to launch a new palliative care journal in Spring 2011.

Barbara Starfield gave the last keynote of the conference. It was a fitting “call to arms” for primary care. In her data rich tour de force she reinforced the message that primary care can help control costs and provide quality evidence based care. She was, of course, speaking to the converted and it is probably more important to spread her message outside this GP community. But, I was intrigued when she pointed out that, the more you educate generalists, the more likely they are to refer to specialists. It seemed counterintuitive to suggest that education could be harmful. But, she qualified it by emphasising the need to educate in managing multiple morbidity. It sounded right at the time but I am not quite sure how it might work.

There was something missing at this WONCA meeting: no pharma sponsorship, trade stands or marketing. It was the first international conference I have attended without pharma involvement and the announcement was applauded by the delegates. What a triumph. Congratulations to Wonca and the host organising committee. There were many positive aspects of WONCA 2010, but to run a conference without the potential for compromise, is indeed a precedent. And, a remarkable achievement.

Domhnall MacAuley is primary care editor, BMJ