1. Patient Centered, Community Designed, Team Delivered A framework for achieving a high performing Primary Health Care system PRIMARY HEALTH CARE & PHARMACISTS JANUARY 18, 2012

2. 2 What is Primary Health Care? Primary health care is foundational to the health system. It is often the first point of contact people have with a health care provider when they have a health concern. It may be a Family Physician/Nurse Practitioner visit, advice from the pharmacist or information on chronic disease management. A strong primary health care system provides access to high quality care delivered by a team of health professionals that meets the needs of patients and their families of all ages in any health care setting.

3. 3 Pharmacists Seniors’ Care Addictions CPAS Physicians Research Community Development Chronic Disease Management Public Health Mental Health Home Care Primary Health Care Patient and Family-Centred Care Nurse Practitioners

4. 4 Why change? Patients want to be more informed and involved with their own care. Communities would like greater say in the design and delivery of health care services for their residents. First Nations and Métis peoples need a culturally responsive system. The federally-funded First Nations system must also work in partnership with the provincial system. Family physicians and other health care providers seek more flexible funding options, greater work life balance and more teamwork.

5. 5 Primary Health Care - Objectives Develop a draft framework on the approach to strengthening and progressing Primary Heath Care in Saskatchewan. Engage in consultations with stakeholders to affirm direction of the framework. Test new models of primary health care delivery while progressing PHC across the province.

6. 6 Phase I Governance Structure

7. 7 Saskatchewan’s Vision and Aims for PHC Vision Primary Health Care is sustainable, offers a superior patient experience and results in an exceptionally healthy Saskatchewan population. Major Aims Access Everyone in Saskatchewan - regardless of location, ethnicity, or ‘underserved’ status - has an identifiable primary health care team that they can access in a convenient and timely fashion. Patient & Family Experience A model of patient and family centered care has been implemented to achieve the best possible patient and family experience. Healthy Population The primary health care system has contributed to achieving an exceptionally healthy population with individuals supported and empowered to take responsibility for their own good health. Reliable, Predictable & Sustainable We are achieving reliable, predictable and sustainable delivery of primary health care.

8. 8 Proposed Framework Recommendations Everyone in Saskatchewan will have access to a Primary Health Care Team that meets their every-day health needs and helps them navigate the rest of the system. Primary Health Care services will be designed with patients and the community and rooted in community. Build a culturally responsive system that is representative of the community it serves, with specific attention First Nations & Métis.

9. 9 Proposed Framework Recommendations Flexible approach to service delivery model design and Primary Health Care Team composition to meet community need and match with community resources and assets. Build a coordinated system that includes independent family physician practices, RHA managed primary health care services, and the federally-funded First Nations primary health care delivery system. Flexible funding approach, with resources and decision making located closest to the patient, community and RHAs. An accountability framework will be developed to support this flexibility.

10. 10 The team that delivers service Key Functions Diagnose, Treat and Prescribe Case Management supports self- management Navigation and Coordination Chronic Disease Prevention and Management Attributes of Core Team Multi-skilled Professionals Co-location is preferred After hours access for their patients Representative of the community it serves Cultural Competence Core Team (e.g.) Healthcare Provider –Physician or NP linked to Physician Clinical Nurse –RN or RPN Clerical Staff With Access to Extended Members/ Other Resources based on the needs of the community Traditional Healers Pharmacist Public Health Nurse EMT / First Responder Mental Health Professional Midwives Home Care Community Developer Specialist Physicians Other – not exhaustive list Each patient/family is a key member of their team. Each Team includes or is linked to a family physician

11. 11 Service Delivery Models Community A Cty B Cty C Cty D Cty E Community A Community CCommunity B Multi-Community Delivery Hub and Spoke Delivery The Extended Team The Core Team Single-Community Delivery Communi ty A Connection Options  Itinerant  Outreach (Bus)  Virtual

12. 12 Elements of High Performing Primary Health Care Systems Team-based, patient and family centered care After hours access Evidence-based care incorporating best practice including that for chronic disease management Patient/Community Advisory Councils Supports patients in system navigation Collects data and measures performance Continuous quality improvement

13. 13 Benefits to patients and families Patients and families are true partners in their health care. Patients and families will be assisted in managing and maintaining their own health to the greatest extent possible. Patients living with or at risk of chronic disease will be supported and empowered to manage their conditions and given timely access to care when needed. Patients will choose their primary health care team and understand and appreciate the benefits of being connected to a team as their home base for health services and improved access.

14. 14 Benefits to communities Primary health care development in every community will begin with the community’s involvement in assessing its needs and planning how to meet those needs. Community engagement is essential to building the trust and relationships required to successfully implement and evaluate effective primary health care. Community engagement will lead to an on- going exchange of information and ideas among health care leaders, providers, and planners.

15. 15 Benefits to First Nations and Métis People First Nation and Métis communities will participate in building a system that provides their members with the best possible care and experience. There will be increased collaboration between the First Nations and RHA primary health care systems.

16. 16 Benefits to health care teams Practitioners will enjoy the full benefits of team-based care, including better job satisfaction and increased information sharing between health care professionals. Health care policies and funding will focus more on promoting health, managing chronic disease, and developing teams and innovative programs that reflect patient and family centred care. Opportunities for input and joint problem solving will exist at all levels of the primary health care system, and will include representatives from all stakeholder groups: patients and families, community leaders, First Nations and Métis peoples, and health care providers.

17. 17 Benefit to physicians Physicians will be able to work to their full scope of practice while enjoying a better work-life balance through improved team work. Physicians will be better linked to RHA support services, such as dieticians and social workers, the goal being streamlined patient access. Strengthened relationships between Physicians, health regions and communities.

18. 18 How will we do this? Build Long Term Relationships Increase Patient and Family Self-Reliance Engage Communities Engage First Nations and Métis Communities Enable Primary Health Care Teams to Flourish

19. 19 How will we do this? Proactive chronic disease prevention & management Build models that work Shift focus to promoting health Transition support

20. 20 The Foundation: Primary Health Care Healthy Community Focus Managing Chronic Diseases Everyday Health Services After-Hours Everyday Health Services Urgent Care Security in EMS Acute Care Emergency Care

21. 21 Next Steps: Affirming the Direction Consultations with: –Leadership Council –RHA Physician Groups –RHA Leadership Teams & Boards –Council of Health Sciences' Deans –NIRO –Community Clinics –Board or Committee of SMA, SRNA, SANP –SK Academic Health Sciences Networks –Board or Committee of SUMA and SARM –FSIN & MNS officials –Health Canada

22. 22 Next Steps: Learn by Doing Progressing & Testing –develop tools and supports –test elements such as community engagement, First Nations partnership, chronic disease management, PHC team development –Continue to make progress across all of Saskatchewan Physician Engagement & Transition –develop instruments and strategies to engage physicians –identify and develop supports for transition to new models

23. 23 Next Steps: Learn by Doing Tools and Supports Learn by Doing WG Physician Engagement & Transition WG

24. 24 Next Steps: Creating the Links Chronic Disease Prevention Management Mental Health & Addictions First Nations & Métis Urgent Care Models Pharmacists in PHC Teams or Initiatives EMR /IT

25. 25 Pharmacists on Teams Improve communication between all health care providers Improved access to care i.e. often the pharmacists are the HCP available evening & weekends Medication management i.e. chronic conditions

26. 26 Pharmacists on Team con’t Contribute to data collection as part of the team Continuous Quality Improvement with all health care providers Role in helping to navigate the system

27. 27 How? Ministry of Health pilot showed effectiveness of Pharmacists on teams ~23 sites currently have formal connection with Pharmacists (27 pharmacists) i.e. Wynyard, Wadena Link through Director of Primary Health Care in each Region

28. 28 What We Learned Be the Change you want to See / the Medium is the Message Patient and Community Voice Openness, Flexibility & Creativity When the work ends, it really is just beginning Trust is built by commitment to action over time

29. 29 Discussion Thank You! Questions?