From the President: November 2019

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Our Executive and many of our members are involved in numerous ways in the development and use of Artificial Intelligence (AI) in relation to their practice. As an organization we emphasise that nothing can replace the face to face and continuous contact between family doctor and patient. At the same time, we acknowledge that AI is around, available and in increasing use both by our patients and by us. I am pleased that the WONCA Working Party on eHealth, chaired by Pramendra Prasad, is taking the lead on this issue on behalf of family medicine.

WONCA is now engaged in a pilot project with Ping An Good Doctors of China (PAGD) to assess an AI assisted primary care system. Some of our members may remember this group from the lunchtime symposium they held during the WONCA World Conference in Seoul 2018.

All of us have reservations about AI and its use in primary care: but in certain circumstances, such as isolated areas, patients without access to a qualified family doctor, emergencies and disasters, AI may well have much to offer. It is much better that WONCA is involved at the outset, helping to steer and test-drive options so as to get the best possible solutions to problems, rather than coming to the party late and finding that the systems are not easy to change or adapt to life in primary care. I wish our colleagues well in this endeavour and they will report in more detail as the project gets underway.

And now to another challenge. We know from the immense amount of work going on behind the scenes that WHO, World Bank, Gates Foundation and many national governments are now involved in developing and deciding on ways to measure the achievement of SDG3, specifically in relation to Universal Health Coverage.

We know that measuring delivery of primary care is hugely difficult – there are so many qualitative aspects to primary care which do not fit neatly in a numerical method of measurement. Additionally, it is now clear to the major health development partners that measuring inputs in terms of specific diseases is a very fractured and distorted way of reflecting delivery of primary care.

It is with some disappointment, then, that in its development of the upcoming Version 11 of the International Classification of Diseases (ICD11), WHO has once again neglected primary care classification. This is despite clear offers of help from WONCA at central level and from the WONCA Working Party on Classification (WICC), chaired by Thomas Kühlein. Indeed, the Collaboration Plan between WHO and WONCA for the period 2019-2021 – updated in November 2018 specifically addresses this issue:

5. Active contribution to the development and implementation of ICD-11 and ICPC
WONCA is working with WHO on the development and implementation of ICD11, in particular:
• Providing primary care input into ICD11
• Working on conceptual consistency between different primary care classifications
• Joint work to ensure conceptual consistency between ICPC and the other members of the Family of classifications, in particular ICD-11 and ICHI

We have expressed our concerns to the Director General of WHO and to the Executive Director of UHC, Dr Peter Salama, who is responsible for the WHO classification work. Not to include primary care classifications in the newest version of the clinical classification used globally is doing a disservice to all of us who are endeavouring to deliver integrated, person-centred health services to our patients, as described in WHO’s own global policies. It is also doing a disservice to patients globally, as every nation in the world has promised, in the Astana Declaration, to deliver on UHC. How will we reflect how well or badly we are doing in reaching our goal, without standardised ways of reflecting the service which is being delivered to patients worldwide? We all know it’s not easy but to disregard the assistance available from technically competent, experienced professional family doctors is not easy to understand. We await a response to our concerns.

Donald Li, WONCA President

Photos: The WONCA President, Donald Li, has recently attended the Family Medicine Forum of the Canadian College of Family Physicians and presented a WONCA Plaque to President Shirley Schipper (left) and was seen with Michael Kidd and Francine Lemire (right)