PRIMARY CARE TEAMS

Horgan unveils health plans

VICTORIA British Columbians without family doctors who are forced to visit hospital emergency rooms could soon have another option as new “urgent primary care centres” were announced Thursday by the provincial government.

Premier John Horgan said the goal is to hire more general practitioners and team them up with nurses, pharmacists, dietitians, mental health professionals, social workers, physiotherapists and others grouped together in centres that are open on evenings and weekends.

“Far too many British Columbians cannot find a family doctor,” Horgan said. “In Surrey alone … 78,000 do not have a primary care provider, that’s the entire city of Prince George. Imagine that, that there’d be no family doctors in Prince George. In Chilliwack, one in four people don’t have access to a primary care provider. For families, it often means if they need service in the evenings or weekends, they often find themselves in an emergency room.”

The locations of the first 10 urgent primary care centres will be announced in the next few weeks, said Horgan, but the goal is to open at least two in each of B.C.’s five regional health authorities.

How each centre would operate could be slightly different depending upon the rural or urban community.

The goal, said the Ministry of Health, is to have people seen on the same day they ask for help, whether it be through an appointment or walk-in.

For example, a parent with a sick child on an evening or weekend could go to the clinic to see a nurse or doctor, then get referred to a nearby open lab for any required tests, so they don’t have to sit for hours waiting as a non-urgent case at a hospital emergency room.

The three-year plan is a major shift in how the government delivers primary health care, and comes with an annual $128-million funding increase once phased in. It’s also the latest attempt to solve the lack of family doctors. More than 780,000 in B.C. — almost 17 per cent of the population — don’t have a family doctor.

“We do know the model of primary care that has existed in British Columbia since the creation of medicare is in need of change,” said Health Minister Adrian Dix.

Some other provinces, such as Ontario, have also pushed toward primary health centres where teams of professionals treat patients. In Ontario, almost 90 per cent of residents identify as having a family doctor, though there remain concerns about busy hospital emergency rooms and “hallway medicine” in packed hospitals.

Experience internationally has shown team-based primary care can improve quality and reduce costs, said Dr. Morgan Price, interim co-head of UBC’s department of family practice.

“We know that new grads in recent years are interested in providing full service primary care to patients in communities, and they are wanting to do that in teams. They are generally more interested in providing care than in managing a private office and all those other pieces,” he said. “This is going to help recruit and retain physicians in B.C., I’m quite convinced.”

Fewer than half of British Columbians can get a health care appointment within a day, and only a quarter can get care in the evening or on weekends.

In hospitals, 36 per cent of patients who last visited the ER had a condition that could have been treated by a family physician, according to Ministry of Health estimates.

The government is also promising “primary care networks” where websites help residents find the right health-care provider. Pilot sites will be in Burnaby, Richmond, Prince George and South Okanagan-Similkameen.

The government will provide funding to hire up to 200 new family doctors, with money available for them to take salaries instead of fee-for-service billing (essentially, charging per procedure) if they’d prefer.

The new urgent-care centres could be owned by local health authorities, the province or groups of physicians, alleviating new doctors from the administrative workload of staffing, leasing space and running a business.

Not everyone who comes out of med school wants to buy into a practice and take on all those responsibilities.

“Not everyone who comes out of med school wants to buy into a practice and take on all those responsibilities,” said Horgan.

Doctors of B.C. president Dr. Trina Larsen Soles said physicians support the premier’s plan.

“I find his plan to be bold and extremely ambitious,” Soles said.

She called the funding “a very good start. Is it enough? No. But it is enough to start with.”