A healthy Nanaimo through empowering and supporting our primary care community.
2022 / 2023
ANNUAL REPORT
divisionsbc.ca/nanaimo
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!
ANNUAL REPORT
CONTENT 04
06
08
10
MESSAGE FROM THE CHAIR
MESSAGE FROM THE EXECUTIVE DIRECTOR
EXECUTIVE OVERVIEW
BOARD OF DIRECTORS
12
14
16
17
THE TEAM
TIMELINE OF EVENTS
DETAILED DASHBOARDS
ADVOCACY & LEADERSHIP
20
22
26
28
MINDFUL OF MEMBERS’ NEEDS
ACCESS TO RESOURCES
COMMUNITY CONNECTIONS
DIVERSITY & CULTURAL SAFETY
31
34
THANKS & ACKNOWLEDGEMENTS
FINANCIAL STATEMENTS
36 CONTACT US
Photo Credit: Dr. Cody Van Valkenburg
Annual Report / 2022 - 2023
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ACRONYMS
CME – Continuing Medical Education
ISC – InterDivisional Strategic Council (ISC)
NMSES – Nanaimo Medical Staff Engagement Society
CSC – Collaborative Service Committee
LFP payment model – Longitudinal Family Physician payment model
NPs – Nurse Practitioners
DoBC – Doctors of BC FP – Family Physicians
LTCI – Long-Term Care Initiative
FPSC – Family Practice Services Committee
MAC – Members’ Advisory Committee
FNHA – First Nations Health Authority
MHSU – Mental Health and Substance Use
HHR – Health Human Resources
MOA – Medical Office Assistant
IDC – Island Divisions Collaborative (IDC)
NDoFP – Nanaimo Division of Family Practice, “The Division”
Photo Credit: Adobe Stock
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NANAIMO DIVISION OF FAMILY PRACTICE
NRGH – Nanaimo Regional General Hospital PCN – Primary Care Network R&R – Recruitment and Retention TRHC – Truth and Reconciliation Health Care committee
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.
OUR MEMBERSHIP
38% Family Physicians
14% Locums
11% 314 TOTAL MEMBERS 226 members (72%) are funded
Emergency Physicians
10% Retired Physicians
9% Hospitalists
7% Residents
7% Nurse Practitioners
4% Other
Annual Report / 2022 - 2023
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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.
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.
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NANAIMO DIVISION OF FAMILY PRACTICE
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
CHAIR STATEMENT
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.
• 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
As always, please connect, I truly value all feedback and perspectives.
Taylor Swanson
CHAIR
Annual Report / 2022 - 2023
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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.
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
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NANAIMO DIVISION OF FAMILY PRACTICE
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.
EXECUTIVE DIRECTOR STATEMENT
Photo Credit: Adobe Stock
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
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
Annual Report / 2022 - 2023
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OUR DIVISION
EXECUTIVE OVERVIEW MISSION A healthy Nanaimo through empowering and supporting our Primary Care community.
Photo Credit: Adobe Stock
STRATEGIC VISION
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NANAIMO DIVISION OF FAMILY PRACTICE
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%
of 18 Division-led committees and working groups focus on collaborations between members and partners to make change in primary care.
“I STRONGLY BELIEVE THE DIVISION IS CRUCIAL FOR NANAIMO GPS TO COORDINATE CME, COMMUNICATIONS,
27%
of members attended at least one of the 5 CMEs that were offered in 2022-2023.
ADVOCACY, AND MORE.” — NANAIMO DIVISION MEMBER Annual Report / 2022 - 2023
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BOARD OF
DIRECTORS DR. TAYLOR SWANSON CHAIR
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DR. DIANNE WALLIS TREASURER & SECRETARY
DR. JOHN TREPESS DIRECTOR-AT-LARGE
DR. REBECCA WRIGHT DIRECTOR-AT-LARGE (ASSOCIATE)
COURTNEY DEFRIEND DIRECTOR-AT-LARGE (COMMUNITY)
NANAIMO DIVISION OF FAMILY PRACTICE
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.
DR. CAITLIN BLEWETT DIRECTOR-AT-LARGE (ASSOCIATE)
DR. MICHELLE WORKUN-HILL DIRECTOR-AT-LARGE
DR. LAURA SHANNER DIRECTOR-AT-LARGE (COMMUNITY)
DR. DUDA (DUDRAVKA) UCHMAN DIRECTOR-AT-LARGE
THE PEOPLE
Annual Report / 2022 - 2023
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BECCY ROBSON EXECUTIVE DIRECTOR
KATHY SHAW EXECUTIVE COORDINATOR
LEILA SCANNELL QUALITY IMPROVEMENT MANAGER
SARA LUNEY ENGLOUEN R&R PROGRAM LEAD
THOMAS WRIGHT R&R PROGRAM ADMINISTRATOR
KATRINA LOVE CME & EVENTS COORDINATOR
LAURA LOUDON PCN PROGRAM MANAGER
GLORIA HARDING INDIGENOUS RELATIONS MANAGER
BARBARA LESLIE
KELSEY CHANDLER
MEGHAN BAJZATH
PCN PROGRAM LEAD
PCN AND INPATIENT PROGRAM LEAD
PCN PROGRAM COORDINATOR
MEET THE
TEAM
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NANAIMO DIVISION OF FAMILY PRACTICE
The Division is comprised of administrators, coordinators, leads, and managers who work together to help create a healthier Nanaimo.
THE PEOPLE
VICTORIA WILSON PCN PROGRAM COORDINATOR
JUANESSA PRINCE PCN ADMINISTRATIVE ASSISTANT
LILIIA LIUSHNENKO PCN PROGRAM ADMINISTRATOR
REGAN GRILL OPERATIONS MANAGER
ERIN HEMMENS PEDS PROGRAM LEAD
BRENDA ADAMS
FERNANDA GUTIERREZ
JANICE SCHMIDT
LTCI PROGRAM COORDINATOR
PATHWAYS COORDINATOR
PROJECT MANAGER
Annual Report / 2022 - 2023
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2022-23
TIMELINE OF EVENTS
Photo Credit: Adobe Stock
2022 April 9 Nanaimo Clinic Crawl April 13 Hired new R&R Manager May Launch of Physician Advisory Committee Division office expansion completed
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June 20 Hired Indigenous Relations Manager
August PCN Year 2 Strategy Planning Session Part 2
June 29 PAM Collaborative Working Group
September 20 Quality Improvement Manager Hired
July 13 PCN Year 2 Strategy Planning Session 1
September 21 CME: Pelvic Health 101
July 21 NDoFP and NMSES Summer BBQ
NANAIMO DIVISION OF FAMILY PRACTICE
September 26 PCN New to Practice Webinar September 28 PCN Patient Attachment Collaborative Working Group
2022-23
2022-2023 welcomed the return of in-person engagement events, CME, and networking opportunities.
2023 October 5 FPSC approved inpatient bridge funding
January 25 MOA Violence Prevention training
February 21 CME: Internal Medicine World Café Part 1
October 13 CME: Forensic Nursing
January 28 UBC Family Medicine Resident & Locum Physician Clinic Crawl
February 21 Member attachment Initiative launched
October 18 PCN Innovative Practice Engagement Event October 27 NDoFP Annual General Meeting
February 28 CME: Internal Medicine World Café Part 2
November 16 CME: Don’t Just Do Something… Stand there! (and do less) December 13 DoBC Dinner
Annual Report / 2022 - 2023
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DETAILED
DASHBOARDS 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)
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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.
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NANAIMO DIVISION OF FAMILY PRACTICE
Annual Report / 2022 - 2023
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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 18
NANAIMO DIVISION OF FAMILY PRACTICE
ADVOCACY & LEADERSHIP
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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).
Annual Report / 2022 - 2023
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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
“THE DIVISION IS ACTION-ORIENTED, RESPONSIVE TO MEMBER INPUT AND NOT SILOED.” — NANAIMO DIVISION MEMBER
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.
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NANAIMO DIVISION OF FAMILY PRACTICE
Recruitment & Retention At a Glance Recruitment
2022 Clinic Crawl
4 Physician candidate site visits 4 Family Medicine Physicians Recruited 2 (seasonal) Locum Physicians Recruited
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.
6 Family Practice physicians considering relocation to Nanaimo in 2023/2024
02
Retaining UBC Family Medicine Residents 5/8 2022 UBC Family Medicine graduates have remained in Nanaimo post-graduation 3 are completing post-residency training with plans of returning Nanaimo in Summer/Fall of 2023.
Clinic Crawl 2023 Residents and locums toured local clinics, learned about practice opportunities, and connected with physicians
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Recruitment of Y4 Family Practice Elective Preceptors Increasing preceptor capacity aims to bring the Family Physicians of tomorrow to Nanaimo today, promote longitudinal Family Medicine and showcase our community 2 Family Practice elective preceptors recruited. Efforts are ongoing.
Division Member Attachment Initiative Aim: to attach members and their families (when possible) to a Primary Care Provider 8 clinics enrolled to receive attachment requests 2 Physician + family attachments successfully coordinated. 1 Physician + family pending attachment
Annual Report / 2022 - 2023
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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.
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NANAIMO DIVISION OF FAMILY PRACTICE
Understanding the Local Landscape
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.
Continued Medical Education (CME) At a Glance
5
CME Events, representing a return to normal volume
159 Total attendees Family Physicians and Specialists
14 facilitated the events
of attendees agreed that the programs
100% met the intended learning objectives
MEMBERS LOVED
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.
… “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
Financial support was also obtained from FPSC for the Inpatient Care Initiative. Faced with the potential collapse of the inpatient service and,
Annual Report / 2022 - 2023
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“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
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.
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NANAIMO DIVISION OF FAMILY PRACTICE
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:
Photo Credit: Adobe Stock
Remunerating physicians for working towards achieving the FPSC 5 Best Practices
Providing DoFP Project Management Support
Providing DoFP Administrative Support
QI & Education
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:
31 LTCI PHYSICIANS 55% are core physicians
82% OF LTC BEDS COVERED of a total of 1,027 beds
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
care homes in Nanaimo 14 Long-term covered
Physicians and NP participating 18 LTCI in vacation coverage
48 856
vacation requests covered patients with continuation of care
$61,809 total remuneration to physicians
Annual Report / 2022 - 2023
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“THE DIVISION TIES US TO HOSPITAL AND COMMUNITY, LINKS US WITH QUALITY CARE INITIATIVES, AS WELL AS PROVIDES ENGAGEMENT OPPORTUNITIES.” — 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
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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,
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NANAIMO DIVISION OF FAMILY PRACTICE
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.
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DIVERSITY AND CULTURAL SAFETY KEY MILESTONES •
Cultural Safety Leadership Strategy
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Indigenous Relations Manager recruited
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Members invited to consult with Indigenous Relations Manager on Indigenous issues
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Truth and Reconciliation Healthcare Committee
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Honoured members’ contributions to Truth and Reconciliation
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Indigenous Health Team implementation commenced
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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
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NANAIMO DIVISION OF FAMILY PRACTICE
CULTURAL SAFETY
CULTURAL RELEVANCE STRATEGY
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.
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.
Transforming conversations & relationships into programs and initiatives
Honouring the work that has taken place and preparing to continue the journey of awareness and improvement alongside our Indigenous partners
LEADERSHIP & RELATIONSHIP AWARENESS BUILDING 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
PROMOTING LEARNING & CHANGE CULTURAL SHARING
Planting the seeds for growth and improvement
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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
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“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
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.
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NANAIMO DIVISION OF FAMILY PRACTICE
THANK YOU!
THANK YOU &
ACKNOWLEDGEMENTS Collaborative Service Committee
Member Advisory Committee
Dr. Taylor Swanson, NDoFP
Dr. Taylor Swanson, NDoFP Board Chair
Dr. Diane Wallis, NDoFP Board Member
Dr. Aaron Sobkowicz, Medical Arts
Dr. John Trepess, NDoFP Board Member
Dr. Aobhinn Grimes, Lexitor
Dr. Duda Uchman, NDoFP Board Member
Dr. Derek Poteryko, Island Health D. John Trepess, NDoFP Dr. David Sims, NDoFP Inga Cooper, Tillicum Lelum Darcy Ross, Island Health
Dr. Jenny Tram, Wallace Street Clinic Dr. Marcus Barron, Medical Arts
Dana Leik, Island Health
Dr. Sidney Morrison, Medical Arts
Marina White, Snuneymuxw First Nation
Dr. Shirin Madjzoub, Thrive Family Health
Connie Paul, Snuneymuxw First Nation
Elaine Clark (Nurse Practitioner), Medical Arts
Dr. Sandra Allison, Public Health
Dr. Emily Maclean, Anchor
Dr. Steven Loken, Island Health
Dr. Rebecca Wright, Resident, Anchor
Susan Barr, Patient Partner Tanille Johnston, FNHA Lorraine Kirk, IH Shelley Gallant, IH
Dr. David Sims, Wellington Dr. Luella Johnson Miller, Caledonian Dr. Chris Newcombe, NRGH
Susan Youle, Patient Participant
Dr. Duncan MacGillivray, Hospitalist
Lisa Bhopalsingh, City of Nanaimo
Dr. Michelle Workun-Hill, 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
Annual Report / 2022 - 2023
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Photo Credit: Dr. Cody Van Valkenburg
Inpatient Care Initiative
PEDS Working Group
*Dr. Kevin Martin
Dr. Michelle Francis (Project Lead)
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
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)
CME Advisory Committee *Dr. Danielle Downe *Dr. Michelle Workun-Hill *Dr. Kelvin Houghton *Dr. Jessica Otte Katrina Love, NDoFP Project Coordinator
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
Debbie Harilstad (MOA Lesley Beamond
PCN Low Barrier Working Group
Erin Lutz (Evaluator)
Karly Fennell
Family Practice Representatives
Jody Sawchyn
Dr. Kathleen Torrie
*Dr. David Sims
Heather Gonyer
Amanda Lemon
Dr. Kirsty McIlwaine
Deborah Harver
Erin Hemmens, NDoFP Project Lead
Laura Loudon, NDoFP Program Lead
Cassandra Claire (MOA)
*Physician Lead *Board Lead
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NANAIMO DIVISION OF FAMILY PRACTICE
THANK YOU!
Photo Credit: Dr. Cody Van Valkenburg
PCN Allied Health Working Group
PCN Steering Committee
*Dr. John Trepess *Dr. David Sims
*Dr. David Sims (Patient Medical Home)
Lorraine Kirk
Dr. Derek Poteryko
Deborah Harver
Grace Elliot Nielsen
Rand Thompson
Donna Edwards
Truth & Reconciliation Task Group
Tim Low
Connie Paul
Connie Paul
Donna Edwards
Dana Leik
Grace Elliot Nielsen
Tanille Johnston
PAM Collaborative Working Group
Inga Nielsen-Cooper
Lorraine Kirk
Dr. John Trepess
Claudio Aguilera
Deborah Harver
Dr, Meredith Borbandy
*Dr. John Trepess
Laura Loudon, NDoFP PCN Lead
Dr. Jenny Tram
Marina White Tanille Johnston Joy Bremner Tim Low Deborah Harver Dana Leik Amanda Lemon Jennifer Jones
*Dr. John Trepess (PCN)
Marina White
Child Youth Working Group/ PCCYF
PCN Evaluation Working Group *Dr. John Trepess (PCN) Tim Low Connie Paul Deborah Harver Lisa Demers Laura Loudon, NDoFP Program Lead
Dr. Ivan Serunkuma Dr. Skye Creba Jessica McDonnell
Dr. Kevin Martin
Diane Jones
Dr. Wilma Arruda
Heather Gonyer
Deborah Harver
Shanda Birch
Kelsey Chandler, NDoFP Program Lead
Kelsey Chandler, NDoFP Program Lead
*Laura Shanner Gloria Harding, NDoFP Indigenous Relations Manager Laura Loudon, NDoFP Program Lead
Annual Report / 2022 - 2023
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FINANCIAL STATEMENTS
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NANAIMO DIVISION OF FAMILY PRACTICE
FINANCIAL OVERVIEW
Annual Report / 2022 - 2023
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Photo Credit: Dr. Cody Van Valkenburg
THANK YOU! The Divisions of Family Practice Initiative is sponsored by the Family Practice Services Committee, a joint committee of the BC Ministry of Health and Doctors of BC.
2137 A Bowen Road Nanaimo, BC V9S 1H8 Tel: 250 591 1200 Fax: 250 591 1205 info@nanaimodivision.ca https://divisionsbc.ca/nanaimo