We redesign primary care through the eyes of citizens and clinicians
Vancouver Citizens Health Initiative is a new organization dedicated to the future of accessible and sustainable primary care for all residents of BC. Our purpose is to involve citizens in building a healthcare system that is accessible to all for generations to come. In working towards that goal, we learn and adjust our thinking through dialogue with people who are passionate about health care and open to new ways of delivering care to achieve wellness.
We think a lot about what health care will need to look like if it's going to be available and affordable to everyone. We've taken apart the big pieces of the puzzle and rearranged them so that they support health-related relationships. We consider all the issues that help or hinder wellness, and envision a culture that enables clinicians to focus on their optimal contribution. We're getting ready to build and operate clinics that can work within the current funding model but which will provide a wider range of supports for patients, inside the clinic and in the community.
We would like you to become part of the dialogue as we implement, test and improve innovative ways to deliver primary care.
We are part of the solution to a big problem
The Vancouver Division of Family Practice is a non-profit society funded to address the shortage of family doctors. Working in collaboration with Vancouver Coastal Health Authority, one of their goals is to increase the capacity of existing doctors' offices, and connect patient with family doctors. For updates on their work, you can visit their site by clicking here.
We feel we can help because we have a unique perspective: as a community group, we are "outside the box." We don't look at the problem as one that is the exclusive responsibility of family doctors. Rather we see the issue as one of collective responsibility, and seek to bring a new set of eyes to the problem and integrating solutions from several areas of expertise.
We offer a community-based solution to a problem that many in our community are facing. And we approach primary care from the perspective that patients are community members before and after they visit a doctor's office. We know that if we are to have a sustainable system that helps people achieve and maintain wellness, we'll need to harness the collective wisdom of citizens and clinicians alike.
We've done this before...
A Dental Clinic for Low Income Children
In the late 1990's, parents in Vancouver's inner city identified that children were not able to access dental treatment. A quick look at the statistics showed that over 60% of kindergarten students had untreated cavities that were big enough to see with the naked eye. Kyle Pearce build and led a group of 25 health advocates, parents, dentists, Ministry officials and school principals to figure out what could be done. After two years of research and trying different approaches, Kyle developed a business plan, raised $350,000 in funds and made an agreement with the School Board to rent a space to host the dental clinic. In 2001, the group opened the Strathcona Community Dental Clinic, which uses a social enterprise model to address the dental needs of Vancouver's children and their families. Thirteen years on, the clinic is an essential part of the neighbourhood and the struggle to address the most common chronic disease of childhood.
Elements of the model:
- Non-profit governance and charitable status allows the clinic to generate revenues as a business while accessing donations and other funding sources;
- Services are provided in 4 languages to address the needs of a diverse population;
- Special outreach to seniors, many of whom are new to Canada and are responsible for child minding while parents are working;
- Fixed rate payment for dentists ensures consistency of the rotation, and provides reasonable compensation for dentists who have more lucrative practices elsewhere;
- All staff are paid, enabling children and families to build relationships with staff.
The SCDC is one of the few community-accountable dental clinics in BC that has been in the black since its third year of operations. It continues to fund dental care for families falling in the cracks and is looking for opportunities for expansion to other communities.
After this project, our Executive Director built a business plan for a similar clinic in Surrey that provides care for low income, street-involved adults and youth. The clinic, called "Keys Dental Clinic" is a hygienist-led model.
Team-Based Interdisciplinary Care
In 2013 Kyle Pearce led a project that gave shape to an idea for a first-generation clinical innovation that will increase the capacity of the primary care system in Surrey and North Delta. The project was called "G8" and started with surfacing the best ideas from a committee that included a doctor, the local organization of doctors (Division of Family Practice), and the health authority. Once we surfaced the best ideas, we developed a "straw model" and then generated a financial plan and analysis so we could see if the model would work. At the same time, we met with health authority staff, hospitalists and family physicians to generate elements of this new group practice with an integrated and interdisciplinary model of primary care. We wrapped up our project with a Business Case that the Division used to seek funding for the establishment of the clinic as part of their approach to increasing access to a GP in Surrey and North Delta, BC.
The model we shaped, costed and assessed included some great bells and whistles:
- Integrative group practice primary care with 4 experienced physicians (with existing panels), and 4 new physicians (with no panels) sharing office space and staff;
- Most current approaches to scheduling (Advanced Access) and group visits, resulting in increased access and quality of care for urgent and chronic issues;
- Extended hours of operation with emergent care component for both attached and unattached patients (who will be offered a place on the practice’s panel);
- Shared after hours call and hospital call provision;
- Shared coverage for patients when one GP is away from the clinic;
- Shared registered nurse to support non-physician clinical functions and coordinate chronic care programs and follow-up;
- Health authority and community resources available on a referral-out and flow-in basis to enable interdisciplinary care and ensure that patients with chronic conditions receive holistic and integrated care.