1. Reclaiming generalism in SA Jannie Hugo Cape Town 11 May 2013

2. Thank you Amanda Tony Colin Pfaff: suspended for practicing PMTCT in early this century. The time when in DOH HIV did not course AIDS

3. Is this a revolution?

4. Main Message Place: Community Game Plan: COPC / Generalism Team: Patient, CHW, Nurse, ClinA, GP/FP Scale: We must Go BIG

5. The art of the Idea And how it can change your life John Hunt and Sam Nhlenathwa Zebra Press, Cape Town Price: R274

6. John Hunt An IDEA is a PARADIGM SHIFTING moment that forward projects FUTURE POTENTIAL in an initially ETHERAL but progressively tangible MANNER

8. We don’t know what we DON’T KNOW until we DO what we don’t USUALLY DO

10. Place

11. Game Plan Generalism Community Oriented Primary Care

12. Expert Generalist Elements of Expertise Complexity Overview Priorisation Integration Outperceive the environment (intuition)

13. reference Medical generalism. Why expertise in whole person medicine matters. June 2012. Royal College of General Practitioners.

14. Complexity Theory

15. Complexity theory image URL http://bet- buddy.blogspot.com/2010/11/using- complexity-theory-to-help.html

16. Complexity Fuzzy, rather than rigid, boundaries Agents' actions are based on internalised rules The agents and the system are adaptive Systems are embedded within other systems and co-evolve Tension and paradox are natural phenomena, not necessarily to be resolved Interaction leads to continually emerging, novel behaviour

17. Complexity Inherent non-linearity Inherent unpredictability Inherent pattern Attractor behaviour Inherent self organisation through simple locally applied rules

18. BMJ. 2001 September 15; 323(7313): 625–628. Complexity science The challenge of complexity in health care Paul E Plsek, Trisha Greenhalgh

19. Overview Patient Practice Community you service

20. Prioritisation / Focus Patient Practice Community you service

21. Integration Patient Practice Community you service

22. Intuition Patient Practice Community you service

23. COPC Community Oriented Primary Care

24. COPC Book Author: Tessa S. Marcus Title: Community Oriented Primary Care L2: primary health Series: Pathways ISBN: 9781775785804 Year of publication: 2013 Publisher: Pearson Available in Bookmark Price: R249

25. Principles of COPC Local Health and Institutional Analysis Comprehensive Care Equity Practice with Science Service integration around users

26. Local Health and Institutional Analysis Scientific Information People and organisations in defined local places

27. Comprehensive Care Promotion Prevention Treatment Rehabilitation Palliation

28. Equity Focus where most need, More resources where more need Accessible Appropriate Affordable Relevant

29. Practice with Science Scientifically informed Interdisciplinary and Multi-professional

30. Service Integration around Users Person-centered health care People and Practitioners in Partnership Continuity of Care Collaborative Juggling

31. Team

33. Team of Generalists General Practitioner 8000 Family Physician 500 Nurse Practitioner Clinical Associate 200 Community Health Worker 60 000

34. Scale We must go BIG

35. If you want to take a leap, take a quantum leap Incremental change is good if you are a glacier