Vancouver Division Q&A In response to your feedback
Thank you for providing your comments about the work of the Vancouver Division. More than likely the thoughts of one physician are similar amongst our membership. We look forward to creating an open dialogue in response to your questions.
Ongoing discussion around primary care in Vancouver and the work of your Division is important to us. We are excited to expand on this Q&A to keep you informed on areas important to members.
We encourage you to continue to share your feedback here.
Vancouver Division Board of Directors & Physician Lead
Our health care system is struggling with too many patients unable to access effective primary care and many family physicians are feeling burned out, overworked and unsupported. The current situation in Vancouver is unsustainable for individual providers and for the system as a whole.
In 2015, the GPSC undertook a province-wide visioning process in which over 2,000 family practitioners participated through in-person sessions and web-based dialogues. The following year, informed by the results of the visioning process found here, as well as national and international evidence regarding the importance of primary care in high-performing health care systems, the GPSC began focussed efforts to support the development of Patient Medical Homes as the foundation of the primary care system in this province, found here.
In 2017, the Ministry of Health released a set of Policy Papers that specifically addressed the primary care system, including the importance of Patient Medical Homes and Primary Care Networks, as well as team-based care.
In 2018 the Vancouver Division ran a membership referendum to confirm, “that family physicians… (believe that they feel they should be) …the driving voice behind designing the future of primary care in Vancouver.” Based on the overwhelmingly positive response, the Vancouver Division has been steadily preparing the organization to influence primary care change in Vancouver.
The primary goals of this work are to improving access to quality primary care for all people and to improving the work experience of family doctors.
The PMH model describes how a medical practice can be optimally designed to meet the needs of the patients, the providers and the community. The ultimate achievement of this goal will provide access to quality primary care. How the attributes are achieved is likely to vary in interpretation throughout the province reflecting the diversity of communities and practices.
The good news is that the vast majority of practices in BC are PMHs of some form. We believe that by supporting practices and providers to explore and develop the PMH attributes we will improve access to quality primary care, and by extension, enhance patient and provider experience of the system.
The attributes of PMHs fall into three broad areas:
More information on the attributes, including definitions and a diagram of the three areas can be found here.
It is generally understood that high-functioning systems that effectively meet the needs of patients and providers are based on a strong foundation of primary care. We believe that well-supported PMHs are essential for both this foundation and for developing effective PCNs that target services to effectively support patients and their needs. The Vancouver Division is focussing much of its efforts on working with members to understand how their current practices fit into the PMH model. We are also exploring ways in which members can be supported to shift or strengthen their practices to meet their personal and practice needs and how they can be prepared for some of the changes they will experience as PCNs are implemented.
This work is built upon the learnings of the Vancouver Division since its inception, including:
Our work in the area of PMH falls into these broad categories, and is summarized here:
As with all of the work of the Division, we are committed to the principles laid out in our Strategic Priorities:
There are different levels of evaluation and measurement for this work.
At a Division level, we evaluate our work through annual strategic planning, committee reporting, work planning and budget tracking (which is linked to work plans). We are currently exploring a more formal evaluation program which will pull together our current work along with our formal evaluation of PCN implementation and provincial level evaluations and tools.
Provincially, the GPSC has developed a number of tools to support practices, community (Division) and provincial level evaluations, including the PMH Self-Assessment Tool and the Patient Experience Tool. The GPSC PMH Evaluation Framework (which is being finalized and will be shared) ties together the work that is going on around the Province, including Vancouver.
The Vancouver Division remains committed to using iteration and improvement science, both formally and informally, to ensure the effectiveness of our work and investments.
This work has individual, community, city, regional and provincial level considerations and opportunities. Different groups are involved at different levels and one of the jobs of the Vancouver Division is to ensure that the voice of our doctors is effectively represented.
For Division-led PMH work, we are coming to you where you work in the community. To support networking of practices, we have identified local Family Physician Champions and hired regional Community Outreach Facilitators (staff leads) to work with doctors and clinics in each Local Health Area (LHA). In the coming months, we will be reaching out to family doctors within each region to bring you together and start the local conversations about what opportunities exist currently, what is likely to come, and most importantly, what is working and not working in your community.
We are currently reaching out to all of the family practice clinics in Vancouver, starting with a connection to office managers or senior MOAs. The goal of our contact is to familiarize your staff with the Vancouver Division and get some feedback from them regarding what works and doesn’t in your neighbourhood. As we grow to understand the primary care neighbourhoods, we will endeavour to involve you, the physician, directly in the process to create the change you would like to see in your community.
Individually, you can become involved on your own or by connecting with the Vancouver Division to better understand the available resources, which include the PMH Self-Assessment Tool, Panel Management incentives, EMR optimization and education.
PCNs are geographically based, formalized networks of practices and primary care services (typically provided by the Health Authority) that work together to meet the healthcare needs of the community. Requiring a strong foundation of PMHs, PCNs are designed to wrap services around patients. Based on the demographics and healthcare needs of geographically defined populations, PCNs create a new system for introducing more integrated team-based care into primary care in the community.
In Vancouver, PCNs are expected to serve approximately 100,000 patients, based on the city’s Local Health Areas (LHAs). There are likely to be six PCNs in the city, which will be developed over time.
Taking our cue from the results of the 2018 Referendum and understanding the importance of ensuring that family physicians are the driving force behind designing the future of primary care change in Vancouver, the Vancouver Division, in partnership with Vancouver Coastal Health, submitted a formal Service Plan to the Ministry of Health to initiate the first two PCNs in Vancouver. These initial PCNs will be located in Local Health Area (LHA) 1 (Downtown and Fairview Slopes) and LHA 6 (South Vancouver and Oakridge). Map of Vancouver LHAs found here.
The Service Plan also contains ongoing support for the First Nations and Aboriginal Health Primary Care Network that has been independently developed to provide care to on and off reserve First Nations and Indigenous Patients through Vancouver, Richmond and North Vancouver.
Finally, the Service Plan begins to explore the role of community owned and operated Community Health Centres (CHC) within the primary care landscape and how they will fit into PCNs. Work will start with REACH CHC and will evolve to explore other CHCs over time.
As per the requirement from the Ministry of Health, the Service Plan was designed to address the current attachment gap in the LHA communities and to develop a PCN Team to support practices to care for higher needs patients.
Leadership and governance of the PCNs is of paramount importance and we are working hard to ensure that family doctors have a strong voice at all levels.
As we continue to explore networking practices and PCN opportunities within the community, the Division is committed to building off the exciting work of the Residential Care Committee, the primary care maternity network, the Cognitive Based Therapy Initiative, and the communities of care that have been developed through the Vancouver Division’s ongoing committee and initiative investments.
In addition to the current ways that work is evaluated at the Vancouver Division, we are expanding our model to include a formal evaluation of PCNs at the community and city levels. The Ministry of Health and Vancouver Coastal Health Authority are actively designing further evaluation processes which will be implemented locally, regionally and provincially.
As with PMH work, local Family Physician Champions and Community Outreach Facilitators (staff leads) are committed to working with you at the practice and community level to better understand what is needed and how to support you in this process. The immediate work around PCNs will occur in Local Health Areas (LHAs) 1 and 6. For the remaining PCNs not identified in the initial Service Plan, the Vancouver Division believes it is important to start the work of networking practices together to ensure everyone gets a fair and equitable opportunity to participate in the process. The good news for all family doctors in Vancouver is that the wait is over – and our journey to PMH and PCN has just begun. We sincerely hope you will join us on this journey.
Most, if not all practices fit into this work. Whether you work in a ‘full-service’ community fee-for-service practice, a focussed practice, a walk-in practice, a Community Health Centre, or any type of practice, you play a role in providing primary care to patients in the community. You are a part of this work and an important part of the system change. Ideally, all types of practices and providers will work together to form a network of primary care providers to care for patients throughout their lifespan.
We are committed to designing a fair and equitable process that will ensure appropriate distribution of resources as they come available. The resources that appear to be forthcoming are fairly limited and primarily focussed on addressing the attachment gap (number of patients living in a geographic area who do not have a family doctor). We are starting to work with physicians in the Local Health Areas (LHAs) 1 and 6 to determine how best to deploy these resources and we look forward to working with physicians across the rest of Vancouver to determine what will work in their community.
No one is required to participate in this work, although we hope our members will be interested in participating to whatever degree they feel comfortable.
This work is currently being designed to be independent of specific funding models. We know that many family physicians are interested in learning more about non-fee-for-service (FFS) models and a large number of our members work in more than one model; however, we also know that many physicians are not interested in changing their current payment model. While aspects of the PMH and PCN models are likely better supported by alternate forms of funding and the Ministry of Health has expressed interest in supporting physicians to transition to non-FFS models, a clear pathway and process for such a transition does not currently exist.
The Vancouver Division intends to support members’ desire to learn more about models of payment through a variety of venues in the coming year.
Vancouver Division- Exploring Value Based Payment for Family Physicians in Vancouver, view here
Doctors of BC- Physician Compensation Models, view here
College of Family Physicians of Canada- Physician Remuneration in a Patient’s Medical Home, view here
A UPCC is simply a place where patients can access care which is not appropriate for, or not available through, the PMH, and does not require the specialized services of the Emergency Department. Diagnostics such as labs and imaging, as well as acute care services such as IV antibiotics and casting are available on an urgent basis 7 days a week.
UPCCs are ultimately designed to be part of the PCN and are directly linked to PMHs, serving as a tool to facilitate appropriate access to primary care and support physicians to provide the care their patients need.
With only one formal UPCC in Vancouver (as of March 2019), the design of how this model can be expanded to support physicians and patients locally and throughout the city is actively underway. Over time, there is likely to be a UPCC in each of Vancouver’s six PCNs and it is essential that each one adds value to patients and practices within the community. We are working with the local communities, the Health Authority and the Province to achieve this goal.