Family Practice in B'C'

1
Family Practice in B.C.

• The backbone of the health care system.

2
Context the problems -

• The system is not producing good results for
  patients nor apparently for doctors
• There really is a care gap
• We know a lot more than we seem able to do.

3
More context lets pause and examine a commonly
heard threat

• If we dont do it, someone else will.
• Is this true?

4
My usual answer

• Ridiculous!
• Who, how could anyone replace 4,000 B.C. family
  doctors?

5
But - a second look

• A lot of different people in a lot of different
  places in a lot of different ways are trying to
  narrow their own perception of the care gaps
• Who? Walk-in-clinic entrepreneurs, specialty
  carve-out enthusiasts, H.A.s who cant cope with
  the emerg visits, holistic this and that
  care-givers
• Maybe we have a special need to preserve and
  protect the best of family medicine if not us,
  who?

6
Results of the care gaps and the attempts to
close them

• Fragmentation of care
• Poor outcomes
• Low patient satisfaction
• Increased cost to the community

7
More negative effects

• Loss of confidence in the primary medical care
  system
• Worsened relations with specialists
• Loss of professional satisfaction
• Problems with recruitment of new family doctors
• Decreased of sense of mission by some of us.

8
What does this all mean to us?

• It has been a loss
• A loss of an opportunity to fulfill a community
  need and a professionally satisfying role
• But - we should never forget, never under
  estimate the power of a really well trained
  family doctor to do good.

9
Whose fault is (was) all this?

• Dumb question, or at least useless
• After the meeting ask me privately and Ill tell
  you.

10
What to do?

• Jump, heavily, on the new bandwagon as expressed
  in the new contract and the new primary care
  charter some people really believe we are the
  backbone of the healthcare system
• Jump all over the new P.S.P. which well now tell
  you about.

11
Origins in PQIDs

• About 1000 doctors came to meetings to tell BCMA,
  Ministry of Health and Health Authorities what is
  wrong.
• Summary of what was said
• Value us
• Train us
• Pay us
• Support us

12
Whats happened since PQIDs?

• Revitalized GPSC
• 2006 Working Agreement
• Recent arbitration award
• HA investment in Primary Care
• Primary Care Charter
• Change Management-PSP unleashed!

13
Optimism yes, finally!

• Increasing efforts to understand what is needed
  to revitalize F.P.
• New Primary Care Charter which may be useful in
  guiding all parties
• 2006 Working Agreement with new funding
• 136.5 M new annual funding targeted to GPSC
  initiatives to support Family Practice
• Increase in global MSP funds from arbitration
  award (100.5 M) for SGP to allocate to GP fees
• 21.9 M for Change Management.

14
F.P. Renewal, Primary Care Reform, its all
inextricably linked.

• After decades of neglect there is recognition
  that family doctors are the backbone of the
  health care system
• It says so in a new Charter for Primary Care
• There is an amazing degree of harmony in thinking
  of BCMA and Ministry via GPSC Health Authority
  involvement starting June 2007.

15
GPSC Incentives

• One-time payment (10,000)
• Chronic Disease Management
• Expand conditions covered and increase value of
  original fees CHF, DM, HTN flow sheets
• Commitment to address additional conditions.

16
GPSC Incentives

• Patient management conference fees
• Complex Care Fee (April 1, 2007) a biggie
• Obstetrical care bonus/maternity care network
• Prevention (5 of targeted funding 2007).

17
upports EMRs / IT
S

• Clinical information systems coming - soon
• GPSC Interim IT Initiatives
• Connectivity eg. Access to Pharmanet and Lab
  Results
• PITO Funding
• 107.8 million over 5 years, 70 cost-shared.

18
upports Change Management
S

• Funding Since 2004 includes
• 5 million for PQIDs (2004/05)
• 20 million for other change management
  initiatives (2005 onward)
• Change management support
• Clinical enhancement
• Practice management enhancement
• Information system implementation

19
The money, the organization, the role of the
Health Authorities

• 21.9 M Change Management Funds
• A tri-partite partnership BCMA/SGP Ministry
  of Health Health Authorities
• Money ( 1 M to each HA) for facilitators and
  physician peer champions to assist those GPs
  wanting to make changes
• Major funding available to assist in change
  were talking 5-10,000/dr.

20
Two arms to supporting and improving primary
medical care

• One is the new contract with GPSC incentives plus
  changes planned by the SGP with new global
  funding the value us, pay us more part
• The other is Change Management the train,
  support us more part
• Government gets the idea that to improve care of
  patients they have to improve the working
  conditions of doctors.

21
Whats in all this for us?

• Firstly, improved compensation
• Exposure to new ideas and help with implementing
  old ideas you never had time to test
• Networking with other doctors to support each
  other some are quite reasonable people
• Recruit and Retain Family Physicians in BC
• Ultimately improved care for patients.

22
The Business case

• Impact on GPs of the F.P. Enhancements sponsored
  by GPSC CDM, Advanced Access, and Group Visits
  
• Six different practices analyzed on average
  benefits ranged from 18,000 to 39,000 for some
  even more
• And, this does NOT include monies from the PSP
  program for participation in the modules!

23
Looking for a quick win?

• Seems that the Advanced Access module is a real
  winner for both doctors and patients and
  certainly helps the bottom line
• Able to see 10-25 more patients in same no. of
  hours
• Recapture those short visits from the w-i-c s
• Would help in the more rewarding, comprehensive,
  and more longitudinal care goal of F.P.

24
Damn -

• I retired too soon.

25
Family Practice renewal

• Its starting now and its starting with you
• Good Luck.