Opinion: Community health centres needed to improve primary care in B.C.
Survey data show the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average
Dr. Rita McCracken, Dr. Mei-ling Wiedmeyer, Ruth Lavergne Publishing date:Apr 01, 2019 • April 1, 2019
For many British Columbians who don’t have a regular doctor or can’t see their doctor when they need to, getting day-to-day primary care means waiting at a walk-in clinic. Often this means telling your whole medical story in a short appointment focused on a single problem. Yet, lacking continuity of care can lead to worse health outcomes and more trips to hospital. Strong evidence shows investing in primary care leads to better health for patients. Primary care provides a first point of access, a continuous relationship over time, and, importantly, co-ordination as patients move through the health system.
Since last summer, the Ministry of Health has announced six new urgent primary care centres and promised at least four more. UPCCs offer same-day visits for patients who aren’t experiencing emergencies but should be seen within 24 hours, much like walk-in clinics. UPCCs do not offer relationship-based care over time or play a co-ordinating role for patients needing to navigate the system. More than $20 million has already been invested in building centres in Vancouver, Surrey and the West Shore and running them for the first year. An extra $2.9 million is projected for a centre in Burnaby announced last month.
When a new UPCC opened in Langford last fall, patients lined up outside. While some were looking for an urgent appointment, many hoped to find a regular place to go for primary care. Survey data show that the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average. While the number of family doctors per person in B.C. is higher than ever, an increasing number of family doctors working in private walk-in clinics — and now UPCCs — are not providing continuous care.
In B.C., the main option for new family doctors to provide continuous care is to set up and manage their own fee-for-service practices. Fee-for-service payment can be a barrier to team-based, preventative care since it only pays doctors and does not encourage the prevention of illness. It also means doctors have to spend time running a business. For some doctors this model works, but research tells us that most new family medicine graduates want to work in team-based practices that do not require running a business.
Community health centres is a team-based primary care model that the B.C. government included in its May 2018 primary care strategy. These non-profit centres provide team-based care, offering access to social workers, family physicians, nurse practitioners, dieticians, counsellors and others and connect patients to other resources.
Importantly, CHCs are governed by a board that ensures they are responsive to the communities they serve. In Ontario, these centres have helped reduce hospital emergency department use by improving access to care — a B.C. government priority. While UPCCs also might seem like a good way to take pressure off emergency departments, studies show that it’s not patients who could visit UPCCs who contribute to delays and crowding but rather patients with more complex medical conditions who need a hospital bed.
We are concerned that UPCCs are diverting funding and health care providers away from models like community health centres and primary care networks with the greatest potential to provide the quality primary care patients need.
Urgent care services have a place in our system but it’s the wrong prescription for B.C.’s primary care ailments. Primary care reform takes time and we need to be thoughtful to ensure policies align with the evidence. What we need are attractive new community-based practice opportunities, like those found in community health centres for the new generation of family doctors.
Drs. Rita McCracken and Mei-ling Wiedmeyer are family physicians; Ruth Lavergne is an assistant professor in the faculty of health sciences at Simon Fraser University.
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Overview
What is an Urgent and Primary Care Centre?
Urgent and Primary Care Centres (UPCCs) are an important piece of our primary and community care strategy. They were first introduced to the province in 2018, with the creation of five new UPCCs in the West Shore (Langford), Vancouver, Quesnel, Surrey and Kamloops.
The goal of UPCCs is to provide a flexible resource to meet both the urgent and ongoing primary care needs of people in communities (primarily in larger urban centres) across the province. UPCCs will work to address several key problems currently faced by patients and health care providers:
- Many people do not have a regular family physician (GP) or nurse practitioner (NP), and as a result they must consistently visit walk-in clinics or the emergency department when they need primary care.
- People go to the emergency department when they have a regular provider, but are not able to get a same-day or next day appointment when unexpected urgent medical issues arise.
- Physicians and health care providers are unable to add team-based capacity to their clinics (such as a nurse or other allied health care provider) because their current space or lease arrangements do not allow for expansion.
UPCCs will help to address all these challenges by serving three main purposes. They will provide urgent care to patients who have health needs that should be attended to within 12 to 24 hours, but do not need the level of service found in an emergency department. They will have net new capacity for attaching patients to a GP/NP for their longitudinal primary care needs. They will be a team-based care clinic with interdisciplinary professionals who will support the urgent and ongoing care needs of all patients in the community, whether unattached, attached at the UPCC or attached elsewhere in the community.
They will provide an alternative to going to the emergency department by offering urgent care services, specifically:
- Basic in-office emergency services for sprains or simple fractures, minor cuts requiring stitches, mild to moderate breathing difficulties, minor burns or rapid access to mental health and substance use crisis intervention services;
- Assessment and treatment for minor illnesses, such as respiratory infections, eye irritation, fever or flu, skin rashes, urinary tract infections or abdominal pain; and
- On-site or close proximity access to diagnostic imaging and lab services that maintain the same hours as the clinic, such as x-rays, point of care testing and blood tests.
To read more, click on the link below.
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AARON DERFEL, Updated: January 27, 2020
Andrea Mendell, nursing an infected cut on her lower lip, arrived 20 minutes before the Queen Elizabeth Urgent Care Clinic opened its doors at 8 a.m. to make sure she wouldn’t have to wait too long to see a doctor.
But Mendell, a high school teacher from Côte-St-Luc, was stunned to discover that there were already 21 people ahead of her in line, with the first patient having arrived at 5:50 a.m. on a recent Wednesday.
Mendell is one of those patients who heeded the advice of Health Minister Danielle McCann: don’t go to a hospital emergency room unless you have a major problem. Knowing that her infected lower lip didn’t qualify as a major problem, Mendell turned instead to one of the winter clinics that McCann pledged would ease the burden on the province’s overcrowded ERs.
Yet at the same time that Mendell was waiting in the packed winter clinic on Marlowe Ave., the ER at the nearby Royal Victoria Hospital was filled to almost double its capacity, with five patients languishing on gurneys in its hallways.
This is precisely the scenario that the winter clinics were intended to avoid, prompting one ER doctor in the Laurentians to call them a fiasco. Other critics suggest that the failure of winter clinics to solve Quebec’s perennial ER crisis is a symptom of a much deeper dilemma: the chronic shortage of family doctors in Montreal as well as a lack of nurses in hospitals.
To read more, click on:
Quebec’s winter clinics far from the panacea promised by health minister.
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New, privatized health clinic will weaken public system: analyst
Seymour Health Centre given $7 million contract by Vancouver Coastal Health to operate care centre
May 23, 2019 By: Graeme Wood
[Excerpt] The privatization of a new health clinic by Vancouver Coastal Health (VCH) is “deeply concerning on a number of levels,” according to government policy analyst Alex Hemingway of the Canadian Centre for Policy Alternatives.
A $7 million contract provided by the health authority to for-profit company Seymour Health Centre to operate the recently opened City Centre Urgent Primary Care Centre is unlikely to produce better care – while costing more money in the long term, contends a report from Hemingway.
Furthermore, Hemingway sees the VCH model as being a Trojan Horse of sorts for a more powerful private medical lobbying industry in B.C.
“Canada’s largely private (and highly inefficient) system of pharmaceutical drug coverage is a prime example of this lobbying power in action, as is the privatized and staggeringly inefficient U.S. health care system,” said Hemingway.
The idea of a UPCC is to alleviate emergency rooms from patients in need of non-emergency medical care, such as treatment for minor wounds, fever or dehydration.
And, last November, B.C. Minister of Health Adrian Dix touted UPCCs as able to “better connect local residents with the primary care they need.”
Dix didn’t respond to Glacier Media’s request for comment on Hemingway’s report.
Hemingway raised the fact the health authority spent $2 million on facility upgrades in addition to the centre’s lease payments through to April 1, 2020.
To read more, click on https://www.burnabynow.com/local-news/new-privatized-health-clinic-will-weaken-public-system-analyst-3100320
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Why are we letting corporate medicine take hold in Vancouver’s new urgent care centres?
[Excerpt] May 23, 2019 – By Alex Hemingway
Seymour Health received nearly $2 million from Vancouver Coastal Health to renovate their UPCC property. The health authority appears to have used public dollars to enhance a privately owned real estate asset.
Instead of inviting in these for-profit firms, why isn’t Vancouver Coastal Health running the UPCCs and other proposed health care services themselves or by partnering with community non-profits?
The health authority’s moves towards corporate health care delivery take us in the opposite direction of the impressive range of reforms taking place in BC’s public health care system. A swift change of policy is in order here.
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Patients searching for family doctor at new Langford Urgent Primary Care Centre leave disappointed
There was confusion on opening day of a new urgent primary care facility on the West Shore Monday morning.
More than a dozen people waited in line before the Westshore Urgent Primary Care Centre opened its doors for the first time at 8 a.m.
But some of those people were frustrated to learn that they would not be able to find a new family doctor at the centre – at least for now.
Wilson said she was hoping to find a family doctor for her three-year-old grandson as well as herself.
“I had a brain tumour taken out a year ago June, and I’m getting older. I need care,” she said.
When it was announced early last week, the province said the new urgent primary care facility in Langford would better connect locals with health care providers.
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