OUR VISION
OUR SUCCESSES
OUR STORIES
2015–16 ANNUAL REPORT
since 2013: 18,200 patients have been attached. 22 GPs have returned or relocated to practice in the city. 55,000 patients have stronger attachments.
THE VICTORIA DIVISION OF FAMILY PRACTICE (VDFP) IS A NON-PROFIT ORGANIZATION WITH APPROXIMATELY 400 FAMILY PHYSICIAN MEMBERS. IN NOVEMBER 2016, THE VDFP CELEBRATES ITS FIFTH ANNIVERSARY.
2015–16 ANNUAL REPORT
consultation innovation collaboration teamwork creativity excitement dedication expertise partnership
co-chair’s report.
1–2
executive director’s report. 3–5 strategic plan.
6–9
project reports.
10
Hea pathways.
11
VICTORIA DIVISION OF FAMILY PRACTICE
pace.
11
recruitment + retention.
19
a gp for me.
12–13
transitions in care.
20–21
residential care.
14–15
highlights.
22–25
mhsu.
16–17
financial statements.
26–27
alth walk-in clinics.
18
I find [the work] absolutely fascinating. When opportunities come up for pilots,
I say yes,
so we can influence the process instead of sitting back. You can only influence the process and outcomes if you get involved. MEMBER
VICTORIA DIVISION OF FAMILY PRACTICE 1
co-chair’s report. DR. STEVE GOODCHILD & DR. KATHARINE MCKEEN | CO-CHAIRS VICTORIA DIVISION OF FAMILY PRACTICE
The Victoria Division has reached a new point in its development.
Our initial series of pilot and trial projects, originating in Division members’ earliest work, has demonstrated promising impacts; these projects are being expanded or transitioned to permanent programs.
None of the good work members have started is ending, and we are energized when we consider where it may all go next.
Your Division is growing, and we are being called increasingly to explore and implement provincially-derived initiatives, including:
This year, we are working to understand the new focus on the patient medical, and on primary care homes—and to determine how these concepts may help us to support family medicine in Victoria.
We are ready and excited to grapple with highlevel system problems and interventions, while keeping our eyes focused specifically on our core commitment to grassroots action on behalf of our community.
We are identifying the most successful aspects of our work, and determining how to evolve and move forward.
•
A GP for Me
•
The Child & Youth Mental Health and Substance Use Collaborative
•
The Residential Care Initiative
Member GPs: The board is working to serve you and your patients.
2 2015–16 ANNUAL REPORT
co-chair’s report cont.
When deciding what work to do, we ask: how will this plan benefit us as GPs in our offices, and help us to best care for our patients’ health?
What do we need to do, and with whom do we need to work, to bring GPs the supports we need? How can we make practice easier, more sustainable, more effective, and more fun?
We have learned that we cannot make most of the changes we require if we work alone. Therefore, we continue the process of building trust with partners, and most significantly with Island Health.
The Division’s Collaborative Services Committee (CSC)* is demonstrating its effectiveness, productivity and functionality.
We are meeting the challenges of communicating effectively, bridging practice and leadership gaps, and creating a system that can help community GPs and our patients to thrive.
VDFP physicians and staff are working with Island Health clinicians and administrators on the ground to improve the experience of care for physicians and for patients, and particularly for our most vulnerable.
As your board co-chairs, we take our responsibility to our GP colleagues very seriously. We are here to serve you, and believe that in doing so, we will achieve the transformation in primary care that we all desire.
We thank you for your continued trust in us, and for your willingness to commit your time and support to the Division.
Your board has refreshed and re-committed to a strategic plan that places family physicians at the centre, in relation to the greater primary care and health systems.
*THE COLLABORATIVE SERVICES COMMITTEE (CSC) IS A MONTHLY TABLE THAT BRINGS TOGETHER VDFP EXECUTIVE BOARD AND STAFF, ISLAND HEALTH EXECUTIVE LEADERSHIP AND SUPPORTS, AND A GENERAL PRACTICE SERVICES COMMITTEE (GPSC) REPRESENTATIVE.
VICTORIA DIVISION OF FAMILY PRACTICE 3
executive director’s report. ALISA HARRISON | EXECUTIVE DIRECTOR VICTORIA DIVISION OF FAMILY PRACTICE
Happy 5th Birthday to the Victoria Division of Family Practice! These first five years of operation have seen tremendous growth and development, and the beginning of significant positive changes to family practice in Victoria. In 2012, member GPs identified their priorities for action: •
better coverage when they need time off
•
better communication with the hospital
•
improved services for their patients— particularly those experiencing mental health and substance use issues and those who are frail and elderly
•
a collegial community of GPs
•
support to eliminate common practice hassle factors
•
local CME
•
a resource to help link GPs with specialists
•
solutions to address the large numbers of unattached/orphaned patients
The Division has enabled GP members to work toward the desired changes. We have moved from identifying and scoping problems to developing and implementing solutions. Members’ hard work—sometimes on their own, and often with partners across the health system—is paying off with measurable improvements in physician and patient experiences and in system efficiencies. Perhaps most significantly, we see clear signs of a culture shift from isolation and skepticism (community GPs were working alone, and felt siloed from the health authority, specialists and other support) to collaboration and hope. cont.
4 2015–16 ANNUAL REPORT
executive director’s report cont. What are some markers of these changes? •
•
While more locums are still in demand to provide adequate relief for GPs in practice, consistent and accessible support now exists, and alternatives, including cross-coverage, are proving successful.
•
GPs have better communication with the hospital because we worked with partners to build eNotification, and we are supporting evolving relationships with emergency, hospitalist and family physicians.
•
The Division has worked with GPs and psychiatrists to develop highly effective group medical visits for cognitive behavioural therapy skills. To date, more than half of the GPs in Victoria have referred almost 1500 patients with depression and anxiety for low-barrier, MSP-covered services, and patients have experienced clear benefits to their mental health.
•
All GPs can now use the RACE app to speak with a local psychiatrist from Island Health for rapid telephone advice, and GPs are taking advantage of opportunities to learn how to deliver more effective MHSU care within the construct of a typical office visit.
•
Monthly Dine & Learn events and other sessions provide ongoing education, professional development, support networking, and interpersonal connections that foster a strong primary care community.
•
GPs are receiving one-to-one coaching and group education to develop their business skills and to ensure their offices run as smoothly as possible.
Many patients in Victoria still do not have their own family physician, and a number of physicians have left or will soon leave practice to retire. However, we are proud to announce that since 2013: •
18,200 patients have been newly attached
•
22 GPs have returned or relocated to practice in the city
•
55,000 patients have stronger attachments
•
We are supporting physicians in the transition to retirement, and we remain committed to increasing access to primary care for as many patients as possible.
•
Thanks to innovative new practice models such as the VDFP’s TORCH initiative, and incentives to encourage family doctors to practice in facilities and support quality improvement activities, Victoria now has a path to resolving the crisis in medical coverage for residential care.
VICTORIA DIVISION OF FAMILY PRACTICE 5
•
MOAs are engaged and active in quality improvement.
•
GPs can now log in to Pathways to get timely, accurate information about specialist services and availability.
These milestones are just the tip of the iceberg. We continue to develop new initiatives, and to expand existing programs toward even greater success. The Division is indebted to the GPs in Victoria who, since 2011, have shown remarkable dedication to their profession and to their community, and incredible enthusiasm for transforming family practice. The Division supports member physicians’ vision for change. Staff serve members in a variety of ways, such as making connections for last-minute locums, helping new physicians get settled in the city, building practice support tools, and collaborating with physicians and system partners to turn their improvement ideas into new practice realities. A great deal of change remains necessary to meet the Division’s strategic vision of healthy communities through access to excellent local primary care. Momentum is building for an exciting and productive five years to come!
There is
momentum behind the Divisions movement. Physicians are connected to the Division. MEMBER
6 2015–16 ANNUAL REPORT
strategic plan 2016–19.
PR
RE
H S YS T T L EM A E H A RY C A M I
FAMILY PRACTICE OFFICE
GPs provide quality care in their family practice GPs support primary care in Victoria GPs voice and experience influence system decision-making
The VDFP board has refreshed and re-committed to a strategic plan that places family physicians at the centre, in relation to the greater primary care and health systems.
VICTORIA DIVISION OF FAMILY PRACTICE 7
mission. The VDFP supports the community of physicians to improve patient care and population health by: Fostering physician engagement and professional fulfilment
Influencing decisions that impact patient and primary care providers Partnering to facilitate an effective and sustainable health system
Supporting physician leadership
values. articulating our organizational culture/philosophy. The VDFP is committed to building collaborative, respectful relationships with members, partners, and stakeholders. We respond to local concerns through grassroots democratic action. Our work is driven by members’ needs, which we identify through ongoing and meaningful engagement, and exploration of both practice- and research-based evidence. We strive to affect needed changes in our community and health system, and to demonstrate responsible stewardship of public resources.
8 2015–16 ANNUAL REPORT
strategic plan 2016–19. Founded in November 2011, the VDFP has matured as an organization, with a strong governance board, a robust budget, a centrally located office, and a high-performing staff. The Board embraces inclusivity as a central operating principle, ensuring that the VDFP’s work is relevant to, and connected with, a broad spectrum of FPs. During the strategic planning process, the VDFP Board considered its work in relation to the health system as a whole, its member physicians, and the patients and community requiring family practice care. The Board recognizes a host of challenges and issues impacting the present context, such as limited funding from government, debates about the meaning of family medicine, relationships with allied and other health providers, higher patient expectations, increasing administrative burdens, increasing complexity of patients, and patient safety concerns. your 2015–16 vdfp board: DR. STEVE GOODCHILD (CO-CHAIR) DR. KATHARINE MCKEEN (CO-CHAIR) DR. JODY ANDERSON (TREASURER) DR. VALERIE EHASOO (SECRETARY) DR. IAN BEKKER DR. KATHY DABRUS DR. MARTHA MACDONNELL DR. LISA VERES DR. LORNE VERHULST
Looking toward the next three years, the Board is committed to maintaining physician engagement in the VDFP, mitigating the impact of the shortage of FPs in Victoria, building success without undue bureaucracy, making transparent decisions to maintain member confidence to make decisions on their behalf, and demonstrating value and impact to members, patients, funders and partners. The Board will ensure that the Strategic Plan is a living document, and will seek dialogue on a regular basis with physician members in order to be fully informed about members’ views on strategic priorities, and to ensure that members’ perspectives are central to the Division’s strategic direction.
Collaboration
is the start of innovation. MEMBER
VICTORIA DIVISION OF FAMILY PRACTICE 9
MISSION
OUR VISION:
VISION
VALUES
Healthy communities through access to excellent local primary care. IMPROVE COMMUNICATION AND CONNECTION, RELATIONSHIPS BETWEEN CLINICAL PROVIDERS PROVIDE EDUCATION, COACHING AND SUPPORTS TO PHYSICIANS AROUND CLINICAL PRACTICE AND HEALTH SYSTEM RESOURCES
GPs provide quality care in their practice GPs support primary care in Victoria GP voice and experience influences system decision-making
EDUCATE PATIENTS ABOUT ACCESSING HEALTH RESOURCES INCREASE NUMBERS OF ACCESSIBLE PRIMARY CARE PROVIDERS WHO ACT AS PORTALS TO ALL HEALTH CARE RESOURCES ENSURE THAT VULNERABLE INDIVIDUALS HAVE ACCESS TO PRIMARY CARE IMPROVE PATIENT EXPERIENCE OF CARE INFLUENCE INDEPENDENT PROVIDERS AND FACILITATE SYSTEM CHANGE RESPOND TO AND INFLUENCE DECISIONS ASSOCIATED WITH POLICY SHIFT TO EMPHASIZE PRIMARY CARE COMMUNICATE PROACTIVELY WITH PATIENTS, STAKEHOLDERS, PARTNERS AND THE MEDIA
10 2015–16 ANNUAL REPORT
project reports. In its fifth year of operation, the Victoria Division of Family Practice has begun to mature as an organization, with the board focused on governance, members actively engaged in community-driven initiatives, and a new office in Victoria’s historic Bastion Square.
2015–16: A year of growth and development. A high performing team supports physician members to increase their professional satisfaction and personal wellness, to effect positive changes in the health system, and to deliver the highest quality care. The projects that came to fruition in 2015–16 are the realization of priorities that members identified and explored in the Division’s first years of operation.
The Division’s earliest working groups and member surveys indicated that the most urgent projects ought to focus on: improving communication between the community and the hospital; assisting GPs with practice coverage (e.g., locums); ensuring patient access to primary care; and improving care for both frail seniors, and people with mental health and substance use problems. Victoria Division family physicians, in partnership with specialists, Island Health, and community agencies, has made considerable improvements, real change, and new models in all of these areas.
It is just so amazing what is being accomplished, as well as how difficult it is to make a change in a huge system: it just is not ‘simple.’ Having said that, we are accomplishing a lot. MEMBER
VICTORIA DIVISION OF FAMILY PRACTICE 11
pathways. The Fall 2016 launch of Pathways marks an exciting advance between our family physicians and specialists. This secure, free, online tool optimizes patient referrals to specialists and clinics. VDFP has now created the Victoria-centric content and physicians will get to test drive the software at the 2015–16 annual general meeting.
pace.
preserving access to care in an emergency. Formerly known as Physician Emergency Preparedness/Practice Continuity, PACE stands for Preserving Access to Care in an Emergency. We have begun supporting implementation of the Practice Continuity Guide + Workbook. During ShakeOut BC 2016, we conducted the first test of P–DOC (Physician Department of Operations), which coordinates the health system response to a disaster.
12 2015–16 ANNUAL REPORT
a gp for me.
PROJECT OFFICIAL END DATE WAS MARCH 31, 2016. 2016–17 WILL FOCUS ON SUSTAINABILITY OF THE WORK WE HAVE STARTED.
The goal of the A GP for Me initiative was to confirm and strengthen the GP–patient continuous relationship, including: to improve support for vulnerable patients; to enable patients looking for a GP to find one; and, to increase capacity in the primary care system. We focused on four key strategies:
recruitment + retention.
patient matching.
•
The VDFP completed a pilot in collaboration with local GPs, the Royal Jubilee Hospital Emergency Department, and the Family Resource Centre at CFB Esquimalt. The pilot aimed to link patients with GPs who had placed their names on the VDFP’s registry of GPs taking new patients.
Recruited 22 new/returning family physicians in Victoria.
We created a website to promote GP work opportunities. Demand still far exceeds supply. As we move forward, we will ramp up efforts to support cross-coverage and other solutions. •
Filled 64% of locum postings on the VDFP website.
We continue to operate Colleague Connections to support mentoring relationships and members through career transitions. The VDFP provided leadership in the regional Vancouver Island recruitment and retention initiative. We launched islanddocs.com and developed a regional marketing strategy, enabling GPs interested in working on the Island to explore options and to determine best geographical fits. We are also working to reduce barriers for GPs interested in Island practice.
This strategy demonstrated that matching patients to a registry of GPs is a slow and painstaking process. We are re-visioning alternative approaches to boost efficiency. We are also collaborating with Island Health Adult MHSU to identify ways of enhancing access to primary care for unattached patients who receive MHSU services.
VICTORIA DIVISION OF FAMILY PRACTICE 13
practice support.
care of the elderly.
We held a series of CME events to assist physicians in increasing practice efficiency, including Agents of Change Motivational Interviewing, Understanding Your Patient Panel, and events for MOAs.
There were two components to this work:
The VDFP provided direct clinic support to improve patient flow, to promote team building, and to implement the Practice Toolkit. •
The frailty pilot was a partnership with Island Health that brought an RN and physiotherapist into GP offices to work with GPs, MOAs and patients on in-office frailty assessments. It also implemented education sessions to broaden GP and MOA knowledge of community resources to support frail patients.
Provided direct support to 34 offices, representing approximately 60 physicians.
We created the MOA Network with the aims of increasing office efficiency, improving patient experience, and increasing capacity. The MOA Corner is published on the VDFP website, and we are working to launch an MOA Temp Pool. The VDFP also supported the EMR–IT Working Group, which unveils its User Group pilot for Intrahealth users in Fall 2016. changes in key indicators before + after torch. 100% 80% 60% 40% 20% 0% 2014
1. a brief pilot that tested frailty assessments in GP offices.
2015
% residents with advance care plan* % first visits that occurred within first seven days % visited at least once per 90 days* % of gps attending care conferences % residents with 1+ ER visit * denotes statistically significant differences at p<0.05
This pilot has informed our ongoing work on team-based care and on integration of Island Health resources with family practice. 2. a longer pilot where we developed, then tested, a new model of family practice in residential care, TORCH. In collaboration with residential care facilities and Island Health, we supported GPs in the creation of the evidence-based TORCH (Toward Optimal Residential Care Health) model. TORCH aims to enable optimal GP care in facilities. This model is sustainable, and continues to operate and spread under the auspices of the provincial Residential Care Initiative (RCI). TORCH is described in more detail on the following pages, in the context of the RCI—which is its permanent home. We are now in consultation with members to determine how to best evolve the work that began under A GP for Me.
14 2015–16 ANNUAL REPORT
residential care. In order to address the downward trend in the number of physicians providing services in residential care, expected growth in the population of frail elderly in residential care, and local practice barriers, Victoria Division members are working to improve the care of the patients in residential care.
torch: towards optimal residential care health. The TORCH prototype project ran from January to December 2015. During the prototype period, 20 innovative physicians and four committed residential care facility teams contributed to improved care for more than 350 patients through the TORCH model. Results from the comprehensive, external TORCH evaluation show significant improvements on key indicators and quality standards in residential care: •
Residents who received a visit from a physician within the first seven days increased from 45% to 85%
•
Residents with at least one visit every 90 days increased from 37% to 97%
•
Residents with a completed Advance Care Plan in the chart increased from 53% to 90%
•
Hospitalization and ER transfers decreased by 43%
TORCH physicians said they find the TORCH practice model provides more efficient, predictable, and team-based care, resulting in high levels of satisfaction. TORCH provides a structure that enables improvements in proactive medical care, more on-site care, high levels of patient and provider satisfaction, and a reduced reliance on fax communication (which facility staff report is time consuming, and negatively impacts valuable time for patient care). Moving forward, the ongoing maintenance and spread of the TORCH model will be supported by the Residential Care Initiative (RCI).
VICTORIA DIVISION OF FAMILY PRACTICE 15
residential care initiative (RCI). The Residential Care Initiative (RCI) aims to create a culture of excellence and teamwork in medical care for residents in facilities, through supporting physicians and collaborating with other care providers and families, guided by provinciallydetermined best practice expectations and system level outcomes. In 2015, the Victoria and South Island Divisions of Family Practice began to work collaboratively on a joint, unified approach to implementing the RCI, in order to ensure equity across the region for physicians and patients alike. The RCI focuses on: practice support: Physicians who opt-in to the RCI receive quarterly payments to support meeting best practice expectations, as well as supports such as a monthly clinical Learning Series, billing support, and parking passes. practice innovation: Further residential care practice innovation will be supported under the RCI, through spreading the TORCH model to new sites, and by testing a new House Physician Model that aims to increase medical care coordination while allowing for physician flexibility. excellence and teamwork in medical care: The RCI program team launched a Quality Improvement (QI) Intensive program in 2016, to assess collaboratively the current state of best practice expectations, to plan for improvements, and to support the implementation and evaluation of improvements, using a QI lens and PDSA (Plan-Do-Study-Act) cycles. evaluation: A new quality-improvement program evaluation system launching at the end of 2016 will include quarterly reporting to facilities on key indicators: number of transfers to ER; number of admissions to acute care; and, cumulative percentage of deaths at home/facility per total deaths. It will also include annual reporting on best practice expectations and system-level outcomes. •
AS OF OCTOBER 2016, 75 PHYSICIANS IN VICTORIA AND SOUTH ISLAND—41% OF ALL PHYSICIANS ATTENDING RESIDENTS IN LOCAL FACILITIES—HAVE OPTED-IN TO THE RCI, PROVIDING COVERAGE FOR APPROXIMATELY 79% OF RESIDENTS.
The intent is to provide a ‘community of care,’ and there have been
great steps in that direction.” MEMBER
16 2015–16 ANNUAL REPORT
mental health & substance use. Victoria Division members are working on multiple projects to improve treatment for patients with mental health and substance use (MHSU) issues.
cbt skills group medical visits. The Mental Health & Substance Use Care Access Initiative launched CBT Skills Group medical visits for adult patients with mild to moderate anxiety or depression. The program offers eight weeks of instruction about CBT skills and acceptance-based approaches to enhance patient selfmanagement of their MHSU symptoms. This collaborative model of care was developed by a small group of local psychiatrists and family physicians. Part 1 is co-facilitated by family physicians and psychiatrists. Part 2 utilizes family physicians solo-facilitating CBT Skills Groups.
•
More than 1386 referrals from 237 family physicians
•
Approximately 500 patients have participated since October 2015; more than 300 more will participate starting in the fall of 2016
•
19 patients have participated in Booster Groups
•
127 patients are on the wait list
•
The groups are spreading to Langford
Evaluation of the groups has been strong. Patients are satisfied and are recommending it to others. Patients and facilitators learn and practice self-management skills. Patients show measurable improvement in symptom The program will be modified for youth as scores, generally moving from moderate part of the Child and Youth Mental Health Collaborative Victoria Local Action Team. Booster severity to mild or remitted. Groups launched in April 2016 as theme-based, COMPARED TO A NON-RANDOMIZED WAIT LIST CONTROL, PARTICIPANT OUTCOMES ARE one-day refresher courses. SIGNIFICANTLY BETTER THAN THOSE ON THE WAIT LIST, WITH A LARGE EFFECT SIZE FOR DEPRESSION, A VERY LARGE EFFECT SIZE FOR ANXIETY, AND A MODERATE EFFECT SIZE FOR FUNCTION.
VICTORIA DIVISION OF FAMILY PRACTICE 17
mhsu learning series. This series offers CME-accredited education for family physicians to better identify, diagnose, and treat MHSU conditions within their offices. Video footage and a comprehensive MHSU physician resource guide are available on the VDFP website.
collaborative initiatives
with Island Health’s adult mhsu services. VDFP and Island Health’s Adult MHSU Services are working to improve access and collaboration between primary care and MHSU services offered through Island Health.
umbrella–vdfp pilot. In this powerful pilot partnership, family physicians are collaborating with experienced Umbrella Society peer outreach workers to provide ongoing support and system navigation to patients during their recovery journey from alcohol and substance use. cymhsu collaborative:
victoria local action team. THE CHILD AND YOUTH MENTAL HEALTH AND SUBSTANCE USE COLLABORATIVE IS A PROVINCIAL INITIATIVE COMMITTED TO INCREASING TIMELY ACCESS TO SUPPORT AND SERVICES FOR CHILD AND YOUTH MENTAL HEALTH AND SUBSTANCE USE. LOCAL ACTION TEAMS (LAT) ARE KEY TO THE COLLABORATIVE.
VICTORIA’S LAT (VLAT) IS A DYNAMIC TEAM OF ALMOST 60 PARTICIPANTS FROM ISLAND HEALTH, MINISTRY OF CHILDREN AND FAMILY DEVELOPMENT, SCHOOL DISTRICT 61, MULTIPLE COMMUNITY AGENCIES, YOUTH, FAMILY MEMBERS, PEDIATRICIANS, CHILD/YOUTH PSYCHIATRISTS, AND FAMILY PHYSICIANS. THE VLAT IS PIECING TOGETHER THE MANY LOCAL SERVICES TO DEVELOP AN INTEGRATED AND COLLABORATIVE CYMHSU SYSTEM OF CARE.
18 2015–16 ANNUAL REPORT
walk-in clinics. The VDFP has been working to assess the challenges faced by walk-in clinic doctors, and to strengthen relationships, communication, and understanding between them and family practice GPs. More than 26 of these walk-in clinic doctors have begun to take on new patients to support their GP colleagues.
uvic partnership survey. The Victoria Division has launched a research project in partnership with the University of Victoria’s Public Health and Social Policy Department. This team worked with WIC physicians to develop a patient survey, which was distributed to 11 walk-in clinics representing different geographical areas in Greater Victoria. This survey explores: patient impetus for using walk-in clinics; the proportion that is attached; which health needs they are presenting with; and, where else they would have gone if the clinics did not exist. Responses were collected during Summer 2016, and are presently in the process of analysis. A provider survey, launching in November 2016, explores why physicians choose walk-in clinic work, what they appreciate about the work, and what challenges they face.
clinic project group. The walk-in clinic project group met monthly in the 2015–16 period, culminating in an event that featured a speaker from the Walk-in Clinics Association of British Columbia.
primary care home models. In October 2016, Dr. Katharine McKeen presented the importance of including walkin clinics in primary care home models to the Select Standing Committee on Finance and Government Services at the B.C. Legislature.
VICTORIA DIVISION OF FAMILY PRACTICE 19
recruitment + retention. The VDFP hosted events and initiatives within the 2015–16 year aimed at strengthening relationships and understanding the needs of medical students and residents, supporting new members in their transition to Victoria, and exploring innovative options for senior physicians.
young doctors outreach. Island Medical Program (IMP) students and residents—via the UBC Family Medicine Interest Group—were invited to attend a Recruitment and Retention advisory committee meeting in effort to explore how the VDFP could better support their needs. The Division has identified opportunities to work with IMP to shift perceptions about family practice.
retirement planning. More than 30 physicians attended a transitions planning and toolkit session, where Dr. Robbert Vroom discussed opportunities and obstacles to transitioning from full-time family practice while remaining active in medicine.
new member welcome. The Colleague Connections program hosted its first new member welcome event at Victoria’s Abkhazi Garden, allowing new members to meet each other and the board.
Our ever-popular annual Business of Family Practice Dine & Learn event for residents explored topics around opening a practice, locum work, billing, and work–life balance. The second annual resident welcome event paired more than 40 residents with local physicians for an evening of dragon boating and dinner at Glo Restaurant + Lounge. Several residents have accessed the Division’s Colleague Connections program, and recent grads are finding our locum matching service very useful. The Division also presented highlights at one of IMP’s academic half days.
20 2015–16 ANNUAL REPORT
transitions in care. Transitions in Care Phase 2 work continues, with the aim of boosting communication, collaboration, and the quality and timeliness of information transfer between hospital and community providers. Results are indicating improved quality of care during patient transitions.
communication systems. We continue to lobby for universal EMR availability for eNotification. Those supported by Oscar West were added in Fall 2016; we are advocating for other Oscar vendors to embed the service. UVIC Health Services can now receive notifications about its students who access primary care on campus. The Division is working in partnership with Island Health to provide input for its IHealth initiative, particularly regarding information that is shared at the community level, such as discharge summaries.
erp–gp collaboration. ER, family practice, and walk-in physicians have met monthly since July 2015. This group’s first collaborative project was ER Tips and Tricks. As of October 2016, this team had developed nine tips from ER physicians, aimed at helping GPs navigate when to send patients to the
ER, and how to address common, less urgent issues. ER Tips and Tricks is available online at divisionsbc.ca/victoria/ERtipstricks The group is also working together to redesign the ER Referral Form for walk-in clinic patients referred to the ER, as well as to create informational materials about how patients are managed when presenting to the ER. Finally, the team continues to improve the quality and timeliness of ER summary sheets.
If each GP took just
one patient
out of ER, it would reduce the strain by hundreds, even thousands. MEMBER
VICTORIA DIVISION OF FAMILY PRACTICE 21
information transfer + discharge planning. BUILDING ON THE SUCCESS OF ENOTIFICATION, THE VDFP DEVELOPED THREE INITIATIVES TO CONTINUE IMPROVING COMMUNICATION BETWEEN ACUTE AND COMMUNITY SETTINGS:
Now I actually feel part of the team, and when families phone I know what is going on. MEMBER patient summaries on admission. With GPs receiving alerts when patients are admitted to hospital, they can send longitudinal patient data to support treatment. We ran an initial six month pilot (Nov 2015– April 2016) to determine the best process for getting summaries on patient charts. Funding expanded to include VGH and RJH. Island Health provided a central fax number to receive summaries within Patient Placement, avoiding the need to locate patients via phone. Recruitment for an extended pilot is underway.
pre-discharge alert. Island Health’s work with all wards to determine expected date of discharge for each patient will allow us to alert GPs 24–48 hours before discharge so that they may prepare for follow-up. Two pilots demonstrated that pre-discharge alerts are valuable to GPs, and can be sent without overburdening the ward. Island Health is now replicating the system across all wards to improve Structured Team Reporting. We are supporting awareness efforts among interprofessional teams about the need and benefits to informing community GPs prior to discharge.
secure messaging: our latest project! After members expressed the need to text colleagues in a safe and secure manner, we partnered with Island Health and developed a pilot project to evaluate how secure messaging can work in a community setting. Many projects throughout the province are exploring this new and exciting area for digital health. We are collaborating with colleagues from other Divisions as we explore different technologies A pilot to test secure messaging is expected in early 2017.
22 2015–16 ANNUAL REPORT
highlights: june 2015 –november 2016 2015
JUNE 2015
NOVEMBER 2015
• VDFP’s first MHSU Learning Series: Substance Use • Multidisciplinary TIC engagement event • Member engagement event to guide board strategic planning for 2016–19 • Dine & Learn: Geriatric Psychiatry • Practice Support Learning Series: Mission Impossible— Introduction to Motivational Interviewing
• Residents/Mentorship BBQ
AUGUST 2015
• RCI Memorandum of Understanding completed with GPSC and Island Health WEDNESDAY. 16TH SEPTEMBER. 2015 AN EVENING OF
DERMATOLOGY PEARLS
presenters DR. SIKINA ROSSI
6–9pm
6pm registration 615pm dinner+talks
DR. PATRICK KENNY DERMATOLOGIST • melanoma: spotting a killer!
1.877.790.8492 ext 3 1.250.597.0889
hotel grand pacific
463 Belleville Street Victoria underground parking | collect voucher at front desk
DR. SOODABEH ZANDI DERMATOLOGIST • psoriasis and eczema management and phototherapy
DECEMBER 2015
• Vancouver Island Interdivisional CSC | Nanaimo • VDFP begins participating in Island Health’s South Island MHSU System Review • Holiday social for Division members and their families • TORCH prototype concludes; model transitioned to be supported under RCI • Postdoctoral researchers engaged for Walk-in Clinic project • Motivational Interviewing practice and feedback calls begin (until February 2016)
2016
rsvp by tuesday. 1st sept victoriaevents@divisionsbc.ca
DERMATOLOGIST • acne management, and isotretinoin initiation and monitoring
menu
buffet-style dinner will be served
please let us know if you have dietary or accessibility requirements
dine & learn
• Annual General Meeting and confirmation of 2015–16 board of directors • Transitions in Care (TIC) ER/GP engagement event • Provincial A GP for Me workshop | Vancouver • Residential Care Initiative (RCI) member consultations and engagement begin
JULY 2015
limited seating | pre-registration required | no walk-ins | please inform if you cannot attend so waitlisted members can obtain a seat members will receive up to 2 mainpro-m1 credits for participation event and participants may be photographed or videotaped for use in VDFP communication materials | if you do not wish to be photographed, please sign the opt-out form at the registration table
JANUARY 2016
• Joint CSC: Victoria/ South Island Divisions • Victoria CYMHSU Collaborative Local Action Team family physician focus group • Board of Directors strategic planning • Begin to build Pathways Victoria • Dine & Learn: Cancer Care • Practice Support Event: From Surviving to Thriving: Optimizing the business side of family Medicine • First RCI quarterly payments distributed to physicians
VICTORIA DIVISION OF FAMILY PRACTICE 23
SEPTEMBER 2015
• GPSC Visioning Victoria family physician engagement event • Mentorship program engagement event • Dine and Learn: Dermatology • Dine and Learn: Practice Continuity/Emergency Preparedness program launch • TIC pilots for patient summaries on admission and predischarge alert launch • CBT Skills Group Program physician launch/information event • Mentor Coaching event
FEBRUARY 2016
• Vancouver Island Divisions partner with UBC Continuing Professional Development (CPD) physician leadership small group learning session • Practice Support Learning Series Part 2: Mission Impossible—Extreme Personality Styles • Second MHSU Learning Series: Unmasking the Faces of PTSD and Trauma • Dine & Learn: Rheumatology • Presentations on TORCH, TIC, CBT Group Medical Visits, and GP Emergency Preparedness at the B.C. Patient Safety and Quality Council Quality Forum | Vancouver
OCTOBER 2015
• VDFP begins attending Island Health Integration days • Ministry of Health MHSU policy direction consultation | Vancouver • Provincial CYMHSU Collaborative Learning Session | Vancouver • Co-chairs and ED attend Canadian College of Health Leaders Conference | Vancouver • Board development session: Strengths-based Leadership • Provincial Divisions Roundtable | Vancouver • Island Inter-divisional Collaborative Services Committee (CSC) launches development of regional GP recruitment and retention strategy • 8-week mindfulness training course for GPs begins • Ongoing RCI engagement • Dine & Learn: Pediatric Potpourri: Orthopedics + Allergy • First CBT Groups begin operating, serving 100 patients
24 2015–16 ANNUAL REPORT
highlights: june 2015 –november 2016 MARCH 2016
APRIL 2016
• RCI program official launch event with Senior’s Advocate Isobel Mackenzie • VDFP physicians and staff participate in Building Bridges workshop, sponsored by First Nations Health Authority to enhance cultural safety • Dine & Learn: Pediatric Psychiatry
• Vancouver Island Interdivisional CSC | Nanaimo • TORCH prototype wrap-up event • Initiated pilot with Umbrella Society for Addiction and Mental Health to improve substance use treatment in family practice • Dine & Learn: ENT
SEPTEMBER 2016
• Collaborative strategic planning physician engagement event: Evolving the Work of A GP for Me • Board finalizes new strategic plan • MOA Event: Five Roundtables • Engagement with the Victoria hub of the Strategy for PatientOriented Research (SPOR) begins • Island Inter-divisional CSC regional recruitment and retention strategy development complete • Dine & Learn: Plastics Roundtable • RCI Learning Series: Medical Assistance in Dying • RCI opt-in: 76% of facility residents are covered by GPs participating in RCI • Retirement Planning Session
MAY 2016
• Walk-in Clinic physician engagement event • Third MHSU Learning Series: Engaging Addicted Youth • Dine & Learn: Residents + Medical students
OCTOBER 2016
• Inter-divisional CSC | Nanaimo • CYMHSU Collaborative Learning Session | Vancouver • Practice Support Event: Understanding and Refining your Patient Panel • Dine & Learn: Pediatric Medley • RCI Learning Series: PIECES Dementia Training for Physicians • TIC Secure Messaging Event and Patient Summaries Extended Pilot Launch • First test of P–DOC (Physician Department of Operations) during ShakeOut BC
VICTORIA DIVISION OF FAMILY PRACTICE 25
JUNE 2016
• MHSU Steering Committee presentation to Ministry of Health MHSU Branch • Provincial Divisions Gathering | Vancouver • New Members Welcome Reception • RCI Learning Series: Making the MOST out of Conversations • Physicians present booth on Emergency Preparedness
JULY 2016
AUGUST 2016
• Pathways data collection begins | specialists and specialty clinics • RCI Learning Series: Polypharmacy Train the Mentor sessions • Resident/Student summer event: Dragon boating + Glo Restaurant/Lounge • MOA Corner launch on VDFP Website
• VDFP CSC endorses collaboration between Island Health and Victoria Division around integration of senior health services. Reconvenes working group, and strikes task group to co-design the model for working with family physicians • RCI Quality Improvement Intensives launch
NOVEMBER 2016
• More than 750 patients have participated in the CBT Skills Group Program, with 1400+ referrals • Practice Support Event: Agents of Change— Introduction to Motivational Interviewing • PSP Dine & Learn Event: Agents of Change— Motivational Interviewing In-depth Follow-up • Island Divisions/UBC CPD physician leadership training launches | Nanaimo and Victoria • RCI House Physician Model launch • ED and Co-chairs present at the provincial Canadian College of Health Leaders Conference | Vancouver • A GP for Me Provincial Summit | Vancouver • Agents of Change practice and feedback calls begin (until December) • Annual General Meeting & VDFP Fifth Birthday
26 2015–16 ANNUAL REPORT
Statement of Financial Position.
March 31, 2016 with comparative information for 2015
Assets
Current assets Cash and cash equivalents $ Term deposits (note 2) Accounts receivable Prepaid expenses Equipment (note 3)
$
2016
1,672,405 $ 20,005 223,455 793 1,916,658 6,005 1,922,663
2015
201,421 630,005 26,250 6,389 864,065 -
$
864,065
334,181 $ 1,571,136 1,905,317
462,309 389,585 851,894
Liabilities and Net Assets Current liabilities Accounts payable and accrued liabilities (note 4) $ Deferred revenue (note 5) Deferred capital contributions (note 6) Net assets
6,005 11,341
12,171
Commitments (note 7) Economic dependence (note 8) Guarantees (note 9)
$
1,922,663
$
864,065
Statement of Operations and Changes in Net Assets.
Year ended March 31, 2016 with comparative information for 2015
Revenue Partners in Care $ Residential Care Initiative Regional Recruitment & Retention CYMHSU Infrastructure Grant A GP for Me Transitions in Care Provincial Recruitment & Retention Other funding Interest $
345,331 $ 436,834 59,701 24,819 959,454 898,767 616,629 418,626 263,368 185,117 2,109 18,487 52,425 10,280 5,175 12,149 2,765,845 1,543,426
Expenses Human resources – contractors $ Human resources – physicians Human resources – Residential Care Initiative Wages and benefits General and administration Event expenses Board expenses Travel $
862,862 736,049 739,053 425,917 335,061 434,903 91,444 153,817 134,048 137,524 95,646 71,851 19,834 31,604 29,653 2,766,675 1,532,591
Excess (deficiency) of revenue over expenses
(830)
10,835
Net assets, beginning of year Net assets, end of year $
12,171 11,341 $
1,336 12,171
VICTORIA DIVISION OF FAMILY PRACTICE 27
Notes to Financial Statements. Year ended March 31, 2016 5. Deferred revenue: Deferred revenue represents the unspent portion of contributions received during the year. Changes in the deferred revenue balances are as follows:
Opening Net funding Inter-fund Revenue Ending balance received transfers recognized balance Infrastructure
$ 162,800
A GP for Me
$ 1,169,128
$ (120,000)
$ (965,459)
$ 246,469
131,374 903,869
- (616,629) 418,614
Transitions in Care 84,916 289,620
- (263,368) 111,168
Provincial Recruitment & Retention 7,495
- (2,109) 5,386
Regional Recruitment & Retention
-
- 200,000
CYMHSU Collaborative 3,000 60,000
- (59,701) 140,299 - (24,819) 38,181
Partners in Care: MHSU
- 340,000 105,000 (345,331) 99,669
Residential Care Initiatives
- 933,184 15,000 (436,834) 511,350
$ 389,585
$ 3,895,801
$
-
$ (2,714,250)
$ 1,571,136
Victoria
divisionsbc.ca/victoria
I can tell you, the number of patients seen
went up.
I felt like I made
the right choice by going into family practice. MEMBER
2015-16 ANNUAL REPORT PUBLISHED NOVEMBER 2016 EDITING/DESIGN | CRYSTAL SAWYER • TRIVENI WEST COMMUNICATION + DESIGN