“Now I don’t want to rain on this parade, but most of the GPs in my community are working full out and don’t have any room for extra patients. It’s not as if a bunch of family physicians are sitting around killing time and now that these financial incentives have been announced they are going to cancel their afternoon golf and work harder.” [“A GP for Me”: Will it work? BCMJ 2013;55:133.]
This quote does get to the nub of the issue of delivering quality primary care to all the citizens of British Columbia. Some think that attachment is about delivering ever-more new fee codes. This is only a small part of a very complex solution. With the exception of the new telephone codes, which may increase efficiency, the majority of new fees pay us to spend more time with the patients we have and, therefore, will leave us with less time to spend with new patients. There are new codes to take on new patients, but as DRR so eloquently captures, most doctors are already working to their maximum capacity. I would submit that the three prototypes have already demonstrated that a comprehensive attachment strategy, with the same or less effort for the practising GP, could work. Bottom-up in-office innovation is the key coupled with the incorporation and utilization of untapped resources in the community and patient population. Engagement of patients and community by the divisions in prototype communities is unprecedented and has created an ongoing positive dynamic.
A more pertinent question than “Will it work?” is “Will it be supported sufficiently to work?” One may also ask if there are some in positions of influence who fear change and would prefer that this initiative trends back toward status quo. The medical manpower landscape is changing. Those working intolerably long hours are heading toward retirement and those coming up have some expectation of work-life balance. This train of evolving physician expectations is about to meet the train of changing population age demographics head on. Those who fear change are the ones most likely to disembark before that impact occurs. However, they should still be interested in solutions as they will soon be embarking on the aging population train themselves! What to do about it?
Give divisions the resources to get the job done. The prototype communities have demonstrated innovative solu-tions to local care gaps and general strengthening of their primary care communities. When the attachment initiative was started, it was cost-ed out at $20 per citizen. One thing led to another, and over the 2 years of prototyping, the money available to divisions has been whittled down to $3.50 per citizen. For this sum, divisions are tasked with ad-dressing all care gaps in their communities and creating sustainable quality health care for all. This is a tall order at this level of support. Prince George is on track to achieve this lofty goal. We are very fortunate and appreciative of having been supported as a prototype community.
So the failure, if it is to occur, would in my opinion be the lack of vision and commitment to quality patient care for all citizens by those who influence the provision of funding to this initiative. And clearly, it is about a lot more than new fee codes. Squander the opportunity with inadequate support and witness the consequences of all parties with-drawing to their corners to duke it out. What a loss that would be for patients.
—Barend Grobbelaar, MD
Vice-chair, Prince George Division of Family Practice
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