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Annual Report

2011-12

Victoria


Table of Contents 3 4 7 9 10 12 15 18

Report from the Co-chairs Report from the Executive Director Division initiatives/projects Mission statement and purpose Highlights of the year Division timeline Selected highlights Financial Statements

“The Division is the avenue where individuals can make a systemic impact on primary care and where community social networks develop. It is bringing Victoria’s GPs together on both patient care issues and physician wellness. It also offers a great service for communication from and to community GPs and offers continuing medical education in a local setting. I’ve really enjoyed being involved.” - Dr. Jody Dans - Victoria Division member


Report from the Co-chairs The Victoria Division of Family Practice achieved many exciting things during our first full year of operation. Both as Division co-chairs and as physicians ourselves, we believe perhaps the most significant of this inaugural year’s accomplishments has been to re-establish a strong community of family physicians in the city

Dr. Valerie Ehasoo Co-chair

The Division has given us a place to come together as colleagues, to share our common experiences and challenges, and to contribute our ideas for improving the primary care experience for all involved. Through the Division, we have increasing opportunities to speak out as leaders in our health care community. It is inspiring to know that 245 out of a possible 300 local family physicians, together with 15 residents, have already chosen to join us. As a member-driven organization, your input is vital to our success and we look to your direction and energy as we continue to move forward. Together, we represent the voice of primary care in Victoria and we have the ability to influence positive change. Members identified four key priority areas of focus: care of the elderly, locum and physician recruitment and transitions, mental health care access, and primary care access. Working groups have been formed to pursue goals for each and all are at the stage of taking next steps towards solutions.

Dr. Aaron Childs Co-chair

We begin our second year continuing to build relationships with our partners in the Vancouver Island Health Authority (VIHA) and the Ministry of Health, and working together with our communities, including our patients and other stakeholders, to develop and implement solutions. This annual report highlights our collective achievements and reminds us that the landscape of family practice in Victoria today is very different than it was a year ago. Division members’ participation in working groups, Dine and Learns, surveys and other activities has been amazing. We hope the Division will continue to capture members’ interest and inspire others to work collectively at improving local primary care for physicians and patients. Thank you all for a fantastic first year. We look forward to the year ahead, and our continuing collaboration in enhancing the community of family practice here in Victoria.

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Report from the Executive Director I am proud to have been involved with this initiative during its first year of operation. Not only has it been exciting to start something new, it has also been incredibly gratifying to see a community form where there was, a short time ago, only a group of individuals.

Alisa Harrison Executive Director

When I joined the team in February 2012, on the night of our first engagement event, there was already a sense of excitement in the air. The inaugural board knew family physicians in Victoria were hungry for collegiality and connection. They had incorporated the Division because they knew GPs were frustrated with practicing in isolation and coping with systemic challenges alone. In the ensuing months, we were buoyed as one member after another stepped forward, brought colleagues into the fold, and worked to figure out what they could do to create the supportive environment that we know will improve both professional satisfaction and patient care. I came to the Division with a background in health policy research and development, and sustained scholarly engagement with the history and theory of democratic social movements. I have drawn on this combination of knowledge and experience as we have worked to build and energize a community, and create practical opportunities and effective operational structures to enable changes to the primary health care system. As executive director, I have thoroughly enjoyed supporting both the board and our members to increase their leadership capacity and bring their voices—independently and as a collective—to a series of decision-making tables. Building a strong and sustainable organization has been a critical part of my work this year, but the Division’s true significance at this point is measured by its relevance and service to our members. In my view, the key indicators emphasize the integrity and capacity of the group, and answer the question: to what degree do our members feel engaged, and demonstrate their increasing empowerment as physicians in community-based practice and as decision-makers within the health system? I am motivated to help create an environment where members are welcomed and supported in taking action, where we all recognize the value of working together, persist through the hard work of learning to trust and collaborate, and build faith in the possibility that things truly can change. In the year ahead, we will ramp up our efforts to build community among family physicians and deepen the relationships we are now

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Victoria Division of Family Practice 2011-12 Annual Report


nurturing with our partners in VIHA and the Ministry of Health. We will also branch out to engage other individuals and groups in Victoria because everyone has a stake and a role to play in enhancing primary care. I thank all of you—our members, our board of directors, and our staff—for trusting enough to come along on this journey, and look forward with excitement to where you will direct us next.

Above: The Victoria Division Board of Directors (left to right) Drs. Greg Siren, Valerie Ehasoo, Aaron Childs, Jean Maskey, David Harris, Kathy Dabrus, Tejinder Sidhu and Lorne Verhulst. Left: Drs. Barbara Roback (left) and Kathy Dabrus participating in a “Dotmocracy” exercise during the members’ meeting at the Hotel Grand Pacific on April 2012.


Above left: Drs. Doug McGhee (left) and Fiona Manning in conversation at the April 2012 members’ meeting. Above right: Drs. Kathy Dabrus (left) and Layne Woodburn at the first Division engagement event in February 2012. Above right: Dr. Mike Myles chats with Dr. Geoff Luckhurst at the February event. Below: Dr. Lorne Verhulst speaking at the April meeting.


Division initiatives/projects In its first year, the Victoria Division focused on engaging physicians to become members and participate in Division initiatives. The Division used a number of direct and indirect strategies to reinforce the point that this is a physician-driven organization and to emphasize that its power comes from individual members working collectively to enhance primary care. After the first engagement event in February, Division members were surveyed to identify their priorities for action, with approximately half returning a completed survey. About 40 members gathered together in the early spring to discuss the results of the survey. At that time, four priority areas for work were identified: 1. 2. 3. 4.

locum recruitment, physician supply and transitions primary care access long term care (since renamed care of the elderly) mental health and addictions care access.

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In addition, the vital importance of increasing collegiality and rebuilding a family practice community in the city of Victoria was a recurring theme through all these discussions. Members began this work with great enthusiasm. The Division held a large engagement and networking event in May, and members then struck a Community-Building Committee, which initiated what is proving to be a highly successful monthly Dine and Learn series, alternating informal discussions with local specialists and sessions on practice efficiency and professional development. As part of the Community-Building Committee’s effort to support work/life balance, members also worked with Division staff to organize a family barbecue in September, which attracted 140 attendees. In addition, the committee is currently generating a medical resource package to provide basic information about practicing in Victoria to all local GPs, and an orientation program intended to help welcome new GPs to the city, which will include a mentoring arrangement to assist with transitions and provide ongoing professional support. In terms of the four priority areas, during the summer, members responded to additional area-specific online surveys, and then attended facilitated discussion groups (ranging in size from 15 to 31 people) where they began to identify fundamental problems within the system of care. Members engaged candidly and with a clear commitment to working toward real progress for both Victoria’s family physicians and patient population. Members then formed four working groups, through which they continued receiving support to explore the priority areas, and to build the skills and capacity for active participation in decision-making processes. The four groups met throughout the fall and early winter to identify root causes of the problems facing primary care, and begin to determine some solutions. By the end of 2012, the groups were considering a variety of next steps, including a ‘speed dating’ event to introduce physicians and locums to one another and facilitate better practice coverage, a round-table of multidisciplinary mental health and addictions care providers, and working with several local nursing homes to explore new models for access. A smaller committee has also formed to target the problem of GP-hospital communications, and it has begun to make headway in that area. The formation of the working groups coincided with the Division’s efforts to develop a comprehensive manpower survey. Set to deploy in early 2013, the survey will generate a snapshot of Victoria’s family practice environment and help inform the board and the working groups’ decisions going forward. The Division expects to secure supplementary data about the community from its partners in VIHA as well as the Physician Information Technology Office. In the context of building collaborative relationships, the Division also continues to engage medical office assistants (MOAs) as partners in enhancing primary care. An MOA Dine and Learn was held in October to begin discussing how physicians and MOAs can work together to achieve common goals; MOAs were invited along with GPs to a session on billing

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Victoria Division of Family Practice 2011-12 Annual Report


optimization with Dr. Cathy Clelland (SGP) in November; and the Division anticipates forming an MOA working group early in 2013. Some of the Division’s most important collaborative work has focused on developing a strong relationship with the neighbouring South Island Division. To that end, the two divisions have formalized good communications practices and South Island has welcomed Victoria as a partner in two of its major projects: Partners in Care (PiC) (one of Victoria’s cochairs and the executive director sit on the PiC steering committee), and the development of a multidisciplinary maternity clinic. Throughout the year, Victoria’s board of directors has engaged in a number of activities designed to establish a healthy, transparent governance process and support continuing board development. Individual directors have attended the Leadership and Management Development course via the General Practice Services Committee (GPSC) and Simon Fraser University, as well as courses delivered through the Physicians’ Management Institute. A board retreat in March provided workshops on governance and strategic planning, which was followed in December by a full-day strategic planning session to refine the Division’s strategic direction and to prepare for its first AGM, slated for February 2013 at the Fairmont Empress. The Division expects to elect three to four new board members at that time.

Above: Local family physicians participating at the Division’s first engagement event at Fairmont Empress in February 2012. Right: Drs. Nena Edmunds and Fiona Manning at the engagement event.


Above left: Drs. Jody Anzarut (left) and Karin Down participating in the “Dotmocracy” exercise at the April 2012 members’ meeting. Above right: Dr. Tejinder Sidhu leading a discussion at the members’ meeting. Above right: Dr. Tony Leung at the family barbecue in September 2012. Below left: Medical office assistants participating in the dine and learn at Swan’s in October 2012. Below right: Drs. (left to right) Caspar Friesen, Doug McGhee and Donna Doyle at the May engagement event at the Hotel Grand Pacific.


Mission statement and purpose Vision Promoting healthy communities through excellence in local primary care.

Mission The Victoria Division of Family Practice is a physician-led non-profit society that strives to improve patient care and population health by: • ensuring access to excellent primary care, • increasing family physicians’ influence and impact on health policy development and health care delivery decisions, • building partnerships that facilitate an effective and sustainable health system, and • enhancing physician collegiality and professional fulfillment.

Values The Victoria Division of Family Practice conducts its operations with the following values in mind: • • • • • • • • • • • • • •

compassion and patience inclusivity collaboration grassroots democracy transparency respect timely, respectful communication fair process accountability stewardship and responsibility ongoing and meaningful input and engagement building real relationships local responsiveness evidence-driven.

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Highlights of the year 2011 November • Incorporation and signing of the Document of Intent by all partners.

2012 February • First physicians’ engagement event drew 120 Division members. March • Inaugural issue of the Division’s quarterly newsletter, The Bulletin. • Online survey of members’ priorities. • Participation began in two South Island-led initiatives: Partners in Care and maternity care. • Division board retreat on governance and strategic planning. April • Members’ meeting to discuss survey results and establish key priority areas. • Completion of initial organizational start-up processes. May • Second physicians’ engagement event: focus on community-building. June • Inaugural Dine and Learn on practice efficiencies. • Community-Building Committee established. • Communications Committee established to address barriers to GP-hospital communications. July • Brief surveys on four priority areas: locum recruitment, physician supply and transitions; primary care access; long term care (since renamed care of the elderly); mental health and addictions care access. August • Accredited by the College of Family Physicians to provide Mainpro M-1 credits for participation in Victoria Division events. • Division membership surpasses 200 out of a potential 300.

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Victoria Division of Family Practice 2011-12 Annual Report


• Formed discussion groups to address each of the four priority areas (continued into early September).

September • Working groups established for each of the four priority areas. These meet monthly or bi-monthly. • Family barbecue at Willow’s Beach organized by the Community-Building Committee. • Began developing a welcome and orientation program as well as a medical resources package for family physicians. October • Formation of Victoria’s Collaborative Services Committee (CSC). • Began developing a comprehensive manpower survey to assess the state of family medicine in Victoria. • Second Dine and Learn, with specialists from internal medicine. • Dine and Learn to build partnerships with GPs’ MOAs. • Working groups continued to meet to identify root causes of problems in primary care. November • Session on billing optimization with Dr. Cathy Clelland drew 115 GPs and MOAs. • Third Dine and Learn, with specialists from pediatrics. December • Working groups began planning initiatives and events for 2013, as well as reaching out to community stakeholders and potential partners. • Division membership reached 240. • Division board conducted strategic planning.

2013 January • Fourth Dine and Learn: physician health and wellness, facilitated by the Physician Health Program of BC. February • First AGM. • First Dine and Learn of the year, with musculoskeletal specialists.

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Above: A graphic recording of the April members’ meeting by Lisa Arora from Get the Picture. Right: In discussion at the April members’ meeting were (left to right) Lisa Adams (provincial Divisions team), Dr. Aaron Childs and Dr. Steve Goodchild. Below: Local physicians participating in round table discussions at the April members’ meeting.


Selected highlights Working groups: All working groups have followed an iterative and developmental process designed to maximize member input and ensure a strong mandate for moving forward. Although each group has taken a slightly different shape, they have all spent the initial months fully scoping the problems in each area and drilling down to identify the issues’ root causes. Each group has sustained physician engagement throughout the process. The smallest group, care of the elderly, has approximately six regular participants. The remaining groups have approximately 10-15.

Locum/practice coverage Lack of office/practice coverage has been identified as a fundamental problem in Victoria. The group has determined it is unlikely there will ever be enough locums to go around, and as such is seeking innovative solutions to the challenge of securing a replacement when a physician needs time away from work. At present, the focus is on identifying methods of matching local GPs/practices with one another to facilitate appropriate cross-coverage among colleagues. In addition, this group is actively involved with the developing provincial recruitment and retention strategy.

Primary care access This group has addressed the problem of access to primary care from physician, patient and system perspectives. They have identified a number of questions for exploration, focusing broadly on increasing attachment, considering doctor-patient compatibility, supporting physicians in making family practice more attractive and sustainable, educating patients about the health system, and increasing the prevalence of multidisciplinary primary care. In 2013, the group will work on developing solutions to these challenges.

Care of the elderly This group began with the title “long term care,” but has morphed into care of the elderly in recognition of the need to address care needs in nursing homes as well as in the community. Members have identified several core issues related to system inefficiencies, lack of specialist support and GP isolation, and poor communication with GPs who visit nursing homes to deliver care. They have reviewed system redesigns in other jurisdictions—in particular Care By Design in Halifax—and demonstrated interest in developing a model that links a core group of GPs to a given long term care facility and could also provide care to a group of frail elderly patients in the surrounding community. Several members of the group are exploring potential partnerships with some long term care facilities and several others have formed a Continued on page 16 Victoria Division of Family Practice 2011-12 Annual Report

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Continued from page 15 subcommittee that will focus on issues around patient access to long term care.

Mental health and addictions care access This working group has identified a wide variety of barriers to care for patients and for physicians trying to access appropriate services and supports for their patients. One of the underlying issues identified is lack of knowledge of the system as a whole: physicians do not have a strong sense of the variety of services available or how to access them. As a result, the working group is planning a multidisciplinary mental health providers’ roundtable to create a map of services in Victoria, and to increase collaboration across disciplines. A benefit of this will be to link with providers beyond psychiatry, which could assist with providing good care to individuals with mild-moderate mental health concerns as well as those with refractory/ severe illness. To this end, the group has connected with Dr. David Yaxley (USTAT), and is exploring collaboration with VIHA to develop the roundtable. Similarly, the group is taking steps to link with the South Island Division’s Partners in Care initiative, which has identified psychiatry—and in particular, a central access model—as a priority area for improvement. The group is also spending time focusing on ways to provide in-office support to family physicians who are struggling to care for patients with mental health and addictions issues.

Committees: Community-Building Committee Dine and Learn This series has been a huge success. It is a core component of the Division’s plan to support collegiality among Victoria physicians and increase both professional capacity and fulfillment. Each session has filled quickly and generated a sizeable waiting list; a spot at a Dine and Learn is clearly a hot commodity. The series began in June with a session on practice efficiencies, which had participants sharing efficiency pearls by posting them on large sticky notes around the restaurant, and discussing them across tables. The Division followed by distributing a summary report to the full membership. After breaking for the summer, the Community-Building Committee launched its initiative to bring family physicians together with local specialists for brief lectures as well as face-to-face contact over a meal in order to facilitate better relationships going forward. Family BBQ As part of the goal to build a sense of community among family practitioners and support their work/life balance, the Division held a family BBQ at Willow’s Beach in September. The BBQ—including food, bouncy castles and cotton candy—attracted approximately 140 people to this first-of-its-kind opportunity to socialize and make connections between physicians, their partners and families.

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Victoria Division of Family Practice 2011-12 Annual Report


Above: Drs. (left to right) Tejinder Sidhu, Eugene Leduc and Tony Leung at the April members’ meeting. Right: Drs. Talita Strumpfer (left) and Abeer Abed at the family barbecue. Below: The CommunityBuilding Committee organized a family barbecue at Willow’s Beach in September 2012.


Audited Financial Statement for 2011-12 The following is an audited statement for the 12 month period of March 2011 to March 2012. March 2011 - March 2012 Human Resources Physician – Board

$ 98,329.09

Physician – Member

$ 46,904.35

Contracted – Coordinator

$ 14,606.62

Contracted - Admin Assistant

$ 1,287.50

Total - Human Resources

$ 161,127.56

Administration Memberships / Subscriptions

$ 200.00

Office Supplies

$ 75.00

Insurance

$ 1,475.00

Total – Administration

$ 1,750.00

Event Expenses Resources

$ 200.00

Total - Event Expenses

$ 200.00

Board Costs Board Education / Training

$ 5,711.42

Board/Committee Meeting Costs

$ 516.80

Total - Board Costs

$ 6,228.22

Total Expense

$ 169,305.78

Graph of 2011-12 Expenses Physician - Board - 58% Physician - Member - 28% Board Education - 3.4% Administration - 10.6%

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Victoria Division of Family Practice 2011-12 Annual Report


Unaudited Financial Statement for 2012 The following is an unaudited statement for the nine month period of April 1 to December 13, 2012. Income

1 April - 13 December, 2012

GPSC – Infrastructure

$ 909,995.00

Interest

$ 376.08

Total Income

$ 910,371.08

Gross Profit

$ 910,371.08

Expense Human Resources Physician - Board

$ 103,251.76

Physician - Member

$ 97,426.42

Physician - Non Member

$ 1,780.55

Contracted - Coordinator

$ 73,516.80

Contracted - Admin Assistant

$ 19,068.75

Contracted - Bookkeeper

$ 2,535.00

Contracted - Other

$ 3,945.50

Total - Human Resources

$ 301,524.78

Administration Memberships / Subscriptions

$ 584.42

Banking Fees

$ 317.81

Professional Fees

$ 476.50

Telephone & Communication

$ 283.09

Promotional Material

$ 4,469.59

Design Work

$ 1,311.63

Printing

$ 1,525.26

Postage

$ 343.71

Office Supplies

$ 5,069.70

Miscellaneous

$ 6.75

Total - Administration

$ 14,388.46

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Travel Board Travel Accommodation

$ 1,228.71

Airfare

$ 1,357.33

Ferries

$ 271.15

Meals

$ 238.56

Mileage

$ 220.00

Parking

$ 129.23

Taxis

$ 196.03

Total - Board Travel

$ 3,641.01

Coordinator Travel Meals

$ 207.42

Accommodation

$ 1,203.18

Local Mileage

$ 249.00

Ferries

$ 399.59

Parking

$ 62.85

Total - Coordinator Travel

$ 2,122.04

Other Travel Expenses

$ 170.50

Total - Travel

$ 5,933.55

Event Expenses Food

$ 36,949.35

Meeting Rental Space

$ 6,677.65

Resources

$ 12,676.36

Supplies for events

$ 367.58

Door Prizes

$ 93.92

Total - Event Expenses

$ 56,764.86

Board Costs Board Education / Training

$ 1,806.63

Board/Committee Meeting Costs

$ 6,879.53

Total - Board Costs

$ 8,686.16

Total Expense

$ 387,297.81

Net Income

$ 523,073.27

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Victoria Division of Family Practice 2011-12 Annual Report


Graph of 2012 Expenses General Board Duties - 15.52% Physician Engagement Event - 12.02% Board Education - 5.3% Primary Care Working Group - 4.92% Mental Health Working Group - 4.73% EMR - 4.64% Meetings with Partners - 3.59% Locum Working Group - 3.33% Long Term Care Working Group - 2.98% Community Building - 2.52% Dine and Learn - 2.29% Surveys - 2.16% Family Picnic - 1.21% Maternity Working Group - 0.65% Information Meeting - 0.06% Administration - 34.08%

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Victoria Division of Family Practice Contact information: 1591 Simon Place, Cowichan Bay, BC V0R 1N1 Phone/fax 250-597-8469 victoria@divisionsbc.ca www.divisionsbc.ca/victoria

Board of Directors Dr. Aaron Childs - co-chair Dr. Valerie Ehasoo - co-chair Dr. David Harris - treasurer Dr. Lorne Verhulst - secretary Dr. Kathy Dabrus Dr. Jean Maskey Dr. Tejinder Sidhu Dr. Greg Siren

Division staff Alisa Harrison - executive director Nicole Dehoop - administrative assistant Cindy Storie-Soth – bookkeeper

Photographs of the Victoria area courtesy of: Picture BC: front cover - Victoria’s Inner Harbour during the city’s 150th anniversary celebrations. Heather Armstrong Photography: the April event at the Hotel Grand Pacific.

The Divisions of Family Practice initiative is sponsored by the General Practice Services Committee, a joint committee of the BC Ministry of Health and Services and the BC Medical Association.

www.divisionsbc.ca/victoria

Victoria


Victoria Division of Family Practice 2011 Annual Report