Short history of EQuiP

By José Miguel Bueno Ortiz, Spanish EQuiP delegate

At the WONCA Council Meeting prior to the 12th World Congress held in Jerusalem in 1989, the Improvement of Quality Working Party was set up as a result of the acknowledgement of the growing significance and importance given to this issue by Family Doctors world-wide and to the work that many of WONCAs member institutions were carrying out to develop initiatives on the subject in their own countries.

The work group was created as a sub-committee of the Permanent Medical Education Committee with the following objectives:

1. To revise the current state of quality indicators and standards in General Practice in the member countries
2. To take measurements 
3. To get to know the capacity of the member countries to improve them
4. To draw up methods by way of which WONCA could promote the set-up of quality improvement strategies

At Jerusalem, Dr. Marwick from New Zealand was proposed as Chairman of this work group. The incentive group emerged at subsequent meetings, counting among its members on Prof. Richard Grol, title professor of Quality Assurance at Nijmegen University (Holland), and Chairman of the European group.

In 1990, the Chairman of EQuiP sent a letter to the different Family Medicine associations in the WONCA member countries, introducing EQuiP and inviting them to join by appointing two Delegates.

Dr. Grol was replaced by Prof. Joachim Szecsenyi, professor of Quality Assurance at Heidelberg (Germany), in EQuiP meeting in Lisbon November 2002.

At the meeting in Kos (Greece) September 2005, Prof. Martin Marshall (Manchester, United Kingdom) took over as chair of EQuiP from Prof. Joachim Szecsenyi. In March 2006 Prof. Martin Marshall accepted a post as "Deputy Chief Medical Officer" of the National Health Service (NHS) in Great Britain and presented his resignation. At the Istanbul (Turkey) meeting, in May 2006, EQuiP delegates decided that Prof. Joachim Szecsenyi would lead the organisation again for the next years.

In 2007, Prof. Tina Eriksson was elected president and she took over office at the closed meeting in Bucharest, November 2008. 

This European group held its first meeting at the WONCA European Region Congress in Barcelona in 1990 and set down its objects:

1. To promote collaboration between the organisations, associations and Family Practice colleges of General practitioners/family doctors in Europe on the topic of Quality Development.  
2. To promote the exchange of experts and experience in quality development by organising workdays, drawing up positioning documents, distributing reports and creating collaboration projects.  
3. To enhance the creation of national networks of family doctors, educators and researchers in each country to aid in promoting and implementing EQuiP's results.  
4. To give an impulse to tuition on quality development during the pre-graduate period, continuous medical education and vocational training scheme.  
5. To initiate, support and supervise specific concerted actions concerning quality development. 

EQuiP consists of an assembly and a permanent council.

The executive is formed by the Chairman, the honorary Secretary, the honorary Treasurer and the delegate in WONCA Europe Executive and 1-2 members at large. It is entrusted with the structure, relations with WONCA, budget, quotas and social aspects. This Executive is elected by vote of the Assembly every three years. It has also a delegate in the WONCA World Quality Improvement Working Group.

The assembly is formed by the delegates in representation of the different national organisations members of WONCA Europe. The maximum number of representatives per country is two. The delegates should be confirmed every three years by their respective societies who receive a letter from EQuiP chairman to that effect, in order to ensure that they continue to be representative. The delegates should inform their societies about EQuiP activities at least once a year.

At the assembly meeting in Turkey in the spring of 2006 a decision to work on an EQuiP constitution was taken. A group of delegates were appointed to draw up a draft constitution. Drafts were discussed at and altered after four consecutive assembly meetings in Spain 2006, the Czech Republic 2007, France 2007 and Norway 2008 until it finally was adopted by the EQuiP Assembly at a closed meeting in Bucharest, November 8, 2008.

EUROPEP – The EUROPEP instrument is a 23-item validated and internationally standardized measure of patient evaluations of general practice care. An international consortium of researchers and general practitioners, linked to EQuiP, developed the instrument in the years of 1995 - 1998. The instrument has been used in about 20 countries and is available in Dutch, Danish, English, French, German, Hebrew, Italian, Norwegian, Portugese, Swedish, Slovenish, and Turkish.

European Practice Assessment - EPA - The EPA instrument is an internationally standardized and validated instrument for assessing practice management in primary care practices. It was developed by an international group of researchers, linked to EQuiP, and the Bertelsmann Foundation, Gütersloh Germany. The EPA indicators have been developed in an international study (2001-2004). The national implementation of EPA lies within the responsibility of the individual countries. During the pilot study 50 practices were included for each country. Since the pilot study, EPA was used in the following countries: Belgium, Germany, Netherlands, Slovenia, and Switzerland. Furthermore Romania as a new country has started a pilot study using EPA and several more new countries think of using EPA, or already made project plans (e.g. Saudi Arabia and Qatar).

International Family Practice Maturity Matrix - IFPMM - The Maturity Matrix is an organisational assessment aimed at stimulating practice-led quality improvement in primary care. To allow this assessment tool to be implemented in different primary care contexts across Europe an international version has been developed and is now being tested in a collaboration between Cardiff University, the European Association for Quality in General Practice (EQuiP), and the Centre for Quality of Care Research (WOK) in Nijmegen.  It had been translated and tested in the following countries: Belgium, Croatia, Germany, Greece, Kosovo, Nigeria, Norway, Portugal, Slovenia, Spain, The Netherlands, United Kingdom in 2007-2008. 

EQuiP holds two meetings a year for its National Delegates:

• one two-day meeting. Beforehand, an open meeting is held concerning quality improvement and with EQuiP’s presentation addressed to doctors in the host country.
• a second one and a half day meeting previous to the WONCA Europe Conference 

At each WONCA Europe Conference EQuiP appoints a key-note lecture and runs several workshops as well as chairs quality related papers. The Conference Organising Committee offers EQuiP a booth to offer detailed information about their activities to the congressmen.

Different working groups on various subjects can be formed within EQUIP. During the meetings, a good deal of time is spent working in groups on each of these topics and their results are presented to the plenarium. Sometimes they produce papers and workshops that are run during WONCA Europe Conferences. They work by correspondence between meetings. Examples of them are: 

• Specialised care- primary care relationships (Interface), 
• Medical records 
• Assessment methods and indicators 
• EUROPEP/ IMPROVE: project focusing on elderly patient involvement outlines 
• Continuous Medical Education (CME)- quality 
• Disagreement in consultation 
• TOPAS collaboration – brief overview of practice management project
• Peer review / Quality circles
• Dealing with uncertainty
• Professional Health
• Integrated QI
• Ethics of QI
• Methods and tools of QI - on the Internet
• Teaching Quality Improvement - in collaboration with EURACT and Vasco da Gama
• Indicators for the psychosocial part of the consultation

In 1994 and 1995 EQuiP organised a Summer Schools lasting one week on Quality Improvement, that was held in the City of Maastricht, Holland.

In Spain, official presentation was made of the "European Inventory" about quality improvement during the XII semFYC Congress held in La Coruña in 1993, in which Professor R. Grol participated. 

In 2008 and 2009 Topas-Europe held Summer Schools in research in Quality Improvement - and in 2009 an additional Summer School in QI was held by EQuiP arranged by Klas Winell, the Finish delegate in collaboration with Duodecem.

Uptil now, the following closed meetings were held:

1990 Spain
1991 Netherlands
1992 United Kingdom
1993 Netherlands, Sweden
1994 Portugal, Germany
1995 Belgium, Israel, 1996 Sweden, Hungary,
1997 Czech Republic, Switzerland
1998 Ireland, Iceland
1999 Spain, Denmark
2000 Austria,  Greece.
2001 Finland, France
2002 United Kingdom,  Portugal
2003 Slovenia, Germany
2004 The Netherlands, Belgium
2005 Poland, Greece
2006 Turkey, Barcelona
2007 Czech Republic, France
2008 Norway, Romania
2009 Israel, Slovenia
2010 UK

Next meetings:

2010 Spain
2011 Denmark
2012 Sweden

EQUIP does also organise Open Invitational Conferences in order to offer a platform of exchange of expertise for researchers and policy makers in all European countries which are involved in quality improvement in the field of Family Medicine. To assure intensive discussions the number of participants of this conferences are limited to 150 who are invited by EQUIP delegates and their National Colleges.

1st EQUIP Invitational Conference: ”Quality Improvement in Family Practice: New Developments “ Zürich, Switzerland, 1997.
1st European Network Organisations Open Conference WONCA'99. Palma de Mallorca, Spain, 1999

2nd EQUIP Invitational Conference: “Quality in Family Practice. From ideas to implementation”, Lisbon, Portugal 2002

3rd EQUIP Invitational Conference: “Quality improvement in General Practice / Family Medicine. Is it still a hobby?” Heidelberg, Germany, 2003

4th EQUIP Invitational Conference: ”From Theory to Practice”. Brussels, Belgium, 2004

5th EQUIP Invitational Conference: “The impact of Health System Reform on Quality in GP/FM”. Barcelona, Spain, 2006

The next will be:

6th EQuiP Invitational Conference: Copenhagen, Denmark, May 2011

Dr. Joachim Sczenyi (left) hands a book to Dr. Grol (right) to commemorate his hand over of EQuiP presidency in the  EQuiP conference in Lisbon (Portugal) 1994.

Prof. Martin Marshall takes over the presidency in Kos, Greece 2005, but resigns shortly thereafter because of other duties. 

At the meeting in Bucharest Romania November 2008, Prof. Joachim Szecsenyi (left) hands over the responsibilty for EQuiP to Prof. Tina Eriksson, after the first elections of executive and chair of EQuiP.