2022-23 NDoFP Annual Report

We acknowledge with gratitude that our office is located on the traditional territories of the Snuneymuxw and Snaw-Naw-As First Nations. This report represents the work done through the cycle of seasons on these lands, and in service of the Physicians, Nurse Practitioners, and patients who live, work, and play here. Huy ch q’a!

Photo Credit: Dr. Cody Van Valkenburg

CME – Continuing Medical Education

CSC – Collaborative Service Committee

DoBC – Doctors of BC

FP – Family Physicians

FPSC – Family Practice Services Committee

FNHA – First Nations Health Authority

HHR – Health Human Resources

IDC – Island Divisions Collaborative (IDC)

ACRONYMS

ISC – InterDivisional Strategic Council (ISC)

LFP payment model –Longitudinal Family Physician payment model

LTCI – Long-Term Care Initiative

MAC – Members’ Advisory Committee

MHSU – Mental Health and Substance Use

MOA – Medical Office Assistant

NDoFP – Nanaimo Division of Family Practice, “The Division”

NMSES – Nanaimo Medical Staff Engagement Society

NPs – Nurse Practitioners

NRGH – Nanaimo Regional General Hospital

PCN – Primary Care Network

R&R – Recruitment and Retention

TRHC – Truth and Reconciliation Health Care committee

Photo Credit: Adobe Stock

NANAIMO DIVISION OF FAMILY PRACTICE

38% Family Physicians

14% Locums

11% Emergency Physicians

10% Retired Physicians

9% Hospitalists

7% Residents 4% Other

7% Nurse Practitioners

The Nanaimo Division of Family Practice is member-driven and member-responsive so that we can support our community of providers to continue to offer excellence in Primary Care.

314 TOTAL MEMBERS

226 members (72%) are funded

Looking back over 2022, there has been a lot of change — but by far the largest would be the new payment model, “LFP”.

While not involved in negotiations, the Nanaimo Division and I joined Divisions across BC to push for Family Physician payment reform. Although there was general excitement around a new payment model, it is too early to tell how this will change the primary care field. There are details missing about panel payments; there are kinks to be worked out and likely adjustments to come; but the most pressing matter is the addition of Long-Term Care, Inpatient care, and Maternity care into the fold. The Division will continue to use channels including the regional and provincial knowledge-sharing meetings and the Vancouver Island Divisions Collaborative to push for meaningful reform.

The number of family doctors providing inpatient care shrunk drastically over 2022; however, the program was saved by the extension of existing FPSC funding being offered to Nanaimo. This funding is being flowed through the Division and being used to support clinical work as well as provide administrative support and recruitment.

MESSAGE

FROM THE CHAIR

However, this support is temporary which underlines the importance of LFP being spread to inpatient care. The hospitalist service remains without a new contract and has lost members of their team. This creates another crisis in our community in acute care which impacts all of our patients that turn to the hospital when in need. We continue to foster connections with the Medical Staff Association and Island Health to try to bridge gaps between hospital based and community care.

2022 saw the return of our summer BBQ. It was great to see members and their families who attended. As we emerge out of the pandemic years, we are intentionally focusing on creating more opportunities for member engagement, such as high quality CME and other engagement events. Look forward to 2023 for a series of ways and opportunities to engage with the Division and our specialist partners to help us chart a path forward to improve the healthcare system in our community. 2022 also saw the launch of our Member Advisory Committee. This group meets regularly throughout the year and representatives are invited from all community clinics, as well as the Emergency Room and Hospitalists. The goal is to provide better communication between the Board and our members. Participants receive updates on Division initiatives and other work, while the Board has an opportunity to receive feedback and new ideas from our membership. If your clinic does not have a representative, then please reach out as we would love to hear from you.

Throughout the year, we have also created and fostered relationships with the Nanaimo & District Hospital Foundation, and the City of Nanaimo. We are very excited about the opportunities for innovative care that these relationships may allow.

We continue to value our partnerships and relationships with Snuneymuxw and Snaw-NawAs First Nations, Tillicum Lelum Friendship Centre, and the Mid-Island Metis Nation. The addition of an

Indigenous Relations Manager has helped to ensure we are moving forward while always having a lens of Truth and Reconciliation.

Lastly, the PCN continues to expand. We have social workers, mental health workers, and pharmacists doing great work in our clinics. I have seen and heard the impact these allied health workers have had on patients while simultaneously relieving some of the burden from family doctors.

This year has, for me, created hope that our primary care system can be saved from the brink of collapse. However, there is still a lot of hard work ahead.

• We need the LFP to truly work for doctors and we need it to be an incentive for recruitment.

• We need more doctors - our Recruitment and Retention team is working hard on this file.

• We need flexibility and innovation in care — while the Division has grown, we are still nimble in our response.

• We need permanent solutions to ensure physicians continue to provide excellent care in hospital, long-term care, and for maternity patients.

• We will continue our advocacy; and we will continue to partner with Island Health, the MSA, our Indigenous Partners, the Hospital Foundation, the City, and anyone else who we believe provides us with the opportunity to create better healthcare in Nanaimo.

As always, please connect, I truly value all feedback and perspectives.

Taylor Swanson CHAIR

• New payment model

• Inpatient care program saved by the extension of existing FPSC funding

• Launch of our Member Advisory Committee

• Fostered relationships with our partners

• Addition of an Indigenous Relations Manager

• Primary Care Network (PCN) continues to expand

Welcome to this review of our work at the Nanaimo Division of Family Practice.

I recently met with a colleague from the non-profit community in Nanaimo whom I had not seen for many years. They, of course, asked how the Division has been working in the intervening time. I reflected how, in the early part of last year despite starting to move away from the restrictions of the pandemic, the primary care world remained a very dark place. Every Director in every Division had a distressing story about clinics closing. At every meeting we heard yet another heartbreaking experience of Physicians having to deal with patients begging for family members or friends to be attached. Family Physicians were left struggling to do what they loved, and Primary Care seemed to be without hope.

However, as I answered, it became clear this past year had also become a time of change and new

MESSAGE

FROM THE EXECUTIVE DIRECTOR

beginnings. The most impactful innovation in the past year is undoubtedly the new longitudinal payment model for Primary Care Physicians negotiated by the FPSC and Family Doctors of BC which finally provided Family Physicians validation of their profession, and recognised the contribution of Primary Care to the health of our province. Whilst the intricacies of remuneration are still being ironed out, we are optimistic these changes will provide stability to our primary care system as we retain family physicians and attract new recruits to our province. At last, we feel there are rays of light.

Despite the onslaught of several health care crises — the toxic drug supply epidemic, the continuing blight of the pandemic, HHR shortages, and funding challenges — the Division has been able to celebrate new successes. Our funding has supported a unique Shared Care project creating a centralized referral system for paediatrics in Nanaimo. This project, in a first for Divisions, received funding from the Specialised Services Committee and the Shared Care Committee to support a truly shared care Initiative.

From its literal ‘virtual’ beginnings, the Primary Care Network continues to build team-based supports for Primary Care Physicians and Nurse Practitioners. Led our stalwart and dedicated Division team and our Island Health partners, the program has successfully implemented a low barrier outreach service. This year also saw the introduction of social workers and MHSU clinicians embedded in clinic practice. This initiative, although slowly adopted, has resulted in great feedback from our members as their patients benefit from dedicated support within their patient medical home.

2022 saw the Nanaimo Division employ a full-time Indigenous Relations Manager. Gloria Harding is our, and your, connection to Truth and Reconciliation in action. As a proud Métis citizen, she brings a unique lens of cultural values to our work. In Gloria’s own words we celebrate the ‘heart work’ with which she undertakes the hard work of supporting and building culturally safe Primary Care.

The bedrock of a healthier Nanaimo continues to be the focus of the work of the Division, its staff, members, and Board. The Division is seeking support from new and existing partners in Nanaimo, within and beyond traditional healthcare borders, and we are excited to create a coordinated and collective primary care strategy on the foundations of this year’s work. Looking forward, we anticipate a positive year of planning for the future with partners from the City of Nanaimo, the Nanaimo & District Hospital Foundation, Island Health, and other community partners.

Thank you to our small hardworking administrative ‘Team Awesome’ who show up with passion, compassion, determination and creativity every day to support our members to improve Primary Health care in Nanaimo.

I would like to take this opportunity to thank our Board of Directors under the leadership of Dr. Taylor

DIRECTOR STATEMENT

EXECUTIVE

Swanson for their guidance and support for both staff and members though another tumultuous year. Often strategic statements and vision documents can remain an aspiration. The vison and strategic roadmap created by the Board in 2021 helped direct the Division and its members though difficult times, and challenging years; and as we emerge in 2023, we are able to ground this vision in concrete actions to support Family Medicine in Nanaimo.

Our strategic cornerstones of Advocacy and Leadership; Meeting Members’ Needs; Engaging the Primary Care Community; and Accessing Local Resources, are underpinned by our Diversity and Safety strategy which is deliberately and mindfully threaded through everything the we do as a Division.

This year’s report has been created to showcase these priorities and how this is reflected in all our work here at the Nanaimo Division of Family Practice. I hope, as you read this report, you see the growth of a Division intended to meet your needs.

Finally, thank you for being our member. We stand for you and with you, in darkness, and at the dawn.

Beccy Robson EXECUTIVE DIRECTOR

Photo Credit: Adobe Stock

EXECUTIVE OVERVIEW OUR DIVISION

MISSION

A healthy Nanaimo through empowering and supporting our Primary Care community.

STRATEGIC VISION

Photo Credit: Adobe Stock

ABOUT US

KEY ACHIEVEMENTS TO CELEBRATE IN 2022-2023

• Team-based care integrated into 5 clinics.

• Low-barrier outreach service implemented.

• Well-attended and valued CME and events.

• Recruited 4 Family Physicians and retained 5 UBC Family Medicine Residents to Nanaimo.

• Deepened connections to cultural safety with the hiring of our Indigenous Relations Manager. 67% 27%

of 18 Division-led committees and working groups focus on collaborations between members and partners to make change in primary care. of members attended at least one of the 5 CMEs that were offered in 2022-2023.

“I STRONGLY BELIEVE THE DIVISION IS CRUCIAL FOR NANAIMO GPS TO COORDINATE CME, COMMUNICATIONS, ADVOCACY, AND MORE.”

— NANAIMO DIVISION MEMBER

BOARD OF

DIRECTORS

DR. TAYLOR SWANSON

DR. REBECCA WRIGHT

CHAIR DIRECTOR-AT-LARGE (ASSOCIATE)

DR. DIANNE WALLIS

COURTNEY DEFRIEND

TREASURER & SECRETARY DIRECTOR-AT-LARGE (COMMUNITY)

DR. JOHN TREPESS DIRECTOR-AT-LARGE

The Nanaimo Division of Family Practice Board of Directors are a group of caring, compassionate and dedicated physicians working collaboratively to foster a strong primary care community.

DIRECTOR-AT-LARGE (ASSOCIATE)

DIRECTOR-AT-LARGE

DIRECTOR-AT-LARGE

DR. CAITLIN BLEWETT DR. MICHELLE WORKUN-HILL

DR. LAURA SHANNER DIRECTOR-AT-LARGE (COMMUNITY)

DR. DUDA (DUDRAVKA) UCHMAN

BECCY ROBSON

EXECUTIVE DIRECTOR

TEAM MEET THE

LEILA SCANNELL

QUALITY IMPROVEMENT MANAGER

SARA LUNEY ENGLOUEN

R&R PROGRAM LEAD

KATHY SHAW EXECUTIVE COORDINATOR

KATRINA LOVE CME & EVENTS COORDINATOR

LAURA LOUDON

PCN PROGRAM MANAGER

THOMAS WRIGHT

R&R PROGRAM ADMINISTRATOR

BARBARA LESLIE

PCN PROGRAM LEAD

KELSEY CHANDLER

PCN AND INPATIENT PROGRAM LEAD

GLORIA HARDING

INDIGENOUS RELATIONS MANAGER

MEGHAN BAJZATH

PCN PROGRAM COORDINATOR

The Division is comprised of administrators, coordinators, leads, and managers who work together to help create a healthier Nanaimo.

VICTORIA WILSON PCN PROGRAM COORDINATOR

PEDS PROGRAM LEAD

FERNANDA GUTIERREZ

LILIIA LIUSHNENKO LTCI PROGRAM COORDINATOR

PCN PROGRAM ADMINISTRATOR

ERIN HEMMENS

REGAN GRILL

JUANESSA PRINCE OPERATIONS MANAGER

PCN ADMINISTRATIVE ASSISTANT PROJECT MANAGER

BRENDA ADAMS PATHWAYS COORDINATOR

JANICE SCHMIDT

2022-23

TIMELINE OF EVENTS

April 9

Nanaimo Clinic Crawl

April 13

Hired new R&R Manager

May Launch of Physician Advisory Committee

Division office expansion completed

June 20 Hired Indigenous Relations Manager

June 29

PAM Collaborative Working Group

July 13

PCN Year 2 Strategy Planning Session 1

July 21

NDoFP and NMSES Summer BBQ

August PCN Year 2 Strategy Planning Session Part 2

September 20

Quality Improvement Manager Hired

September 21

CME: Pelvic Health 101

September 26

PCN New to Practice Webinar

September 28

PCN Patient Attachment Collaborative Working Group

Photo Credit: Adobe Stock

2022-2023 welcomed the return of in-person engagement events, CME, and networking opportunities.

October 5

FPSC approved inpatient bridge funding

October 13

CME: Forensic Nursing

October 18

PCN Innovative Practice Engagement Event

October 27

NDoFP Annual General Meeting

November 16

CME: Don’t Just Do Something… Stand there! (and do less)

December 13

DoBC Dinner

January 25

MOA Violence Prevention training

January 28

UBC Family Medicine

Resident & Locum Physician Clinic Crawl

February 21

CME: Internal Medicine

World Café Part 1

February 21

Member attachment Initiative launched

February 28

CME: Internal Medicine

World Café Part 2

DASHBOARDS DETAILED

ADVOCACY & LEADERSHIP

KEY MILESTONES

• Strengthened relationships with Indigenous partners, Island Health, local MLAs, and other Primary Care leaders

• Continued to support and participate in provincial and regional meetings with strategic partners (ISC, IDC, CSC, FPSC)

• Improved the flexibility of New-to-Practice contracts and PCN contracts

• Contributed to the PCN Governance Refresh (which resulted in greater representation of Primary Care and flexibility in funding for Registered Nurses)

Seek opportunities to strengthen the voice of the Division to fundholders and policy-makers

A core strategic aim is to support a culture of leadership so that the Division can successfully advocate for members’ needs. This includes building relationships with fellow Primary Care leaders, fundholders and policy makers, and seeking opportunities to ensure members’ concerns and ideas are heard. Throughout 2022/2023, ongoing advocacy efforts have impacted members, patients, and the broader system structures that influence Primary Care.

Our advocacy and leadership journey begins with the Board of Directors, a group of 9 Family Physician and community member leaders who set the foci for the Division and engage in ongoing strategic decision-making. This year, the Board continued to offer their energy and expertise to navigate emergent issues in Primary Care. They have practiced critical self-reflection, by evaluating their own performance and initiating quality improvement activities. They have collaborated with a host of partners and stakeholders. Throughout all of this, they have strived to represent the best interests of members to decision-makers.

Importantly, the 2022/2023 fiscal saw the development of strong relationships with Indigenous partners, Island Health, and other primary care leaders. Some of these relationships have been forged through informal, one-on-one meetings such as the Executive Director and Chair of the Board of Directors meeting with local MLA’s Adam Walker and Sheila Malcolmson. These opportunities provided context and understanding of the attachment crisis in BC and on the Island. Minister Walker and Minister Malcomson are allies of the Division. We have also built relationships and pursued advocacy goals through formal, regularly occurring committee meetings:

The InterDivisional Strategic Council (ISC) is a regional collaborative working table co-chaired by Ted Patterson ADM, Dr. Tracey Thorne (Divisions), James Braman (VP Primary Care Strategy, Island Health), and Brenna MacDonald (FNHA). The ISC functions as a mechanism to harness and elevate collective voice through a focus on regional, provincial, and system-level issues. Meeting quarterly, representatives from Island Health, Vancouver Island Divisions, and FNHA come together to identify and create strategic solutions to systemic issues affecting primary care.

The ISC was paused during Covid to review its purpose. Our Executive Director formed part of the Terms of Reference Review committee prior to the relaunch in June 2022. The Division is an active participant in this and the Island Divisions Collaborative (IDC) where themes and issues are discussed for escalation to the IDC. It is through this forum that issues such as MHSU access, and Return of Service are addressed. The ISC created a Task force committee in 2022 to address systemic issues affecting patient access. Dr. Diane Wallis, Division Treasurer & Secretary, participates in this working group. Advocacy through the provincial network of ISCs supported Primary Care reform led by Doctors of BC and BC Family Doctors. This table supports relationships between decision makers from FNHA, Island Health and other Divisions, and is a direct pathway to the Ministry of Health.

The Collaborative Services Committee (CSC) is a Doctors of BC funded collaborative table where leaders from Island Health, Divisions, and community partners can meet to discuss issues impacting Primary Care in Nanaimo. In May 2022, the CSC presented to Minister Sheila Malcolmson on the Primary Care crisis and brought forth solutions to the Ministry of Health. As MLA for Nanaimo and Minister for Mental Health and Addictions, Minister Malcolmson has a strong understanding of the issues facing Nanaimo and now has a greater understanding of the pressures on Primary Care.

“THOUGH OUR ADVOCACY TO MINISTER MALCOLMSON WE WERE ABLE TO AMPLIFY THE VOICES OF LOCAL PRIMARY CARE PHYSICIANS.”

— NDOFP EXECUTIVE DIRECTOR

Family Practice Services Committee (FPSC) Representation. The FPSC is a partnership between the Doctors of BC and the Government of BC, and acts as the collaborative, governing table leading Primary Care transformation for the province. The FPSC provides leadership and works in partnership with regional health authorities, First Nations and Indigenous groups and other community partners to advance an integrated system of Primary and Community Care across the province. Dr. Taylor Swanson, Chair of the Nanaimo Division of Family Practice was elected in 2022 as a Vancouver Island regional representative on the FPSC Full Committee. Here, he provides input and shares feedback from the Island Divisions, including Physician concerns raised at Collaborative Services Committees (CSCs) and Interdivisional Strategic Councils (ISCs) and brings forward matters of strategic regional importance to the FPSC.

These growing relationships, alongside a strategic focus on leadership and advocacy, have spurred meaningful change. For example, continued input from the Nanaimo PCN and other PCNs resulted in a process to refresh PCN governance to ensure greater representation of Primary Care across the province and flexibility in funding for Registered Nurses (final recommendations expected in September 2023).

The Nanaimo PCN also advocated on behalf of our members to develop improved contracts We worked with the Ministry of Health and Island Health to improve the flexibility in Newto-Practice contracts, while supporting physicians and clinics to help them navigate the process to establish these contracts. Similarly, we continued to negotiate the requirement for Alternative Payment Program (APP)-funded Physicians to contribute overhead in PCN funded services. We are advocating for greater flexibility in attachment expectations in services for more complex/vulnerable patient populations (e.g., in Indigenous Health Centres and Low Barrier Primary Care Outreach).

Photo Credit: Adobe Stock

MINDFUL OF MEMBERS’ NEEDS

KEY MILESTONES

Streamlined onboarding for PCN Allied Health staff

• Developed Primary Care Access Strategy

• MOA Network created

• Launches Supported WorkBC-funded

• Second annual Clinic Crawl

Recruited 2 new Y4 Family Practice Elective Preceptors

• Launched the Nanaimo Division Member Attachment Initiative

Supporting and valuing our members

The Nanaimo Division of Family Practice is a membership-driven organization, seeking to understand, then respond to, our members’ needs. This informs strategic priority setting and program design. Maintaining a focus on members’ needs is intended to directly enrich the experience of providers, and ultimately improve the experience of longitudinal primary care for patients. In the 2022-2023 fiscal year, we made significant progress towards this key driver. Several important milestones are noted below.

The PCN team has continually worked to hear from members and integrate their feedback into service design and quality improvement. For example, based on clinic feedback that onboarding Allied Health professionals was challenging, the PCN team streamlined the onboarding process for Social Workers, Mental Health Clinicians and Clinical Pharmacists. This resulted in processes that integrated better with existing clinic processes making the workflow easier for everyone.

The PCN regularly adopts this approach to co-developing member-relevant solutions. Through a creative collaborative working group and a series of action cycles, FPs, NPs and Clinic Managers worked with the PCN team to design the local patient attachment process to move patients off the Health Connect Registry to local providers actively attaching patients. The PCN team also engaged members to explore types of innovative practice models, for both new and existing clinics.

Similarly, the PCN team hosted a series of sessions with members to understand and explore potential solutions to gaps in urgent care access in the community. This has informed a Primary Care Access Strategy, including ways to incentivize and support enhanced walkin and same day care in existing Family Practice clinics.

“THE DIVISION IS ACTION-ORIENTED, RESPONSIVE TO MEMBER INPUT AND NOT SILOED.”

— NANAIMO DIVISION MEMBER

Finally, recognizing the challenges MOAs are facing, the PCN established an MOA Network to provide training and support to Primary Care MOAs. This was kicked off with Online Violence Prevention training and an in-person session in January 2023 attended by 47 MOAs and Clinic Managers. We also collaborated with Discovery College to promote a highly successful WorkBC funded MOA training program.

Our Recruitment and Retention (R&R) program is also paramount to meeting members’ needs; members as well as the Board of Directors continue to identify this area of work as a top priority. The program seeks to support prospective and current Physicians as well as UBC Family Medicine Residents. Knowing the importance of recruiting new Physicians, the R&R Team hosted the second annual Clinic Crawl. Participating residents indicated that this event increased their interest in staying in Nanaimo post-graduation and that it was a good way to explore family practice opportunities. In addition, in partnership with the Island Medical Program, two new Y4 Family Practice Elective Preceptors were recruited. Increasing Preceptor capacity allows more future Family Physicians to train in our community while promoting longitudinal Family Medicine and showcasing our community.

In response to the growing need for Members to be attached to their own Family Physician, the R&R team developed the Nanaimo Division Member Attachment Initiative. This initiative attaches the Physician and, whenever possible, their immediate family, to a Primary Care Provider outside of their practice clinic.

Recruitment

4 Physician candidate site visits

4 Family Medicine Physicians Recruited

2 (seasonal) Locum Physicians Recruited

6 Family Practice physicians considering relocation to Nanaimo in 2023/2024

5 / 8 2 0 2 2 U B C F a m i l y M e d i c i n e g r a d u a t e s h a v e r e m a i n e d i n N a n a i m o p o s t - g r a d u a t i o n

3 a r e c o m p l e t i n g p o s t - r e s i d e n c y t r a i n i n g w i t h p l a n s o f r e t u r n i n g N a n a i m o i n

S u m m e r / F a l l o f 2 0 2 3 .

Clinic Crawl 2023

R taining UBC Family Medicine Residents e n t s a n d l o c u m s t o u r e d l o c a l c l i n i c s , e d a b o u t p r a c t i c e o p p o r t u n i t i e s , a n d e c t e d w i t h p h y s i c i a n s

Recruitment of Y4 Family Practice Elective Preceptors

I n c r e a s i n g p r e c e p t o r c a p a c i t y a i m s t o b r i n g t h e F a m i l y P h y s i c i a n s o f t o m o r r o w t o N a n a i m o t o d a y , p r o m o t e l o n g i t u d i n a l F a m i l y M e d i c i n e a n d s h o w c a s e o u r c o m m u n i t y

2 F a m i l y P r a c t i c e e l e c t i v e p r e c e p t o r s r e c r u i t e d E f f o r t s a r e o n g o i n g

A i m : t o a t t a c h m e m b e r s a n d t h e i r f a m i l i e s w h e n p o s s i b l e ) t o a P r i m a r y C a r e P r o v i d e r

ACCESS TO RESOURCES

KEY MILESTONES

5 Continued Medical Education events with over 150 attendees

Indigenous resource library

Initiated development of Hospital Foundation Incentives Package

Funding to maintain Inpatient service at NRGH

• Vacation coverage for LTCI Physicians in Nanaimo

• Central Intake to Pediatrics project commenced

• Team-Based Care established in 5 Primary Care Clinics

• PCN team to support Patient Attachment

• Social Prescribing Project Expression of Interest

SPOTLIGHT ON NEW PARTNERSHIPS: NANAIMO & DISTRICT HOSPITAL FOUNDATION

The Nanaimo Division of Family Practice has created a strong partnership with the Nanaimo and District Hospital Foundation to explore opportunities to establish Nanaimo as the go-to choice for relocating Physicians. The partnership recognizes the importance of not only attracting new Family Physicians, but also creating a supportive environment to retain these Physicians after they arrive. The Nanaimo and District Hospital Foundation has remodeled its fundraising strategy and objectives to create a holistic ‘health care eco-system’ approach to Nanaimo. The Nanaimo Division of Family Practice has created a strong partnership which will create opportunities to directly support Physicians in the community. The R&R committee supported the development of a proposal for financial support for existing Physicians to update their equipment. This is complemented by a second proposal to financially support new Physicians.

Understanding the Local Landscape

Through strengthening links between Family Physicians and local health resources, seeking out synergies with current and potential partners, and providing opportunities for education, the Nanaimo Division of Family practice seeks to support Physicians and their practices, and contribute to local population health. In 2022/2023, the Division achieved the following milestones in this strategic area.

One of these core milestones was the continued provision of relevant, well-received Continued Medical Education (CME) events on topics such as Pelvic Health, Forensic Nursing, and Internal Medicine. These events provided a unique opportunity for members to strengthen relationships with colleagues while also expanding their own knowledge base and awareness of local resources.

In addition to CMEs, we aimed to increase access to culturally relevant resources. The Indigenous Resource Library was developed and placed on the NDoFP website. This library includes links to Indigenous patient resources, upcoming events, reading, and educational resources. This site also includes information on the Nanaimo Division’s Cultural Relevance Strategy.

Resources also include financial support. Furthering the relationship between the Division and the Nanaimo and District Hospital Foundation, a proposal for a Hospital Foundation Incentives Package started development in 2023. This package will help strengthen Nanaimo’s competitive edge for recruitment and provide Primary Care clinics with access to resources for new equipment and clinic space to enhance the patient experience.

Financial support was also obtained from FPSC for the Inpatient Care Initiative. Faced with the potential collapse of the inpatient service and,

Continued Medical Education (CME) At a Glance

5

14 159 100% MEMBERS LOVED

Total attendees

CME Events, representing a return to normal volume Family Physicians and Specialists facilitated the events

of attendees agreed that the programs met the intended learning objectives

… “The content itself. The enthusiasm/expertise. Very excellent!” – Pelvic Floor 101

The clinical pearls that were easily applicable to practise. Meeting local specialists” – Internal Medicine Part 1

“Please do this again and again, thanks. Loved it!” – Internal Medicine Part 1

given the importance of inpatient care both to patients and providers, the Division secured financial resources to ensure the continuation of this service. The Inpatient Care Initiative will explore options for a sustainable service redesign while recruiting more Inpatient Physicians.

The Division works to streamline and improve upon existing systems. The Central Intake for Pediatrics project focused on improved access to specialists. The goals of Central Intake are to reduce wait times, improve communication between Specialist and Primary Care offices and improve the patient experience. Pediatric referrals are now made through one easy referral form which has been added to EMRs, Pathways and Powerchart.

Access to resources is not only beneficial to our members, but the strategy also impacts patients. For example, the addition of team-based care into five Primary Care clinics has increased patient access to resources such as Social Workers, Mental Health Clinicians and Clinical Pharmacists. Supporting the new Patient Attachment Process for clinics has seen over 1000 people from the Health Connect Registry become attached to a Primary Care provider.

Strengthening links between Family Physicians, patients and local health resources is the aim of the Social Prescribing Project. Social prescribing is the practice of referring patients to non-clinical resources that address their needs and improve their wellbeing (such as exercise, art, books, volunteering, housing, social or cultural groups, and recreation). The Expression of Interest for this project has been approved by Shared Care for funding and work is on-going.

“I REALLY DO THINK THAT THE INTERIM FUNDING WAS THE DIFFERENCE BETWEEN OUR [INPATIENT] PROGRAM COLLAPSING AND IT FEELING HOPEFUL AND HOPEFUL FOR RECRUITMENT.”

— INPATIENT CARE FAMILY PHYSICIAN

BEST PRACTICES IN LONG TERM CARE

The LTCI improves patient health outcomes and reduces unnecessary hospital admissions by removing barriers, improving providerpatient experience, and enhancing processes to allow LTCI Physicians achieve the Family Practice Services Committee (FPSC) Best Practice Expectations:

24/7

Availability and on-site attendance, when required

AT LEAST 1 EVERY 3 MONTHS

Proactive patient visits

EVERY 6 MONTHS

Meaningful medication reviews

Complete documentation

EVERY 6 MONTHS

Attendance at case conferences

Long Term Care Initiative (LTCI) At a Glance

This Division program has been supporting LTC physicians, patients, and facility staff since 2015. Division staffing changes in the past year reduced the dynamic changes typical to this program; however, its structure is so robust that it continued to impact LTC in Nanaimo by:

 Remunerating physicians for working towards achieving the FPSC 5 Best Practices

 Providing DoFP Project Management Support

 Providing DoFP Administrative Support

 QI & Education

31 LTCI PHYSICIANS

82% OF LTC BEDS COVERED

55% are core physicians of a total of 1,027 beds

14 18 48 856 $61,809

Long-term care homes in Nanaimo covered LTCI Physicians and NP participating in vacation coverage vacation requests covered patients with continuation of care total remuneration to physicians

Photo Credit: Adobe Stock

— NANAIMO DIVISION MEMBER

COMMUNITY CONNECTIONS

KEY MILESTONES

• Development of the Members’ Advisory Committee (MAC) in May 2022

• Return of the annual FP and SP networking BBQ, co-hosted with NMSES

• Participation in the DoBC Learning Forum

Strengthening the relationships within the membership and between the primary care community

“Change happens at the speed of trust” (author unknown)

Trust is key in the work that the NDoFP does, and that trust is created through the development and nurturing of relationships. The 2022 DoBC Learning Forum was a professional opportunity for Physician and Administrative Leadership to come together, nurture those relationships, learn from one another, share concerns and seek solutions. This collaborative approach contributed to the Governance refresh for Primary Care Networks and was key in creating the Business Support Initiative, in partnership with Hive Consulting.

Keeping members and the Primary Care community connected is indeed an important function of the Division. Towards this aim, we co-hosted a dinner with the Nanaimo Medical Staff Engagement Society (NMSES) and Doctors of BC featuring a keynote address from Dr. Ramneek Dosanjh, President of Doctors of BC, to hear about new developments in Primary Care.

Another way we seek to maintain connections within and between our Members and the Division is through the Members’ Advisory Committee (MAC). This committee, created by the Board of Directors,

“THE DIVISION TIES US TO HOSPITAL AND COMMUNITY, LINKS US WITH QUALITY CARE INITIATIVES, AS WELL AS PROVIDES ENGAGEMENT OPPORTUNITIES.”

Division Staff at the 2022 Summer BBQ

is a knowledge sharing forum that aims to to improve and facilitate communication within and between clinics, membership groups, and Division leadership. The MAC meets regularly and continues to serve as an important vehicle for achieving numerous drivers and activities outlined in the Division’s Strategic Plan.

We also maintain ongoing communication with members, such as through members’ update emails. This year saw steady increases in members reading the quarterly PCN Bulletin, a resource that provides updates on the various PCN strategies, evaluation data, and available clinic supports. The PCN team continued to “close the loop” by sharing back to members how information they have provided is being used to inform/improve PCN services.

As part of staying connected, we also support member engagement. In 2022, we celebrated the return of the annual summer FP and SP networking BBQ, after a two-year hiatus due to Covid-19. This event is co-hosted with NMSES, and is a chance for members to increase connections between the two memberships (i.e., NDoFP and NMSES), and ultimately contribute towards improved continuity of care.

MEMBERS’ ADVISORY COMMITTEE (MAC)

“THIS COMMITTEE SUPPORTS LEARNING ABOUT WORK BEING DONE AND BEING ABLE TO DISCUSS/GIVE INPUT TO GROUND THIS WORK IN THE REALITY OF OUR PRACTICES.” — NANAIMO DIVISION MEMBER

MEMBERS’ ADVISORY PARTICIPANTS AGREED THAT THE MAC IS AN EFFECTIVE FORUM FOR RECEIVING INFORMATION ABOUT THE BOARD, IMPROVED THEIR UNDERSTANDING OF CURRENT DIVISION ACTIVITIES, AND ALLOWED THEM TO SHARE FEEDBACK ABOUT CURRENT DIVISION ACTIVITIES.

DIVERSITY AND CULTURAL SAFETY

KEY MILESTONES

Cultural Safety Leadership Strategy

• Indigenous Relations Manager recruited

• Members invited to consult with Indigenous Relations Manager on Indigenous issues

Truth and Reconciliation Healthcare Committee

• Honoured members’ contributions to Truth and Reconciliation

• Indigenous Health Team implementation commenced

• DoBC cultural longhouse experience

Embedding a lens of cultural safety in all we say and do

Our mission of “A Healthy Nanaimo through supporting and empowering our primary care community” depends on a strong commitment to diversity and cultural safety. Providing opportunities to understand and incorporate cultural safety into daily work and practice as well as creating structures to support cultural safety will have an impact on addressing inequities in Indigenous health and reducing systemic racism in Primary Care. Toward these aims, the Board of Directors created a Cultural Leadership Strategy in 2021 working with partners from Snuneymuwx First Nation and members of the Truth and Reconciliation in Healthcare committee.

In June 2022, the Nanaimo Division of Family Practice hired our first ever Indigenous Relations Manager. Funded through the PCN, Gloria Harding provides a valuable Indigenous lens on the operations and strategy of both the PCN and the Division. Among her many contributions, Gloria has invited members to connect with her if they wish to discuss any Indigenous considerations when it comes to addressing the needs of Indigenous patients. Together with the PCN team, Gloria works with Snuneymuwx First Nation, Mid Island Metis Nation and Tillicum Lelum to define and begin to recruit for an Indigenous Health Team

The Division has supported a Truth and Reconciliation in Health Care (TRHC) committee since 2018. Representatives from the Snuneymuxw and Snaw-Naw-As First Nations and the Mid-Island Metis Nation are joined by leadership from Tillicum Lelum representing our urban Indigenous population. This collaboration provides a unique opportunity for our Indigenous partners to bring their experiences and provide guidance to promote cultural safety in Primary Care. Monthly meetings ensure that Indigenous voices are heard and

CULTURAL RELEVANCE STRATEGY

Whilst embracing humility and vulnerability, we are committing to walk alongside our Indigenous partners in their approach to create transformation of Nanaimo’s health system.

Honouring the work that has taken place and preparing to continue the journey of awareness and improvement alongside our Indigenous partners

We strive to understand how to respect Indigenous perspectives and accept the responsibility to embed cultural awareness into every aspect of our work

Recognizing our unconscious prejudices influence the cycle of development

Recognizing the value of relationality and offering time and space to create meaningful connections. Transforming conversations & relationships into programs and initiatives

Planting the seeds for growth and improvement

Acknowledging our spheres of influence in the health system to create opportunities for culturally relevant and equitable health care delivery.

Monitoring development and sharing knowledge to improve and develop sustainable strategies and planning

Reviewing the fruits of our labours by acknowledging our journey and bringing lessons learned and successes to the strategic table

LEADERSHIP & AWARENESS RELATIONSHIP BUILDING PROMOTING CHANGE LEARNING & CULTURAL SHARING

• Recognizing how colonial trauma has diversified our Indigenous communities, we will leverage traditional knowledge and partnerships to enhance opportunities that lie within learning and sharing two eyed seeing. Creating partnerships and opportunities to learn about both worlds & share knowledge

influence Division initiatives and culturally safe Primary Care practices. We have also sought Indigenous patient voices to better understand barriers and needs when it comes to Primary Care, such as through patient surveys that have underscored the importance of increasing culturally safe access for Indigenous patients.

Part of our work in cultural safety also involves increasing our awareness and understanding of Indigenous perspectives. To support this, the Joint Collaborative Committees partnered with Len Pierre Consulting to host a cultural learning experience for Physicians in local Indigenous communities. This gathering provided an opportunity for members of the Board, the Executive Director, and other local physicians to connect with the Snuneymuwx First Nation community by experiencing an encounter in the longhouse, traditional meal, cultural protocols and teachings.

“WE STRIVE TO UNDERSTAND HOW TO RESPECT INDIGENOUS PERSPECTIVES AND ACCEPT THE RESPONSIBILITY TO EMBED CULTURAL AWARENESS INTO EVERY ASPECT OF OUR WORK.” — BOARD LEADERSHIP STRATEGY

THANK YOU!

ACKNOWLEDGEMENTS THANK YOU &

Collaborative Service Committee

Dr. Taylor Swanson, NDoFP

Dr. Derek Poteryko, Island Health

D. John Trepess, NDoFP

Dr. David Sims, NDoFP

Inga Cooper, Tillicum Lelum

Darcy Ross, Island Health

Dana Leik, Island Health

Marina White, Snuneymuxw First Nation

Connie Paul, Snuneymuxw First Nation

Dr. Sandra Allison, Public Health

Dr. Steven Loken, Island Health

Susan Barr, Patient Partner

Tanille Johnston, FNHA

Lorraine Kirk, IH

Shelley Gallant, IH

Susan Youle, Patient Participant

Lisa Bhopalsingh, City of Nanaimo

Member Advisory Committee

Dr. Taylor Swanson, NDoFP Board Chair

Dr. Aaron Sobkowicz, Medical Arts

Dr. Aobhinn Grimes, Lexitor

Dr. Jenny Tram, Wallace Street Clinic

Dr. Marcus Barron, Medical Arts

Dr. Sidney Morrison, Medical Arts

Dr. Shirin Madjzoub, Thrive Family Health

Elaine Clark (Nurse Practitioner), Medical Arts

Dr. Emily Maclean, Anchor

Dr. Rebecca Wright, Resident, Anchor

Dr. David Sims, Wellington

Dr. Luella Johnson Miller, Caledonian

Dr. Chris Newcombe, NRGH

Dr. Duncan MacGillivray, Hospitalist

Dr. Michelle Workun-Hill, NDoFP Board Member

Dr. Diane Wallis, NDoFP Board Member

Dr. John Trepess, NDoFP Board Member

Dr. Duda Uchman, NDoFP Board Member

Kari Jonker (Nurse Practitioner), Nexus

PCN Leadership Team

*Dr. John Trepess

*Dr. David Sims

Deborah Harver, Island Health

Lorraine Kirk, Island Health

Shaina Pennington, BC Ministry of Health

Jennifer Barlow, Ministry of Health

Beccy Robson, NDoFP ED Laura Loudon, NDoFP PCN Program Manager

*Physician Lead

*Board Lead

Inpatient Care Initiative

*Dr. Kevin Martin

Dr. Taylor Swanson

Dr. Danielle Downe

Dr. Sidney Morrison

Dr. David Sims

Dr. Tony Zuccaro

Dr. Sunny Elle

Dr. Justin Kingsley

Dr. Charlotte Breakey

Kelsey Chandler, NDoFP Program Lead

CME Advisory Committee

*Dr. Danielle Downe

*Dr. Michelle Workun-Hill

*Dr. Kelvin Houghton

*Dr. Jessica Otte

Katrina Love, NDoFP Project Coordinator

PEDS Working Group

Dr. Michelle Francis (Project Lead)

Dr. Jane Pegg (Project Lead)

Dr. Bani Falcon

Dr. Mitchell Zelman

Dr. Francine Ling

Dr. Bhavika Patel

Dr. Kelly Cox

Dr. Jennifer Kouwenberg

Dr. Keith Menard

Stacie Powell (MOA)

Sandra Taylor (MOA)

Debbie Harilstad (MOA

Cassandra Claire (MOA)

Lesley Beamond

Erin Lutz (Evaluator)

Family Practice Representatives

Dr. Kathleen Torrie

Heather Gonyer

Dr. Kirsty McIlwaine

Erin Hemmens, NDoFP Project Lead

Recruitment and Retention Advisory Committee

*Dr. Cody Van Valkenburg, Caledonian Clinic

*Dr. Michelle Workun-Hill, Board Representative

Dr. Emily Mclean – UBC Residency Program

Dr. Rebecca Wright – UBC Residency Program

Dr. Shenelle Rodrigo – UBC Residency Program

Sarah Luney Englouen, NDoFP Program Lead

PCN Low Barrier Working Group

Karly Fennell

Jody Sawchyn

*Dr. David Sims

Amanda Lemon

Deborah Harver

Laura Loudon, NDoFP Program Lead

*Physician Lead

*Board Lead

Photo Credit: Dr. Cody Van Valkenburg

PCN Allied Health Working Group

*Dr. John Trepess

*Dr. David Sims

Lorraine Kirk

Deborah Harver

Rand Thompson

Truth & Reconciliation Task Group

Connie Paul

Donna Edwards

Grace Elliot Nielsen

Inga Nielsen-Cooper

Claudio Aguilera

*Dr. John Trepess

Marina White

Tanille Johnston

Joy Bremner

Tim Low

Deborah Harver

Dana Leik

Amanda Lemon

Jennifer Jones

*Laura Shanner

Gloria Harding, NDoFP

Indigenous Relations Manager

Laura Loudon, NDoFP Program Lead

PCN Steering Committee

*Dr. John Trepess (PCN)

*Dr. David Sims (Patient Medical Home)

Dr. Derek Poteryko

Grace Elliot Nielsen

Donna Edwards

Tim Low

Marina White

Connie Paul

Dana Leik

Tanille Johnston

Lorraine Kirk

Deborah Harver

Laura Loudon, NDoFP PCN Lead

Child Youth Working Group/ PCCYF

Dr. Kevin Martin

Dr. Wilma Arruda

Deborah Harver

Kelsey Chandler, NDoFP Program Lead

PCN Evaluation Working Group

*Dr. John Trepess (PCN)

Tim Low

Connie Paul

Deborah Harver

Lisa Demers

Laura Loudon, NDoFP Program Lead

PAM Collaborative Working Group

Dr. John Trepess

Dr, Meredith Borbandy

Dr. Jenny Tram

Dr. Ivan Serunkuma

Dr. Skye Creba

Jessica McDonnell

Diane Jones

Heather Gonyer

Shanda Birch

Kelsey Chandler, NDoFP Program Lead

Photo Credit: Dr. Cody Van Valkenburg

Photo Credit: Dr. Cody Van Valkenburg