Chaos in primary care. GPSC replies

In his letter, Dr Brown makes some valid points. Family practice is facing many challenges. But is it in its death throes? In my opinion, the answer is no. The value of primary care as laying the foundation for efficient, effective, and sustainable health care is well supported by evidence and is now being acknowledged broadly by government policymakers, health care administrators, and our medical associations as we plan for the future.

The reality is that change, which is often messy, is needed. That is where we find ourselves now. We are in a period of significant change not seen for decades, and it can feel chaotic. But I believe that it will lead to a primary care system that better supports family doctors and the teams that work with them to better meet the needs of the patients we serve. I would like to provide some perspective on some of the issues and what is currently happening.

First, we know that family doctors are frustrated by mounting demands and system challenges that affect our ability to work in an efficient and healthy way to deliver quality care. Doctors of BC members identified these as among the most significant contributors to physician burdens in a consultation conducted last year.

A key issue, as Dr Brown points out, is compensation: many of the things that family physicians do in support of the longitudinal care of their patients are not well supported by the current fee-for-service payment model. In response to this, the General Practice Services Committee (GPSC), a partnership of Doctors of BC and the BC government, has over the years introduced various incentives to help support family doctors in the chronic and complex care of their patients. While this has been valuable, the increase in coordination needed to deal with the large amounts of information, increased complexity in the system, and the aging population means that it is not enough. The recent introduction of the new GPSC Community Longitudinal Care Payment for fee-for-service family physicians is one step toward recognizing this.  

Beyond various incentives or payments, moving away from fee-for-service to other methods of compensation is an option now desired by many physicians. A consultation process currently underway between the Ministry of Health and Doctors of BC is actively exploring the development of new compensation models, with the aim of starting to provide these options later this year.

The need for change, however, goes beyond compensation. As Dr Brown notes, physicians need to be supported by a network that enables them to provide patients with appropriate access to comprehensive care as part of their practice. The divisions of family practice, developed and supported by the GPSC, provide physician support and connections at the local level that set the foundation for this networking and for broader system partnership and planning.  

Change is inevitable, and physicians are being enabled and empowered to have a significant voice in creating and leading this change. The collaborative tables set out through the Physician Master Agreement provide the opportunity for this influence. The GSPC is the leading collaborative table for primary health care transformation in BC, supporting the creation of patient medical homes and the implementation of primary care networks enabled by team-based care.  

The patient medical home—the cornerstone of primary care networks—describes an ideal family practice where the physician is supported by a team of providers to provide longitudinal quality care to a defined population of patients. With the support of a team, a family doctor will be freed up to appropriately address concerns that require a physician’s expertise. To support family practices to shift to team-based care in patient medical homes, the GPSC is providing in-practice coaching and supports, incentives, and technology supports.  

Through primary care networks, divisions of family practice—representing physicians and practices/patient medical homes—are partnering with health authorities, First Nations, and community partners to bring health care providers together into clinical teams, to wrap services around doctors and their patients, and to collectively meet the primary care needs of their communities.

Across the province, hundreds of physicians are participating in and leading primary care change at the practice, community, and provincial levels. I believe we have the right people at the right tables to work through the challenging conversations that need to happen to ensure that the changes we make result in a more fulfilling and rewarding professional practice for physicians and the teams that work with them, make better use of system resources, and ultimately provide better care for the patients that we all serve.  

The issues are real. Change is messy and it takes time. But with this level of talent, strength, and leadership among our physicians, I believe we are stepping forward together into a brighter future.
—Shelley Ross, MD
Co-chair, General Practice Services Committee

This letter was submitted in response to “Chaos in primary care.”