Attachment Update

Divisions Provincial RoundtableMay 31, 2012

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Timeline

*Program design

*Prototype selection

*Development funding June

2010

*Research*‘Good enough’ definition

*Engage CSC*Develop plan

*Year 1 Implementation funding March

2011*Practice

payments using algorithm

*Research and finalize plans,

implement*Engage docs, HA and local

partners

*Year 2 Implementation funding March

2012

*Connect and strengthen *Practice

payments using algorithm

*Test My GP, refine definition

*Evaluate

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Innovations to share

• 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

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• Community-level collaboration with public health,

municipalities

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PGDoFP Strategic Directions

Providing and Supporting Access to Multidisciplinary Care 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) 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

Sustain a Strong Community of Family Physicians 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 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

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.

VISION 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.

MISSION

• Increasing capacity in patient-centered Primary Care • Mentoring for continued improvement

• Leading from within and fostering shared leadership • Building consensus • Meeting people where they are at, both physicians and patients • Encouraging inclusiveness

GUIDING PRINCIPLES

S T R A T E G I C

D I R E C T I O N S

2 0 1 2

2 0 1 5

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Prince George - Attaching Patients

Current activities

• 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

• Primary health care clinic (will incorporate UPC)• Opening July 2012• Increase support for practice effectiveness and capacity

Cowichan Initiatives

Provincial Attachment

Working Group

Family Practice Hospital Support

Program

Cowichan Maternity Clinic

Aboriginal Health Working Group

Chronic Pain Working Group

Warmland Health Services:

Unattached Patient Services

End of Life/Palliative Care

Working Group

CVDFP Attachment

Working Group

Current Initiatives:

Proposed Initiatives:

Practice Coaching

Locum Coordinator

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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?