Richmond has become one of the pilot sites for regional “primary care networks", where websites help residents find the right health care provider. It's part of an initiative led by B.C. government to address doctor shortages and provide patients with better support.
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 new centres that are open on evenings and weekends.
“Far too many British Columbians cannot find a family doctor,” said Horgan.
“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 in the North, Interior, Fraser Valley, Vancouver Island and Lower Mainland.
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 X-rays, tests, blood work, diagnostics or prescriptions so that 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. The previous Liberal government promised to link every person to a doctor by 2015 but had to abandon the plan as unachievable even after spending millions of dollars to try to court new doctors.
“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 now identify has 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 evenings or weekends. In hospitals, 36 per cent of patients who lasted visited the ER had a condition that could have been treated by a family physician if they’d had one, 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,” 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.”
Spending on health care represents almost 40 per cent of B.C.’s entire annual budget, or an estimated $21.7 billion in 2018/19 out of a spending plan of $53.6 billion.
“Historically more doctors have wanted to explore alternate payments than the budget has allowed,” said Soles. “Essentially what they are doing is opening that box up. We know in certain rural communities that’s been the only thing that’s salvaged the medical care, when you don’t have the volume.”
The government also announced funding this week for 200 new nurse practitioner positions.
It’s unclear what affect the changes will have on the walk-in clinics in B.C. that for some people are the only way to get to see a doctor, despite long lines. Soles said she expects they will continue to operate and be included as one of the options for people to use in the new health care networks. “Quite frankly there’s more than enough work for every single one and then some,” she said.
The urgent primary care centre proposal was a promise by the B.C. NDP in the 2017 provincial election.
