Amanda Howe is a practising family doctor, an academic professor, and a national and international leader in family medicine. Since 2001, she has been Professor of Primary Care at the University of East Anglia, where she was part of the founding team for a new medical school. During her career, she has held multiple roles in undergraduate, postgraduate, and faculty education, including being Course Director for the UEA medical programme during its early years of development and accreditation. She has particular expertise in the teaching and learning of professionalism and patient safety; in the models and effectiveness of involving family medicine in community based medical education; and in resilience and doctors’ wellbeing. She served from 2009 – 2015 as an Officer of the Royal College of General Practitioners, previously chairing their research committee and the U.K. Society for Academic Primary Care. She is past President of the World Organization of Family Doctors where she was President from 2016-2018. Her lifetime commitment is to making family medicine better – for patients, governments, and for those doctors who choose to practice it!

Family doctors emphasise the need to engage with people rather than diseases, as the basis for effective communication, education, diagnosis and ongoing care. Such empathic interaction has enormous potential capacity to help people –therapeutic relationships, enablement, empowerment and healing are all outcomes of these skills when we use them well. But there are challenges, and costs. Emotional engagement is a tough demand, and sometimes circumstances can undermine our motivation and compassion, leaving us drained and at risk of burnout. Recognising our own emotional needs and ensuring these are met in our busy professional lives is important in its own right – this talk will use evidence and experience to reflect on how to do this, and why.

Richard Hobbs, MA, FRCGP, FRCP, FRCPE, FESC, FMedSci,

Richard Hobbs is Nuffield Professor of Primary Care at the University of Oxford, and Head of the Nuffield Department of Primary Care Health Sciences. He has served a decade as National Director of the National Institute for Health Research’s School for Primary Care Research and was Director of the NHS Quality and Outcomes Framework (QOF) Review panel from 2005-09. He has served many national and international scientific and research funding boards in UK, Ireland, Canada, and WHO, including the BHF Council, British Primary Care Cardiovascular Society, and the ESC Council for Cardiovascular Primary Care. He currently chairs the European Primary Care Cardiovascular Society, a WONCA Special Interest Group.

He is one of the world’s most referenced academic leaders in primary care, and has developed at Oxford one of the largest and most highly ranked centres for academic primary care in the world. He has also made major contributions to growing primary care academic capacity, in terms of people development and research networks. A highly cited primary care clinical scientist, he has authored over 450 peer reviewed publications, has an h-index of 90, with over 56000 citations (34000 since 2013) and 57 papers cited over 100 times, 14 papers cited over 1000 times and 5 papers with over 2000 citations. He has an outstanding track record in cardiovascular research, delivering trials that changed international guidelines and practice, especially in the areas of stroke prevention in atrial fibrillation (BAFTA, SAFE, and SMART trials), heart failure burden and diagnosis (ECHOES and REFER trials), and hypertension self-management (TASMINH series). He is only the fifth ever recipient of the RCGP Discovery Prize in 2018 (an occasional award made since 1953) and received the Distinguished Researcher Shine Prize from WONCA World in 2018.

There is a more applied clinical research focus in many countries with developed healthcare systems, like the NHS, that complements basic science and discovery research. Potentially, applied research may highlight the importance of more research that answers questions relevant to primary care, especially with health service changes in many countries that result in most patients with chronic disease being managed in primary care. This necessitates the greater involvement of service primary care in the delivery of clinical research, and especially clinical trials and high quality epidemiological studies, not least to help deliver adequate patient recruitment and produce generalisable results.

However, we know that research is more difficult to design and deliver in complex settings and primary care is an exemplar for a “complex research environment”: since it comprises multiple, multi-disciplinary practitioners in small units, with limited space and (usually) low research experience and high service demands.

This presentation will consider whether primary care research is important or not, and whether academic primary care has helped enable a greater research capacity in the complex environment of general practice to host more and better research. Finally, after a long career as an academic GP, he will consider whether, over and above the hosting of research, the research questions initiated and delivered by academic primary care are important for patients and health systems.

Bohumil Seifert started his academic career and international activities after 20 years of serving full time as a GP in the community. He is still practising on a half timetable in Prague. He has been teaching family medicine in the university since 2003. He completed his doctoral studies in Preventive Medicine in 2007 based on the work: Epidemiological studies in primary care and their impact on clinical gastroenterology. In 2009 he was appointed as an associated professor at Charles University and Head of the Department of General Practice.
Bohumil Seifert’s main research interest has been in the epidemiology and management of gastrointestinal disorders in primary care and in the secondary prevention of colorectal cancer. He has published several articles in relevant journals, contributed to books and presented data on this topic at international meetings (UEGW, DDW, WONCA). He was a member of the ROME IV Primary Care Committee for Functional Gastrointestinal Disorders. He has been a leading author of an e-learning course on Irritable bowel syndrome actually available on the website of United European Gastroenterology.
He has been serving since 2002 as the Scientific Secretary of the Czech Society of General Practice and has been the Czech representative in the WONCA World and European Council since 2004. He has been working for many years in different international networks and work groups under WHO and WONCA Europe. He was a member of EQuiP and served as the secretary of the European Society for Primary Care Gastroenterology. He has chaired several international meetings in Prague, particularly the WONCA World Conference 2013 and the WONCA Europe conference in 2017.

Functional somatic disorders (FSD), like chronic pain of unknown origin, chronic fatigue syndrome or irritable bowel syndrome, are common and represent a major burden for health care systems. Diagnostic and therapeutic approaches to these symptoms vary between countries, within medical specialties and between individual physicians.
A patient's career with a functional disorder is usually lifelong, severe, although life is not threatened, accompanied by alternating crises and periods without difficulties. Patients may be frustrated with the lack of treatment. There are several theoretical concepts that can help practitioners understand the issues of functional problems. In one extreme the functional disorder is perceived only as a somatic expression of the feeling of personal psychosocial imbalance and in the other, functional disorder is a disease for which we have not yet been able to explain the organic cause. Many interesting concepts are, however, evolving in the area between these extremes.
FSD present a particular set of management challenges for GPs who meet patients early in their illness trajectory and usually before other doctors. Michael Balint once said that the patient coming to the GP believes he was given a ticket to a wise man, who would help him decrypt the problems even if he could not even name them. This particularly fits patients with a wide range of psychosomatic and functional disorders.
An initial positive diagnosis of FSD leads to a better atmosphere for long-term cooperation and has the advantage of avoiding unnecessary investigations. It is usually possible when the risk of organic problem is low, the history of patient behaviour, his/her symptoms, profile, psychosocial background and basic investigation indicate FSD.
On the other hand patients often expect referral and reassurance by specialists. Physicians, even if they anticipate a functional problem, are taught to rule out first serious diagnosis and to avoid the risk of diagnostic failure. They need to retain the confidence of their patients throughout an illness that may be protracted and have an uncertain therapeutic response. Effective doctor-patient interactions lie at the heart of this process and a number of consultation models for gathering information, building the relationship, explanation and planning are available. In the management of functional somatic disorders a GP should balance the doctor- and patient-centered interventions and master the human side of medicine.

Ana Nunes Barata is a young Family Doctor working as a full-time Family Doctor in Amadora, Portugal. She has a MSc in Hospice and Palliative Care and a postgraduate degree in Geriatrics and also collaborates with the home-care nursing team in Amadora.
Since the start of her residency training program in 2012, Ana has collaborated with the Vasco da Gama Movement (VdGM). She worked towards the establishment of a global exchange program for trainees and young family doctors in primary care and, in 2013, together with the seven WONCA's Young Doctors Movements, the Family Medicine 360º was established. Ana has been its global coordinator since then. In VdGM, Ana has also collaborated with different Special Interest Groups, namely the Equally Different group. In 2016, Ana was elected the Young Doctor Representative in WONCA World Executive for the 2016-2018 biennium.
Ana has also been working together with other groups, namely the WHO's Youth Hub and the IFMSA in order to advocate for the importance of the development of family medicine so to achieve Universal Health Coverage.

What makes Family Medicine different from other specialties? Family Medicine focuses on the person and the context that surrounds each individual. As a first point of contact with the healthcare system, its holistic scope makes it a complete subject where the well-being and care for the person plays a vital role.
Communicating and acting with compassion, respect and empathy are the cornerstone for the work of a Family Doctor. These attitudes make clinical practice patient-centered and are the most important therapies in Family Medicine, supporting the importance of solidarity in healthcare.

A/prof. Barbara Ukropcová, MD, PhD is a scientist and physician in the Biomedical Research Center, Slovak Academy of Sciences, and the co-founder of the Center of Physical Activity, dedicated to the implementation of exercise in the prevention & treatment of chronic diseases. Her research is focused on the role of physical inactivity in the pathogenesis of chronic diseases and the mechanisms of exercise health benefits. She teaches at the Faculty of Medicine and the Faculty of Physical Education and Sports, Comenius university. Dr. Ukropcová serves as a board member of Obesity Section, SDS and is a founding member of the Exercise and Physical Activity Study Group of the European Association to Study Diabetes. She is dedicated to promoting active lifestyle and exercise prescription in prevention/treatment of chronic diseases among students, health-care professionals and general public.

Noncommunicable chronic diseases, including cardiovascular, metabolic and neurodegenerative diseases and cancer, represent the major causes of morbidity and contribute to 65% of mortality worldwide. Low physical activity, sedentarism and excessive caloric intake that characterize the current lifestyle of humans across the globe, contribute substantially to the “diseasome of physical inactivity” and represent the key modifiable risk factors that can be targeted at both individual and population levels. Numerous prospective and intervention studies have shown that regular exercise at a sufficient dose has an unambiguous potential to prevent, slow-down and even reverse the progression of chronic diseases at preclinical and early clinical stages and to improve patient’s quality of life at the advanced stages of the disease. In our intervention studies, we have observed improved motor and cognitive functions, muscle strength and physical fitness as well as whole-body and muscle metabolism in populations of patients with various chronic diseases. Our recently established Center of Physical Activity enables the long-term supervised exercise interventions which in combination with education, regular feedback and long-term follow-up provide a functioning model of lifestyle modification. Many of our observations clearly support the importance of regular exercise in prevention and supportive treatment of chronic metabolic and neurodegenerative diseases. The biggest challenge, however, is to translate the knowledge from the complex lifestyle intervention studies into clinical practice. Experiences from existing programs provide some evidence that relatively simple physical activity counseling and monitoring algorithms, that could be implemented in the patients’ care, have a potential to effectively increase physical activity, reduce the chronic disease burden and/or to achieve a better disease control and quality of life. Supporting collaboration between general practitioners and specialists in exercise physiology, nutrition and lifestyle coaching would create a niche permissive for effective lifestyle modification.

Ing. arch. Radoslav Herda is a civic activist. He has co-founded two patient organizations SLOVAK PATIENT and Slovak Alliance of Rare Diseases. He is specialized in prevention of health, antimicrobial resistance, patient behavior and primary care. He supports better cooperation between patients, doctors and nurses and brings in the principles of no-blame culture in to healthcare system. He works on creating a better system of compensating the patients after medical errors. SLOVAK PATIENT cooperates with a team which is preparing the guidelines on the prevention, diagnosis, and treatment at Ministry of Health SR and new recommendations for patients and patient safety. Mr. Herda leads influential web portal slovenskypacient.sk.

The patient is primarily human being There is a lack of doctors in every country, and Slovakia belongs among them. If the general practitioners left for retirement at the age of 65, we would lose half of them within 7 years. We are much more aware of their importance and irreplaceability in the threat of lack. Healthcare system in Slovakia is in transition. We introduce e-health, guidelines on prevention, diagnosis and treatment, and raise importance of healthcare efficiency and patient safety. At the same time as the importance of guidelines and treatment-based examinations grows, the position of the doctor and patient medical history are growing. And there is a growing need for understanding the patient's life and his current situation. And for you, general practitioners, experts. You are specialists in understanding our lives. It's your unique and irreplaceable role. At the same time, you are our allies and protectors before falling into the diagnostic-therapeutic cycle of chronic diseases. Those who hold a protective hand over and care for us to be careful not to fall into it. I am a patient representative. It depends on well-functioning communication and cooperation in the spirit of non-blaming culture. We do not want you to be afraid to cure us. We want you to perceive us through our needs, our vulnerability and fragility. Patients are primarily human being. I wish the WONCA 2019 congress very much to success. I see it as a unique place to sharing of valuable experience and knowledge. I believe you will make the most of it for the benefit of all of us. We thank you.