A GP for Me – Assessment and Planning Phase

CSC MeetingMarch 28, 2014

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Our Vision

• Promoting healthy communities through excellence in local primary care

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Our Mission – Improving patient care and population health by:

• Enhancing physician collegiality and professional fulfillment

• Increasing family physicians’ influence and impact on policy and delivery decisions

• Building partnerships that facilitate an effective and sustainable health system

• Ensuring access to excellent primary care

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Our Activities

• Focusing on incremental change driven by member physicians

• Working on short term actions and longer term goals

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Our Approach

• Working with partners (specialists, health authority, and other Divisions) to benefit all in our community

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Working Group Process

Conducting intensive root cause analyses

Identifying core problems related to:Primary care access

Locums and practice coverageMental health and addictions care access

Care of the elderly

Culminating in development of strategic plan

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A GP for Me Provincial Initiative

Initiative designed to answer these questions, and address the barriers preventing patients from receiving

excellent primary care.

How can we strengthen the GP-patient relationship?

How can we better support the needs of vulnerable patients?

How can we ensure that patients who want a family doctor can find one?

How do we increase the capacity of the primary care system?

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Why ‘A GP for Me’?• People without a regular care provider seek care through walk-in

clinics or emergency departments• Leading to fragmented care, poor outcomes and increased system costs

• Studies in BC and internationally demonstrate the benefits of a strong primary care system centered on longitudinal doctor-patient relationships• Fewer hospitalizations, reduced pressure on emergency rooms, improved

patient health outcomes and reduced population health care costs

• In BC, Hollander Analytical Services determined that higher levels of attachment between a patient and family physician leads to better outcomes and significant cost savings for higher-needs patients• Projected that an increase of 5 per cent in attachment for these patients

would result in a cost savings of about $85 million annually

From: http://www.gpscbc.ca/sites/default/files/Physician_Overview_of_AGPforMe_Initiative_130909.pdf

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A GP for Me Phases

1.Assessment and planning

2.Implementation

3.Evaluation

We are currently in the first phase…

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Assessment and Planning – Project Goals

• To determine the boundaries of the community to be served.

• To examine the population and population profile (including residents, FPs, and other primary care resources).

• To identify the key capacity issues facing the local primary care system in relation to the problem of unattached patients.

• To develop strategies to address the key findings of assessment activities.

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Logic Model

Inputs Outputs Outcomes Steering Committee Project Coordinator and Engagement Consultants Detailed workplan Stakeholder engagement strategy:

Focus on vulnerable populations Community survey

Physician and MOA surveys Data collection plan Communication strategy Connections to existing VDFP initiatives:

Welcoming and transitions mentoring

Primary care access Practice coverage Care of the elderly Mental health & addictions care

access

Analyze demand for primary care

Analyze supply

Identify citizen and patient preferences

Identify key capacity issues facing the local primary care system in relation to the

problem of unattached patients

Develop solutions/strategies

Immediate:

Implementation plan/proposal is developed and receives GPSC approval/funding

Intermediate:

Better support for the needs of patients, including those who are the most vulnerable

Better support for the needs of family physicians

Long-Term:

Strengthen the GP-patient continuous relationship

Enable patients that want a family doctor to find one

Increase the capacity of the primary care system

Evaluation Process Engagement Outcomes Knowledge Transfer

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Analyze Demand

• What is the population profile? What is the health status?

• How many people are looking for a family physician and cannot find one? Are there common characteristics amongst these people?

• How many people seek primary health care? Where do they seek care e.g. walk-in, ED, sexual health clinic, etc.?

• What other healthcare services do people access?

• What is the magnitude of unattachment? Is it across the population? Is it more of a problem for particular groups (e.g., individuals living with mental illness and/or addictions, frail seniors, etc.)?

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Work to Date

• Data gathering and analysis:• Population/demographic, health status, utilization,

attachment rates

• Stakeholder engagement:• Focus on vulnerable populations identified through

VDFP working groups and quantitative data analysis

• Individuals living with mental health and addiction problems; frail and elderly; patients living with high co-morbidities; patients living with cancer; new mothers; First Nations off-reserve; and young military families

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StakeholdersCompleted consultations and

focus groups:

Beacon Community ServicesBC Cancer AgencyBC Schizophrenia SocietyCFB EsquimaltCitizen's Counselling CentreCool Aid SocietyCanadian Mental Health AssociationHealth Services, University of VictoriaIsland Health - Home and Community Care, Mental Health and Substance Use Services, Integrated Primary and Community Care, Planning and Engagement, Seniors CareIsland Sexual Health Maternity physicians

Initial contact made and pending focus groups

Capital Mental Health AssociationFirst Nations Health AuthorityThe Midwives CollectiveIntercultural Association of Greater VictoriaYouth ClinicPatient Voices Network

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Analyze Supply

• How many physicians are providing longitudinal primary care?

• What is the retirement timeline for physicians that are currently practicing?

• What are the FPs perceptions about the efficiency of their practice and the primary care system?

• How difficult is it for physicians to find locums and how do they cope?

• Are there some patients who are more difficult to support? What would encourage physicians to take on these patients?

• What makes a strong relationship between a GP and a patient?

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Work to Date

• VDFP physician survey data analysis complete

• First contact with walk-in clinics

• First contact with Residency program

• First contact with Practice Support Program (PSP)

• Focus group with locums (with SIDFP)

• Focus group with residents (with SIDFP)

• Continue building list of community primary health

care resources (non GP) available in LHA 61

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Identify Citizen and Patient Preferences

• What barriers are patients (including vulnerable populations) finding as they try to access primary care?

• When citizens seek care, do they prefer to see their family doctor, a walk-in clinic or other facility, and what considerations guide their choices?

• What are the most important qualities of the relationship that people (including vulnerable populations) want to have with an FP or other primary care provider?

• How do people currently find a FP? Why don’t some citizens want a FP?

• How can the primary care system be more efficient?

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Work to Date

• Community survey launched on-line (with SIDFP)

• Paper survey in member physician clinics

• Consultation and focus groups with selected stakeholders (see slide 15)

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Critical Issues for Patients, GPs, and the System

• Practices are operating at capacity, walk-ins are full, but there are still an estimated 30,000 unattached patients in Greater Victoria (LHA 61) • Research shows that attaching these patients can lessen the burden on

other health services

• Need to work together to ensure appropriate services are utilized and improve patient flow

• Not all unattached patients are the same • Their primary health care needs vary from modest (one GP visit per year)

to highly complex (multiple visits, high associated workload for GP)

• GPs need supports if they are to take on the more complex patients • GPs want to work with other providers to give the best and most

appropriate care to these patients

• This is what GPs mean by 'integration'

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Critical Issues for Patients, GPs, and the System

• The process or mechanism of 'matching' patients and doctors is complex• There is no magic tool!

• Some will self-identify but many of them are identified as unattached as they enter or leave an Island Health service (and this is not tracked consistently)

• There needs to be a way of 'handing off' these patients for follow-up care and monitoring with a GP as/if required

• Matching requires clinical judgment; it is really more like a triaging service • This is not merely administrative, this is a health service

• Division really cannot/ought not to employ clinical staff/deliver clinical services in this way

• Could benefit from a partnership approach

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Critical Issues for Patients, GPs, and the System

• We need more family doctors in Victoria! • 21% of members who responded to our practice survey intend to move,

cut back their hours or retire in the next three years

• An additional 13% are unsure of their plans for that same time period

• 48% of members who responded to the survey find it extremely difficult or difficult to secure practice coverage

• There is a significant need to work together on recruitment and retention

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Develop Solutions/Strategies

To be determined once analysis is complete!

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For more information please contact:

Catriona Park, MHAProject CoordinatorVictoria Division of Family PracticeOffice: 778-747-3502Cell: 250-889-2608cpark@divisionsbc.ca

Christine TomoriCommunity Engagement LeadVictoria Division of Family PracticeCell: 250-507-7084ctomori@divisionsbc.ca