'The traveller within' - why international perspectives matter for every GP Amanda Howe OBE MEd MD FRCGP President, World Organization of Family Doctors Professor of Primary Care, Norwich Medical School, University of East Anglia, U.K.

International perspectives Diversity of patients and their backgrounds Diversity of colleagues Our own diverse backgrounds Global health challenges Environmental impacts Global warming Global markets Family medicine - worldwide

A few statistics UK population – 65.2m, 14% non-white ethnic background (2011) NHS staff profile – more mixed! Profile of recent refugees and forced migrants in Europe – “The latest net migration statistics show that in the year ending September 2016, net migration to the UK was 273,000”. EU > nonEU. Cases of communicable diseases in UK from overseas contacts – “A small proportion of the non-UK born bear the greatest burden of infectious disease reported in the UK. In 2010, 73% of TB cases reported in the UK, almost 60% of newly diagnosed cases of HIV, and 80% of hepatitis B infected UK blood donors were born abroad” Food imports - more than 50% food eaten in UK 238 million passenger journeys by air in/out of UK in 2014! Numbers of doctors leaving UK to work abroad – increased by 30% last year … ……

Where is this journey going? – the consultation (plus) Rights of access in the health care system (and other) Insights and skills of the team and individual workers Translation Willingness to engage in a professional relationship Consultation skills plus … cultural questions and insights Clinical risk factors – social determinants, ethnicity, global travel… Antecedents - choice versus escape, experiences of change… Psychosocial factors – resilience… and damage …. The journey we make together

Structured training for international perspectives … all of the above Consultation skills & relevant assessment Global health curriculum Electives Purposive exposure to patients from different backgrounds (*GP) Community based placements with minority groups (*COPC) Postgraduate placements with different communities (*urban / rural) Out of programme options

Additional options for international experience Travel – holidays, volunteering, study trips, exchanges … Conferences – focused CPD, sharing expertise, new networks .. . Work abroad – including twinning projects Hosting elective students and study visitors Mentorship (including local students) Supporting others (donations, partners and colleagues going abroad…) Added awareness and altruism (*RCGP / WONCA / ….) Supportive advocacy Other?

Strategic perspectives The penalty of distance – supporting rural and remote Carbon footprints – resource consciousness, remote meeting.. Migrant and conflict health – support for local family doctors Emergency preparedness – including community resilience Sustainable lifestyles and practices Social accountability of medical schools Empowerment - community engagement Advocacy for equity – including for providers …

'The traveller within‘… General practice and the patient voice The journey into the world of the other Professional duties and ethics Human rights The diaspora Conveying this voice to others Making learning respectful and positive ‘Systematic inclusivity’

WONCA’s Mission fostering high standards of care in family medicine - improve the quality of life of the peoples of the world by fostering high standards of care in family medicine promoting personal, comprehensive and continuing care promoting equity in the context of health care and other societal needs and initiatives encouraging and supporting the development of academic organizations of general practitioners/family physicians; providing a forum for exchange of knowledge and information representing family physicians to other world organizations and forums concerned with health and medical care WONCA’s Mission

WONCA processes National member organisations Working Parties and special interest groups Links with World Health Organization Registered as a non-governmental organization Regional presidents link with relevant W.H.O. offices Advocacy, standard setting and advice / consultancy Collecting and disseminating data Sharing information, experiences and expertise Participating in teaching, training and research

'The traveller within' - why international perspectives matter for every GP Amanda Howe OBE MEd MD FRCGP President, World Organization of Family Doctors Professor of Primary Care, Norwich Medical School, University of East Anglia, U.K.