Attachment Update
Divisions Provincial Roundtable
May 31, 2012
Timeline
*Program design
*Prototype
selection
*Development
funding June
2010
*Connect and
strengthen
*Practice
payments using
algorithm
*Test My GP,
refine definition
*Evaluate
*Research
*‘Good enough’
definition
*Engage CSC
*Develop plan
*Year 2
Implementation
funding March
2012
*Year 1
Implementation
funding March
2011
*Practice
payments using
algorithm
*Research and
finalize plans,
implement
*Engage docs,
HA and local
partners
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Innovations to share
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Practice Assessment Survey
Integrated practice supports
Practice payments and PIA
Multidisciplinary grants
Community survey of patients
Community level gaps analysis
Community engagement
Primary care clinic with distribution focus
Patient engagement
Definition of attachment
Patient confirmation process – primary care provider
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Evaluating the Issue: Unattached Patients
Prince George
• Estimated unattached patient population: 15,000
• variation according to life circumstance and chronic conditions
White Rock–South Surrey
• 5 to 35% of population unattached:
• Hospital discharges: 5-20%
• ER: 10-35%
Cowichan Valley
• 5% (4,143) Unattached Patients
• 40% (33,148) Poorly Attached Patients
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Attachment Strategies:
Enhancing capacity of the local primary care system:
Practice coaching
Recruitment and locum coverage
Making coordination of care easier – technology, Integration
Recognizing and rewarding longitudinal care provision
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Creating multidisciplinary care models
• Stand-alone clinics with assessment and distribution
functions
• In-practice enhancement of non-physician providers
• Enabling access to phychiatrist, pharmacist, other providers
Improving health of population overall to reduce demand
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Community-level collaboration with public health,
municipalities
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PGDoFP Strategic Directions
VISION
All citizens of Prince George will have access to quality,
coordinated, sustainable, integrated, longitudinal care in an appropriately supported
Primary Care Home that is integral to improving Quality of Life for all.
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Providing and Supporting Access to
Multidisciplinary Care
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Multidisciplinary care for patients who are
unattached and require team-based care
Timely and appropriate access to services, and active
communication between the patient, the team, and
the Primary Care Home
Aligned and integrated with Northern Health’s
services
Developing and Supporting
Excellent Primary Care Homes
(PCH)
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Supporting Primary Care Homes to provide
longitudinal, comprehensive, safe, team-based,
measurable, quality care with an attention to
relationships and diversity
Empowering and supporting Family Physicians
and their practice teams towards excellence by
providing individualized assessment, coaching
and ongoing support
GUIDING PRINCIPLES
MISSION
Through innovation and engaging our skilled physician population
we will be a leader in providing sustainable, quality, longitudinal care that is focused
on the unique needs of individual patients and our community as a whole.
• Increasing capacity in patient-centered Primary Care
• Leading from within and fostering shared leadership
• Meeting people where they are at, both physicians and patients
Sustain a Strong Community of
Family Physicians
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Attract and retain an adequate number of
Physicians to meet the health and wellness
needs of Prince George
Strengthen the skills, knowledge, personal
growth, and engagement of our Family
Physicians
Continue to build a dynamic, healthy,
resilient, caring community of Physicians
Reducing Demand Through
Healthier Communities
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Build upon the understanding that healthy
communities ultimately ensure the most
effective and appropriate use of health
resources
Building relationships with partners toward
creating and maintaining a healthy
community
• Mentoring for continued improvement
• Building consensus
• Encouraging inclusiveness
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Prince George - Attaching Patients
Current activities
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Unattached patient clinic – opened May 2008
Inpatient Primary Care Program (for unattached patients)
Managing ‘retirements’
Analysis of Practice Assessment Survey Data
Recruitment
Supporting practice effectiveness
Next Steps
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Primary health care clinic (will incorporate UPC)
Opening July 2012
Increase support for practice effectiveness and capacity
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Cowichan Initiatives
Family Practice
Hospital Support
Program
Cowichan Maternity
Clinic
Current
Initiatives:
Aboriginal Health
Working Group
Chronic Pain
Working Group
Provincial
Attachment
Working Group
CVDFP
Attachment
Working Group
Practice Coaching
Locum Coordinator
Warmland Health
Services:
Proposed
Initiatives:
Unattached Patient
Services
End of Life/Palliative
Care Working Group
Cowichan - The synergistic effect of taking a
mixed approach…
… allows the community to develop an overall vision and
then implement portions of the vision as funding and
resources allow.
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White Rock-South Surrey - Attachment
Strategies
Increase Capacity &
Support Strength of Attachment
Develop &/Support Targeted Programs for
Vulnerable Populations
Increase Public & Patient Understanding of
Attachment
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White Rock-South Surrey
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Results to Date
WRSS: 2500 patients attached
• 900 through 2 new doctors
• 600 through PCAC
PG: 3771 patients attached
• Recruitment (3192)
• Residential care (114)
• IPC (465)
Cowichan: 575 patients attached
• Maternity clinic (133)
• Hospital support program (21)
• Locum program (421)
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Risks and Challenges
• No Physician Master Agreement, resulting in
funding uncertainty
• Administrative stability (staff turn-over)
• Hospital care pressures
• Physician burnout
• Patient inflow
• Unrealistic stakeholder expectations
• Accommodating patient choice
• Physician office space limitations
• Difficulty recruiting new physicians to some
communities
• Difficulty staffing clinics
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Thank you....
Questions?
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