" The key challenge that impacts on all the others is Workload, Workforce Capacity, Work Conditions”. An interview with Andree Rochfort, EQuiP’s chair
Next years’ 2025 EQuiP conference in Linz, Austria will complete the final pillar, focussing on telemedicine, AI and ICT in delivery of quality primary care
Assistant Professor Dr Andrée Rochfort is a GP with over 30 years clinical experience as a family doctor. She is a staff member of the Irish College of GPs, as Director of Quality Improvement, Health & Well-being.
She is the President of the European Society for Quality and Safety in Family Medicine, EQUIP, the network for quality and safety in WONCA Europe www.qualityfamilymedicine.eu .
Andrée is passionate about EQuiP projects on Planetary Health & Sustainable Healthcare, Digitalisation and Professional Health. She believes these topics are key to the future of primary care because we can utilise them to address persistently increasing workloads and a finite workforce capacity.
Andrée is a Board member of the European Lifestyle Medicine Organisation, a founding member of the European Association for Physician Health, founding member of the Sustainability Working Group of the Irish College of General Practitioners and a founding member of the Irish Society of Lifestyle Medicine.
She has qualifications in medical education, occupational medicine, and lifestyle medicine. She has a Professional Diploma in Leadership and Management.
She is an author of articles in peer reviewed journals, book chapters and a medical textbook editor. When her children were younger, she was a football manager, and mentor, and is proud to have helped the teenage teams win two county titles and one national championship title.
We wanted to sit down with Andree to know more about EQUIP’s activities and her thoughts about sustainability, planetary health and professional health.
How would you introduce EQuiP, the European Society for Quality and Safety in Family Practice to our readers?
EQUIP is the European Association for Quality and Safety in the WONCA Europe Region. It is one of the six WONCA Europe Network Organisations, with a remit for Quality and Safety. It was established in 1991. Until recent years, membership was restricted to a maximum of two GPs per country, nominated by their national college or society of GPs in WONCA Europe. These national representatives now make up the Council members of EQUIP, the decision-making body in the organisation.
We have introduced two new categories of membership - open membership so that anyone with an interest or experience in quality care can join as an individual member such as non-medical experts in healthcare quality, researchers, GPs and other medical doctors. The other category is institutional membership such as university departments, organisations interested in collaborative projects and promotion of quality and safety innovations, clinical initiatives, research and education, and of course national WONCA Europe GP member organisations. The EQuiP website has information on how to join this vibrant group of individuals and organisations www.qualityfamilymedicine.eu
**Invitation**
On behalf of EQuiP I would like to extend a warm invitation to new members to join even for one year and to experience the collegiality of meeting like-minded colleagues who have a common interest - finding better ways of doing things – the art of quality improvement!
People find it difficult to describe what quality healthcare is, how would you describe it?
You are right, perceptions of quality healthcare vary a lot, and are also influenced by whether people are providing healthcare or receiving health care. Quality healthcare is defined internationally in terms its multiple dimensions, as being healthcare that is effective, safe, accessible in a timely way, equitable, person-centered, integrated and efficient. Being efficient includes making efficient use of whatever resources are available.
Quality of care reflects the ability of health services to influence the possibility of desired health outcomes for individuals and for patient populations. It is an evidence-based activity and is part of the requirement for achieving universal health coverage. EQUIP endorses quality improvement as a professional responsibility. Whatever the concept of quality of care means to people in terms of best outcomes, the experience of the process of care is a critical component. The human interaction, and care received from other humans is at the core of care quality.
Efficiency as a dimension of quality, or as a tool through which we deliver quality of care, introduces the concept of healthcare sustainability, and the ability to meet demand with supply of health services while cognisant of the finite resources of funding, staffing, healthcare facilities and services such as diagnostics, medications and procedures. These healthcare resources must be managed in every system. Digitalisation of healthcare can help to improve efficiencies, however, uploading clinical data takes time away from face-to-face patient care. Input from patients and professionals needs to be part of designing better quality services.
https://www.who.int/health-topics/quality-of-care#tab=tab_1
I am passionate about these intersecting areas of Sustainable Healthcare, Digitalisation and Professional Health, because I see them as interconnected in delivering quality improvement with finite resources and in supporting the primary care workforce.
Tell us about the EQuiP conferences and if you link with other WONCA Europe groups.
EQuiP members meet in-person twice a year in a spring EQUIP conference open to all through abstract submission, and an autumn invitation-only closed conference during which projects and working groups develop their outputs and explore new proposals, and prepare presentations for the following spring conference. Friendships and working relationships are part of the joy meeting up.
Each spring the EQUIP delegates have the possibility to host a conference in their own country on a relevant theme, with the support of their member organisation, university or health service. In 2023 we were supported by the Irish College of GPs who hosted the first in-person EQuiP conference after the pandemic, with the theme of a Spotlight on Quality in Europe, giving members an opportunity to showcase their current activities. In 2024 the Belgian members hosted the conference in Ghent, supported by Domus Medica and Ghent University. The health service managers there are exploring population health approaches in primary care, so the theme chosen was the synergy between public health and primary care. In May 2025 the EQuiP conference will be hosted by our members in Linz University in Austria, and the theme chosen is Telemedicine and AI in the future of FM/GP. In 2026 we will host our conference in Krakow in Poland.
EQuiP connecting with other WONCA Europe groups
EQuiP members also enjoy excellent working relationships with members of the other WONCA Europe Networks. Many of our members have dual membership of other networks, and projects. EQuiP communicates with the WONCA Europe SIGs and other primary care organisations https://www.woncaeurope.org/page/special-interest-groups. For example, in 2023 a new Policy and Advocacy Working Group was established by WONCA Europe and its Executive members are the Presidents and Chairs of the Networks. In May 2024 I did a keynote on implementing Planetary Health at the IPCRG World congress. EQuiP has a good working relationship with the WONCA World Working Party on Quality and Safety (WWPQS) and contribute to the outputs and to representation to the WHO Global Patient Safety Network.
EQuiP strongly believes in the power of collaboration with the other networks. In the past year alone, our members have spoken at conferences of EYFDM, EGPRN, EUROPREV and EURACT. Along with EURIPA we had a symposium at Le CMG the French National Congress which was attended by over 4,000 GPs. The Presidents of EGPRN and EURIPA attended the most recent EQUIP conference along with the past president of EYFDM.
What are your aims for the next years?
As president of EQUIP I am in the final year of my term. I am lucky to have achieved most of what I have set out in my work plan, with a final aim to be achieved in Q2 2025. First, in 2022 we established the new EQUIP website and conference platform to support members with an electronic membership process, and for hosting conferences. We plan to expand the features of the website further in 2024 by featuring member profiles and quality activities, and improve member communications to enhance collaborative work between individuals and organisations, and to help us continue to develop and showcase expertise of the EQUIP membership.
In terms of academic work, I am proud to have enabled two key topics with an increasing role in quality improvement to have featured in each EQUIP conference during my term as President – sustainability & planetary health and professional health. Next years’ 2025 EQuiP conference in Linz, Austria will complete the final pillar, focussing on telemedicine, AI and ICT in delivery of quality primary care. Is it possible for eHealth to improve healthcare quality and safety? Can it improve job satisfaction, health and well-being for the GP/FM workforce? Can it make primary healthcare more sustainable?
A final task before the end of my term is to see the election of the next President, to bring new skills and a fresh approach to this quality improvement group. I believe that one term is a healthy term.
What are the main challenges for patient safety and quality care right now?
So many system factors are combining to impact on safety and quality of patient care now. With a quality improvement lens on I see the international reports on many challenges facing primary care, which need to be included in primary care research and education.
The key challenge that impacts on all the others is Workload, Workforce Capacity, Work Conditions.
Other challenges are increasing demands and expectations with the increased scope and complexity of primary care, increasing population and multimorbidity. Managing the social determinants of health and patients’ lifestyle factors add to the challenges, along with social deprivation, health literacy and misinformation. Migration due to conflict, climate change and economic reasons is also a challenge.
Primary care is not the only service sector experiencing these types of pressures.
It has been said that GP/FM is part of the problem, I would add that we ARE part of the solution!
Doctors are indeed part of the systemic problem of the unsustainable growing trend of consumerism in healthcare. We have the evidence for over-medicalisation and waste of clinical resources. However, we are part of the solution, in terms of being a health professional and a citizen. We have a professional responsibility to manage the finite resources of the health system wisely, and to work with patients to manage unrealistic expectations of healthcare, clinical uncertainty and low value care. Healthcare has a significant environmental impact on the planets resources, and we need to be mindful of this as citizens. The GP / FM role in planetary health, one health and the sustainable development goals are described in the 2023 European Definition of general practice / family medicine.
https://www.woncaeurope.org/page/definition-of-general-practice-family-medicine
Three key areas are part of the solution:
Workforce Supports
There is an international shortage of medical doctors. GP/FM in many countries are reporting job-related burnout, occupational stress, and these work-related pressures are aggravating the serious recruitment and retention issues in the short term and longer term.
Prevention
Earlier interventions for prevention of health problems will give better patient outcomes. More integrated collaboration and communication across health sectors and disciplines to support prevention, including social services, public health, health literacy, education for prevention and health promotion will help policy makers develop integrated care solutions for each of the domains of quality of care. Prevention is key to managing health service demands, costs and sustainability.
Leadership, Policy, Planning Public Services
To improve these issues GPs need to connect with GP/FM leadership who need to work closely with health service leaders, planners and policy makers by being the voice of the representative organisations. Leadership can help create the solutions by contributing data and qualitative reports into research and policy development to improve the delivery of safer better primary care (the first point of care for individuals and families with a GP/FM doctor or nurse) and primary healthcare (the first point of care for individuals and patient populations in communities with multidisciplinary primary care workers - usually GP/FM in conjunction with public health services). All of this is quality improvement.
We also need to work with policy makers to plan for future possible challenges such as pandemics, cybersecurity, and conflict situations.
Reference: https://www.who.int/publications/i/item/9789240086234 (creative commons)
You are a chair of the scientific committee of the WONCA EUROPE 2024 conference that will be held in Dublin, 25-28/09/2024, with the theme “The changing nature of family medicine. Cultivating the future”. Why should WONCA Europe family doctors attend it?
#woncaeurope2024, the conference in Dublin is arguably the most important European GP event of 2024!!
It brings together representatives from all 6 WONCA Europe Networks, 8 SIGs and a WP, 48 Member Organisations and individual GPs to share their knowledge, learning and research projects on the widest platform for GP/FM. That’s quite unique in the 2024 calendar!
Conference Keynote Lectures
There are 5 double keynote lecture plenary sessions focussing on Telemedicine, technology and eHealth in the future, sustainable greener healthcare, complexity and multimorbidity, safety at the interfaces of transitions in healthcare, professional health impact of adverse clinical events, and a special session on finding solutions for workload and workforce issues, encouraging individual GPs to connect with leadership in GP/FM.
The opening ceremony keynote lecture this year is in fact an exciting keynote panel presentation featuring two EYFDM early career GPs along with the President of WONCA Europe and the President of WONCA. All four will talk about their own perspective on “Cultivating the future for GP/FM” during the opening ceremony, which also features a Celtic music spectacle!
In addition, we had 1400 abstracts submitted for other presentations in the state-of-the-art Convention Centre Dublin, a venue aiming for carbon net zero by 2025.
This conference gives family doctors an opportunity to boost their job satisfaction, to consolidate skills and learn new approaches to managing the wide scope of the GP job, through shared learning with European GP colleagues, and international GPs from outside Europe.
Though we may work in different health systems we share the core principles of GP/FM and we can all identify with the European Definition of GP/FM and the WONCA tree.
What book would you recommend as good reading?
I really recommend a good joke book from your local library or bookshop, because laughter is the best medicine!
Pillars of Priority for EQuiP 2022-2025
TOPICS FOR PRESENTATIONS AT #woncaeurope2024
Published on 29 July 2024.
