1. Primary Care Panorama A 360 Degree Look at Primary Care 2015 Quality Forum Dr. Bill Cavers- President, Doctors of BC Dr. Brenda Hefford- ED,Practice Support and Quality, Doctors of BC Shana Ooms, Director, Primary Health Care,Ministry of Health Petra Pardy- ED Primary Care, Fraser Health

2. Evidence for benefits of Primary Care: “… helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care… associated with a more equitable distribution of health in populations.” - Barbara Starfield (2005) “…available evidence confirms improved population health outcomes and equity, more appropriate utilization of services, user satisfaction and lower costs in health systems with a strong primary care orientation.” Atun R (2004) What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? Copenhagen, WHO Regional Office for Europe

3. Primary Health Care Charter “Family physicians are the cornerstone of Primary Health Care. They are part of a broader community network and professional team…”

4. www.gpscbc.ca Ministry of Health Services + Doctors of BC Operational rather than structural solutions Input from Health Authorities Responsible for: -Care incentives (fee codes) -Practice Support Program (PSP) -Divisions of Family Practice -A GP for Me “Finding solutions to support and sustain full service family practice in British Columbia” General Practice Services Committee (GPSC)

5. www.gpscbc.ca Experience of Care Improved Experiences for Patients and Providers Per Capita Cost More Sustainable Health Care System Population Health Improved Health of the Population Triple Aim

6. www.gpscbc.ca Chronic Disease Management (CDM) Conferencing fees Complex Care Initiative Maternity Network Initiative Mental Health Initiative Family Practice Incentive Program

7. Evidence from BC 7 “…the more higher-care-needs patients were attached to a primary care practice, the lower the costs were for the overall health care system (for the total of medical services, hospital services, and drugs). The majority of the cost reductions stemmed from decreases in the costs of hospital services.” - Marcus Hollander Healthcare Quarterly, Vol 12 no 4, 2009

8. Learning modules: Advanced Access/Office Efficiency, Group Medical Visits, Practice Self-Assessment Adult Mental Health Child and Youth Mental Health Chronic Disease Management End of Life Advanced Care Planning Shared Care - COPD/Heart Failure Practice Coaching Practice Support Program

9. Formed in 2006 (PMA) Mandate to provide funding and project support to family physicians and specialist physicians to improve the flow of patient care from primary to specialist services. Works closely with the other collaborative committees; the GPSC and SSC has helped more than 2,500 family physicians and 240 specialist physicians to work together on over 240 projects across BC. www.sharedcarebc.ca Shared Care Committee

10. Partners in Care (PIC) Transitions in Care (TIC) Polypharmacy Rapid Access to Psychiatry Teledermatology Youth Transitions Child and Youth Mental Health Collaborative (CYMHC) www.sharedcarebc.ca Shared Care Committee

11. Improve patient care Increase family physicians’ influence on health care delivery and policy Provide professional satisfaction for physicians www.divisionsbc.ca Doctors of BC MoH Ministry of Health PMA Physician Master Agreement GPSC General Practice Services Committee DoFP Divisions of Family Practice Divisions of Family Practice was founded to:

12. Local Divisions of Family Practice are community-based groups of family physicians working together to achieve common health care goals.

13. A new way of working together GP Doctors of BC Health Authorities GP MoH Divisions Health Authority Doctors of BC  Municipalities  Community Groups  Non-profit Societies Results

14. Divisions of Family Practice Growth 2009 to current 14

15. Promoting Clinical Integration Through Collaborative Services Committees Chilliwack Primary Care Seniors Clinic Home Health Integration in White Rock-South Surrey Residential Care Program in South Okanagan Similkameen

16. Attachment Initiative: Three prototype communities 16

17. A province-wide initiative funded jointly by Doctors of BC and the Government of BC to strengthen the primary care system 17

18. Goals of A GP for Me Enable patients who want a family physician to find one Strengthen and support the family doctor - patient continuous relationship, including better support for vulnerable patients Increase capacity of the primary health care system 18

19. Multi-pronged approach 1.Physician practice level incentive fees 2.Community patient attachment strategies through Divisions of Family Practice 3.Integration, alignment, and leveraging of existing health authority, ministry, joint clinical committees, and partner initiatives, programs and policies 4.Patient and public engagement and education 19

20. Practice Level - attachment incentives Four new family physician fees. The fees are for: Attaching unattached patients with complex health needs; Managing the care of frail patients; Providing patient care over the telephone for all patients; Conducting conferences with other health care providers for all patients. 20

21. Practice level results to date* 3,101 family physicians have ‘signed-up’ to participate in A GP for Me locally via their Division of Family Practice. 75% of full service family physicians. More than 415,000 patients have received attachment related services $ 31.0 million has been paid for these services * Based on services from April 1, 2013 to December 31, 2014, paid to December 31, 2014

22. Community supports: Local divisions of family practice $40 million over three years to: Engage and assess: community and patient needs, local family doctor needs, strengths and gaps in local primary care resources Develop and implement community plans for improving local primary care capacity, including finding doctors for patients who want one 22

23. Principles and Funding Parameters 1.Contribution to A GP for me Goals 2.Patient Centred 3.Accountable 4.Quality Improvement Oriented 5.Locally based and community developed 6.Collaborative 23

24. Principles and Funding Parameters 7. Aligned with regional and provincial strategies and initiatives 8. Contribute to integration 9. Comprehensive (promoting generalism and full scope of practice) 10. Sustainable www.divisionsbc.ca; http://agpforme.ca/; www.gpscbc.ca/attachment-initiative www.divisionsbc.cahttp://agpforme.ca/ www.gpscbc.ca/attachment-initiative 24

25. Key Community Strategies 25 Physician retention and recruitment Practice Efficiency and Clinical Improvement Supports Inter-professional team based care Public Education and Health Promotion Attachment mechanism

26. Community level results to date Planning and Assessment ImplementationTotal Expenditure as of December 2014 $10,746,231$7,832,000$18,578,231

27. 27 Integrate and Navigate Primary and Community Care - Supporting Frail Seniors 1.Creation of meaningful connections between clients’ GPs and case managers. 2.The expansion of the care management team to include a Surveillance Nurse (SN) and a client services assistant (CSA). 3.Incorporation of the CARE Management approach into daily practice by Case Managers and the SN

28. 28 Progress to Date Integration Achievements 2010 - 2014 CompletedPotential 1.# HH Offices with Surveillance Nurse Implemented 12 2.# HH Offices with Client Services Assistant Implemented 12 3.# Divisions of Family Practice connected to HH offices 10 4.# GPs engaged across all communities 405 5.# Home Health Long Term clients impacted -10,015 6.# Clients with the Surveillance Nurse -2,500

29. 29 Impact of the Surveillance Nurse on Client Outcomes  Clients with the Surveillance Nurse (SN) are 3.2 times more likely to survive in the community than clients not with the SN.  Clients who are with the SN and who are contacted more frequently by the SN, survive for longer in the community.  A CARE Management approach appears to delay death or transition to AL /RC.

30. 30 Survival In the Community (SN vs non-SN clients, N=590)

31. 31 Survival In the Community ( Total N= 954) Clients who were seen less frequently by SN ( who had 1 or 2 RVs n=408) Clients who were seen more frequently by SN ( who had 3 or more RVs n=546) Days between initial call from SN to any adverse event (AL, RC or Death)

32. 32 Added Value & Impact 1. Case Manager – GP Connections: “This is the missing link..” Surrey Case Manager “I met (Case Manager) last week. It was one of the most productive 20 minutes I’ve spent in medicine. She had a list of my patients on her books. We decided on the best way to contact each other quickly…(This initiative) is a wonderful positive example of the new relationship between MOH, BCMA & HA’s. When something is so right for your patients, it’s obvious” Dr. Ralph Jones (Chilliwack Family Physician / President, SGP) “Very efficient use of my time, a no-brainer.” Dr. Robert Hepburn, Surrey Family Physician

33. Success Factors 33 Relationships Doctor/ patient Members of the health care team GPs and specialists, multi-disciplinary providers, system planners, administrators, community Patients and families, as partners Orca Pod Pacific Coast, British Columbia

34. Success factors 34 Shared Perspectives Shared vision Common ground Flexibility, adaptable Bottom-up Stimulating for all It is not the answer that enlightens, but the question. Eugene Ionesco Decouvertes British Columbia Coastal Rain Forest “ ”

35. Success Factors 35 Annual Polar Bear Swim, Pacific Coast, British Columbia Photo: Mark Klotz, Vancouver, BC Courage Unfamiliar territory Letting go of old ways Okay to fail and learn Trust in the process Open to new possibilities

36. If you want to travel fast, travel alone. If you want to travel far, travel together. “ ” West Coast Trail, Vancouver Island, British Columbia

37. Section Title goes here Section 3 37 An initiative of the GPSC, funded by Doctors of BC and the Government of BC Thank you!