Opinion: Access to care the No. 1 issue according to citizen panel on primary care in B.C.

Opinion: Because we don’t have enough doctors, the panel recommended primary care teams that include nurse practitioners, nurses and mental-health clinicians.

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As the bedrock of our health-care system, primary care is what supports all other areas of care. It provides Canadians with a reliable first point of contact for their health-care needs, keeps our emergency departments caring for true emergencies and ensures people’s health issues are managed so they don’t deteriorate.

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But that solid foundation has been eroded over many years, and we’ve all seen the negative impact of this on our loved ones and those in our communities.

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Last fall, our OurCare research team heard from more than 9,000 Canadians who responded to a survey about their experiences with family doctor care and how they want to see the system evolve to better address their needs. We found that more than one in five adults in Canada don’t have a family doctor or nurse practitioner they can see regularly for care — and even those who do are struggling to get care in a timely way.

People were open to doing things differently. For example, 90 per cent said they would be comfortable getting care from another health-care team member if their family doctor recommended it. What they cared about most was having a family doctor who knew them as a person and considered all the factors that affected their health.

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Over the past six months, we engaged 31 British Columbians (our “citizen panel”) who collectively invested almost 1,000 hours of their time learning about the health system and deliberating about challenges and opportunities to improve B.C.’s primary-care system.

In their report, released Sept. 19, they have described 25 clear, actionable recommendations that will transform the way we think about and deliver primary care in B.C.

Unsurprisingly, access to care was the No. 1 issue that our citizen panelists said had to be addressed.

So, what are the solutions for the access crisis?

Several are already underway: B.C. recently developed an innovative new longitudinal family physician funding model to support family physicians and their offices. The data suggest there are already new family doctors practising comprehensive family medicine as a result of these changes, and we’ve heard stories of family doctors moving from other places in order to practise here.

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While this is good news, we simply don’t have enough physicians in B.C. to meet the demand of all the primary care we need. We are stretched, not just in B.C., but also everywhere in the world.

And because we don’t have enough doctors, we need innovation not just in physician funding models, but also to develop robust primary-care teams that include nurse practitioners, nurses and mental-health clinicians to ensure that we can actually provide the care that we all need and deserve.

The citizen panelists made clear recommendations that team-based care is key to addressing the issues they face trying to stay healthy.

Our citizen panelists specifically called out increased investment in Community Health Centres (CHCs), which are community-governed, multidisciplinary teams that include family doctors and other health professionals, who work together in a co-ordinated fashion to provide primary care. They felt that these CHCs should be deployed with equity in mind: They should first be expanded into remote, Indigenous and low-income communities where we see the most challenges with access to care.

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The panel recognized that there are some patients who struggle to understand how to navigate multiple appointments, book their own lab tests and co-ordinate the many aspects of their care. Panelists felt that a valuable addition to health-care teams would be the introduction of patient advocates who can ensure that no patient is left behind due to their health literacy, language barriers or challenges navigating our complicated health system.

They have also advised major improvements to the technological aspects of primary care, from accessible electronic medical records to expanded virtual-care options.

They also recognized that no new investment or change can be adequately spread or scaled without evaluation to understand its impact, outcomes and return on investment. They believe that there needs to be a system of robust and independent evaluation of primary-care initiatives in B.C., and that efforts should be made to quickly spread and scale effective programs and community-level interventions.

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We have a chance to build a truly world-class primary care system in our province that can be the envy of Canada and the world. The citizens of B.C. have shown us where we can start.

Goldis Mitra is a family physician and clinical assistant professor in the department of family medicine at University of B.C. Christie Newton is a family physician and associate professor in the department of family practice at UBC and president of the College of Family Physicians of Canada. Tara Kiran is a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto and the Fidani Chair of Improvement and Innovation at the University of Toronto.


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