Victoria Division of Family Practice 2016-17 Annual Report

CONNECTIONS

2016–17

Annual Report Victoria

THE VICTORIA DIVISION OF FAMILY PRACTICE (VDFP) IS A NON-PROFIT ORGANIZATION WITH APPROXIMATELY 400 FAMILY PHYSICIAN MEMBERS. IN SEPTEMBER 2017, THE VDFP CELEBRATES ITS SIXTH ANNIVERSARY.

CONTENTS

1

3

7

10

CO-CHAIRS’ REPORT EXECUTIVE DIRECTOR’S REPORT

STRATEGIC PLAN + PROJECTS

18

RESIDENTIAL CARE INITIATIVE

ATTACHMENT & INTEGRATION

24 MENTAL HEALTH & SUBSTANCE USE

6

BOARD OF DIRECTORS + MEMBER ENGAGEMENT

15 CARE OF THE ELDERLY

30 TRANSITIONS IN CARE

34

36

38

PATHWAYS

TIMELINE

WALK-IN CLINICS

42 FINANCIAL STATEMENTS

VICTORIA DIVISION OF FAMILY PRACTICE

Co-Chairs’ Report Dear Members, Over the last several years, we have had the pleasure of co-chairing the Victoria Division of Family Practice, and presiding over the Board as the organization has grown and developed. We are beginning to achieve

DR. STEVE GOODCHILD & DR. KATHARINE MCKEEN CONTINUE THEIR LEADERSHIP AS CO-CHAIRS OF THE VICTORIA DIVISION OF FAMILY PRACTICE

some of your key goals through work with Shared Care, A GP for Me, the Residential Care Initiative, and more.

This year, we saw the provincial government embrace the Patient Medical Home model for British Columbia to enhance and sustain family practice. With the Board and other member physician leaders, we have explored and debated how to meet the new provincial direction in a way that supports our commitment to listen and respond to you. We believe, fundamentally, that the power to transform the health system rests within our community, within you and your commitment to your patients, and with your ideas and actions in your practice. We offer supports and suggest strategies, but, ultimately, we lead from behind, looking first and foremost for where you want to go, and how you want to get there. We declare this message frequently, clearly, and proudly to our funders and partners, because it is our deepest, most central value. If we aren’t serving our members and patients, we are not doing our job.

As the Division faces growing external pressures and demands, we deepen our commitment to meeting your expectations first.

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2016–17 ANNUAL REPORT

Co-Chairs’ Report cont.

AS THE DIVISION FACES GROWING EXTERNAL PRESSURES AND DEMANDS, WE DEEPEN OUR COMMITMENT TO MEETING YOUR EXPECTATIONS FIRST.

We are keenly aware that as family physicians, we hold an immense responsibility for the health of the population. Access to family medicine is rife with challenges, yet we remain the most accessible part of the health system, and our patients look to us for the most fundamental and necessary kinds of supports. With the Division as our mechanism, we problem-solve as a community, and determine together how to sustain and enhance the vital services that we provide to residents of this city. When physician leaders in the Division encourage you to form networks with one another and with interdisciplinary colleagues, or when we offer you tools to improve the efficiency of your practice, it is because we believe that these strategies bring you the help you’re asking for: to feel good about what you do, to be satisfied with your professional life, to be confident that you are serving your patients to the best of your ability, and to be assured that you are not going down this road alone.

We journey forward, buoyed by your commitment, creativity, and deep care for your patients and profession. We look forward to another year of continuing on this path together.

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VICTORIA DIVISION OF FAMILY PRACTICE

Executive Director’s Report “IT ALWAYS SEEMS IMPOSSIBLE UNTIL IT’S DONE.” This phrase (commonly attributed to Nelson Mandela) reflects the Victoria Division’s bedrock philosophy. The problems in our health system are big, and many seem intractable. They are easily observable to physicians and patients alike. It is in this context that our

“THE VDFP’S MEMBER PHYSICIANS ARE AN INSPIRATION.” —ALISA HARRISON, EXECUTIVE DIRECTOR, VICTORIA DIVISION OF FAMILY PRACTICE

community continues to organize, to celebrate incremental successes, and most importantly, to keep working.

The VDFP’s member physicians are an inspiration. Despite major systemic barriers to providing the best possible care, their welldocumented burn-out, the challenges of operating a family practice,

>50% OF GPs ACCEPTING SOME NEW PATIENTS*

and the intense pressure to do more when they are already doing so much, they keep going.

Family physicians in Victoria not only continue to meet the daily challenges of caring for their patients, they also work after-hours to improve the health system. Since the Division’s inception six years ago, Victoria’s GPs have frequently and consistently shown up, usually after full days in the office, to lead or attend the Division’s working groups, planning meetings, and learning sessions. They want to improve their own practice, and to build strategies, initiatives, and interventions that will remove barriers to providing and receiving care. They share their personal stories and clinical experiences, they welcome evidence to grow and guide new ideas, and they work in relationship with

NEARLY

80%

ARE SATISFIED WITH WORK LIFE

86% ARE

CONFIDENT TREATING

MHSU PATIENTS

*IN SPECIFIC CIRCUMSTANCES

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2016–17 ANNUAL REPORT

What do we want?

INCREMENTAL, SYSTEMIC CHANGE!

Executive Director’s Report cont.

When do we want it?

SLOWLY AND SUSTAINABLY!

colleagues—clinicians, health system leaders and others—to build a new consensus about the kinds of health services we need, and how to provide them.

The Division has evolved an infrastructure to support this work. Our governors and staff believe that members can effect fundamental change, and we answer the call to enable this action.

We have already seen promising results. Frail seniors and their families report being happier with their care, and facility staff note marked improvements in practice since GPs—through the Division—changed the interface between family medicine and residential care. Similarly, thousands of patients in Victoria have now shown clinical improvement in their anxiety and depression, after completing a Cognitive Behavioural Therapy Skills Group series (which has been developed by Division GPs with psychiatrist colleagues to offer MSP-covered access to effective mental health supports).

Our CBT Skills model continues to operate in Victoria, receiving referrals from the majority of GPs in practice, and is spreading to other communities across B.C. We are proud of these and a range of other accomplishments on which we continue to build, steadily moving the needle toward a more acceptable, effective, and sustainable system of care.

4

VICTORIA DIVISION OF FAMILY PRACTICE

As an organization, we take seriously our duty as stewards of public resources, and prioritize demonstrating the value of investing in community-based primary care. We evaluate every program and project, and we examine the Division’s impact continuously, correcting our course as needed to stay on the best path to our goals.

AS A GROUP, WE HAVE THE STRENGTH TO TAKE RISKS AND TO HOPE; WE CAN SPELL EACH OTHER OFF, RECOGNIZING THAT OUR WORK IS A MARATHON, NOT A SPRINT. We strive to be transparent with our partners and members. We share our monthly project reports on our website for members, and we welcome members to attend board meetings, to flag opportunities proactively that we may otherwise miss, and to provide us with feedback and questions that will push us to do better.

Our health system is complex and dynamic.

There will always be problems to solve. Individually, this reality can feel overwhelming. The Victoria Division brings individuals into a collective, to move forward together. As a group, we have the strength to take risks and to hope; we can spell each other off, recognizing that our work is a marathon, not a sprint.

As we move into our seventh year of operation, we look forward to continuing to stand with our members and our partners, to model these new ways of working together, and to do what it takes to support a healthy community.

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2016–17 ANNUAL REPORT

2%

Not Engaged

27%

Informed

11%

Accessing Services

14%

Attended 1 event

14%

Attended 2+ events

21%

Involved

11% Leading

Member Engagement FROM OCTOBER 2015 TO SEPTEMBER 2016, 72 PER CENT OF OUR MEMBERS WERE ENGAGED IN ACCESSING SERVICES, PARTICIPATING IN EVENTS, COLLABORATING ON PROJECTS, OR LEADING THE WORK. ENGAGEMENT IS VERY HIGH.

ALTHOUGH NOT INCLUDED IN THE ANALYSIS, THE LAUNCH OF PATHWAYS IS EXPECTED TO HAVE INCREASED ENGAGEMENT DURING THE PAST SIX MONTHS.

100+ MEMBERS ARE ACTIVELY INVOLVED IN PRACTICE CHANGE WORK THROUGH THE DIVISION, AND 55 ARE SERVING IN LEADERSHIP POSITIONS ON COMMITTEES AND ADVISORY GROUPS.

BOARD OF DIRECTORS FRONT (L–R) DR. KATHARINE MCKEEN DR. VALERIE EHASOO DR. STEVE GOODCHILD DR. KATHY DABRUS DR. TIM TROUGHTON

6

BACK (L–R) DR. IAN BEKKER DR. BILL BULLOCK DR. LISA VERES DR. GEOFF INMAN

VICTORIA DIVISION OF FAMILY PRACTICE

OUR INITIATIVES ARE PLANNED CAREFULLY TO EVOLVE THROUGH STEADY, STRATEGIC PROGRESS.

Strategic Plan + Our Projects The Division’s work in 2017 has focused

for collaborative practice are building

on implementing the key elements of our

bridges between family doctors and

strategic plan: supporting GPs to care for

service providers in Island Health, and

patients, enabling a functional relationship

with community organizations such as the

between GPs and the local system of

Umbrella Society. Primary care as a whole

primary care, and empowering GPs to make

is improving: GPs and other providers are

their voices heard in system-level decision-

developing working relationships through

making. Each project the Division leads or

projects like our substance use intervention

joins finds its roots in at least one, if not all

pilot with the Umbrella Society, and

three, of these strategic priorities.

through the newly-forming senior-focused

VDFP physicians are eagerly embracing

Neighbourhood Teams strategy.

new tools and mechanisms—such as

VDFP physician leaders work side by side

Pathways and Physician Connectors—

with leaders in Island Health, Doctors of BC,

to improve the care they deliver in their

and the Ministry of Health to ensure that

offices. More formal alliances are being

policies reflect the importance of primary

formed between GPs throughout Victoria,

care, and that services are designed to

who are exploring team-based solutions

include and support family physicians

to improve the experience of providing

working in the community. Indeed, as we

care, and to fortify the sustainability of their

have learned over the past six years, the

practices.

fruits of our labour depend on the strength

Technological innovations, improved communication systems, and opportunities

of our connections to one another.

Read on to learn more about these and other VDFP projects and initiatives.

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2016–17 ANNUAL REPORT

Our Mission Articulating our organizational culture + philosophy

8

VICTORIA DIVISION OF FAMILY PRACTICE

Our Vision Healthy communities through access to excellent local primary care

GPs provide quality care in their practice

GPs support primary care in Victoria

GP voice and experience influences system decision-making

IMPROVE COMMUNICATION AND CONNECTION, RELATIONSHIPS BETWEEN CLINICAL PROVIDERS PROVIDE EDUCATION, COACHING AND SUPPORTS TO PHYSICIANS AROUND CLINICAL PRACTICE AND HEALTH SYSTEM RESOURCES 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

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2016–17 ANNUAL REPORT

Attachment & Integration WINDING DOWN A GP FOR ME Spring 2017 saw the VDFP wind down projects that had begun under the GPSC’s threeyear A GP for Me initiative, and either sustain them within other initiatives, or evolve them based on results thus far. We are sustaining TORCH and developing complementary residential care models through the Residential Care Initiative, and we have embedded GP recruitment as core Division programming. Care of the elderly, practice support, and practice coverage have all been integrated into our implementation of the Patient Medical Home and Primary Care Networks.

While A GP for Me did not result in every resident of B.C. being attached to a longitudinal family practice, it brought great value to patients and providers in Victoria. Recruitment efforts supported 21 new GPs to begin practice in the city. By adding new GPs, introducing innovative new practice models, and supporting GPs to improve their work flow, our work enabled 20,000 new patient attachments, and strengthened 80,000 existing attachments.

Moreover, the VDFP’s experience implementing A GP for Me was key to developing a positive working relationship with our health authority partners. This alliance is now enabling community GPs to work hand-in-hand with Island Health clinicians and leaders, supporting practice changes that were not previously possible.

10

VICTORIA DIVISION OF FAMILY PRACTICE

RAMPING UP PATIENT MEDICAL HOME/PRIMARY CARE NETWORKS Evolving out of the successes and challenges of A GP for Me, the Ministry of Health and GPSC have identified the Patient Medical Home (PMH) and Primary Care Networks (PCNs) as the key strategic priorities that will guide our ongoing efforts to improve access to community-based primary care.

The GPSC’s PMH B.C. model is an adaptation of Canada’s College of Family Physicians’ framework to define the twelve attributes of an ideal family practice.

GETTING USED TO SOME NEW ACRONYMS Patient Medical Home: The PMH is the site of a patient’s longitudinal primary care.

The family physician and patient are the fundamental relationship in the PMH. Primary Care Networks: PCNs—formerly known as Primary Care Homes—refer to the primary care system integrated with the GP and patient (PMH). PCNs may include multidisciplinary health centres, outreach services that drop in to the GP office, and/or a coordinated system of health authority primary care services linked with family practice.

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2016–17 ANNUAL REPORT

(CLOCKWISE FROM TOP LEFT) DR. KATHARINE MCKEEN, DR. HEERA BINDRA, DR. NAOMI HWANG, KRISTIN ATWOOD, DR. LISA VERES, AND DR. ANNA MASON DISCUSS TEAM-BASED CARE AND THE CREATION OF GP NETWORKS AT FEBRUARY 2017 VDFP EVENT.

Attachment & Integration cont.

The evolution of the PMH/PCN direction has been a key topic for all of our existing work tables and committees. In February 2017—when we hosted a formal engagement event open to all members—69 participants learned how our community is already working with these strategies, and considered how we might innovate, spread, and improve.

MEMBER GPs RECOMMENDED ACTION THAT WILL: •

strengthen working relationships among health care providers and across the system;

•

support collaborative care and the growth of primary care teams accessible to all patients who need them; and,

•

develop a functional business model to enable the shift away from traditional private practice to integration with the broader health system.

They noted that the dominant remuneration model for GPs (fee for service) is a barrier to meeting the attributes of the PMH and PCNs, especially when working with vulnerable or high-needs patient populations. They also expressed frustration about system expectations of GPs, who work with insufficient resources and struggle to preserve their own health and wellbeing.

12

VICTORIA DIVISION OF FAMILY PRACTICE

Despite barriers and challenges, member GPs have developed a clear plan to change the system of primary care in Victoria. With direction from their colleagues, members have identified two broad strategies: geographically-organized interdisciplinary teams focusing initially on service for vulnerable populations; and, family physician networks.

Growth and development of these strategies is being staged to use scarce resources wisely and equitably.

TEAM-BASED CARE FOR VULNERABLE POPULATIONS This work is built on a foundation established by the Division’s Care of

MEMBERS HAVE IDENTIFIED TWO BROAD STRATEGIES: GEOGRAPHICALLYORGANIZED INTERDISCIPLINARY TEAMS (FOCUSING INITIALLY ON SERVICE FOR VULNERABLE POPULATIONS); AND, FAMILY PHYSICIAN NETWORKS.

the Elderly working group and Collaborative Services Committee, and as such is described more fully in the section on Care of the Elderly (pages 15–17).

To summarize here, it tests a virtual approach to team-based care in a decentralized urban environment, enabling collaborative care among clinicians who are not co-located. Its two primary mechanisms— Physician Connectors and Neighbourhood Teams—are new system elements co-designed and implemented by the VDFP and Island Health to support and enhance family practice. Implementation of the Connectors and Teams focuses first on services for frail seniors living at home, then on people with mental health and substance use concerns.

PHYSICIAN CONNECTORS AND NEIGHBOURHOOD TEAMS ARE NEW SYSTEM ELEMENTS CO-DESIGNED AND IMPLEMENTED BY THE VDFP AND ISLAND HEALTH TO SUPPORT AND ENHANCE FAMILY PRACTICE.

Our aspirational goal is for this system to eventually be available for patients across all demographic and diagnostic categories.

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2016–17 ANNUAL REPORT

MEMBERS ARE BEGINNING TO ORGANIZE INTO NETWORKS, STARTING WITH A GEOGRAPHIC ORIENTATION THAT FOSTERS COLLABORATION BETWEEN PRACTICES THAT ARE LOCATED WITHIN A DEFINED AREA.

FAMILY PHYSICIAN NETWORKS Most GPs in Victoria practice solo, or in small groups without shared patient panels.

Isolation from colleagues can have a negative impact on patient care, provider wellbeing, and business efficiency. Members are, therefore, beginning to organize into networks, starting with a geographic orientation that fosters collaboration between practices that are located within a defined area (e.g., a building or neighbourhood).

Networks encourage partnerships between family practices, and between family practice and walk-in clinics, to increase the likelihood that patients can access excellent longitudinal primary care, and can have urgent/unexpected needs met outside of an emergency setting or normal business hours. From a GP’s perspective, potential benefits include achieving economies of scale, enhanced opportunities for cross-coverage, shared access to allied health or specialists who may deliver services within GP offices, and shared services that are in short supply, such as locums.

We are integrating prior VDFP work on walk-in clinics and practice coverage, as well as practice supports such as Pathways and EMR optimization into this strategy, which has the overall goals of retaining GPs in practice and making family practice in Victoria more attractive to new physicians.

14

VICTORIA DIVISION OF FAMILY PRACTICE

Care of the Elderly (COE) The VDFP’s Care of the Elderly (COE) working group has been meeting since 2012, when members prioritized improving care for frail seniors.

The COE working group put its initial focus into residential care, which was in near-crisis mode. Through A GP for Me, they developed the TORCH model of team-based care, which is now sustained and spreading via the provincial Residential Care Initiative.

With TORCH established, the COE group returned to the question of care in the community. In 2015, they underwent a comprehensive process to develop an evidence-based concept paper that identified potential models for improved service delivery for frail seniors living at home. The VDFP CSC endorsed the recommendations in early 2016.

Island Health then began reorganizing urban Victoria’s Home and Community Care service delivery into three neighbourhood hubs, each having its own multidisciplinary team of health authority primary care providers. This restructuring created an opportunity for Victoria GPs to engage in new partnerships and approaches to care.

The Division and Island Health began collaborating to implement the service delivery models that the GPs had presented in their concept paper. The VDFP’s COE group reconvened in Spring 2016, along with Island Health staff and leaders. They met throughout the Summer and Fall (as a whole, and as a smaller task group) to flesh out recommendations for implementation.

WITH TORCH ESTABLISHED, THE COE GROUP RETURNED TO THE QUESTION OF CARE IN THE COMMUNITY.

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2016–17 ANNUAL REPORT

THE NEW TEAM OF PHYSICIAN CONNECTORS ARE A TEAM OF LPNs REACHED VIA PHONE TO CONNECT GPs WITH ALL ISLAND HEALTH SERVICES THAT THEIR PATIENTS MAY NEED.

Care of the Elderly (COE) cont.

Implementation began in Summer 2017, with two new system elements: Physician Connectors, and Neighbourhood Teams.

THE PHYSICIAN CONNECTORS •

The Physician Connectors (3.0 FTEs) are LPNs with significant experience in community intake.

•

GPs reach the Connectors through a phone line that is a portal to all Island Health services that their patients may need.

•

Available Monday to Friday from 8:30 a.m. to 4:30 p.m. The number is automatically forwarded to Community Access outside of these hours.

Sample calls fielded by Physician Connectors •

Processed referral requests for palliative care and wound care

•

Connected the GP to their patient’s community health team

•

Processed referrals to case management for alternate levels of care

•

Processed referrals to the Complex Seniors Health Team (formerly SORT)

•

Assisted with same-day referrals to the Rapid Response Team (formerly QRT)

•

Provided information about Community Health Services

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VICTORIA DIVISION OF FAMILY PRACTICE

NEIGHBOURHOOD TEAMS •

GPs and Connectors are linked with new Neighbourhood Teams, which focus on senior health, and which are based out of three geographic hubs (Victoria, Oak Bay/Gordon Head, and Saanich).

•

VDFP is supporting GPs to develop meaningful working relationships with these teams.

•

GPs in a given neighbourhood will work more directly with Island

GPs AND ISLAND HEALTH CLINICIANS WILL BEGIN BUILDING WORKING RELATIONSHIPS THROUGH A SERIES OF NEIGHBOURHOOD DEVELOPMENT SESSIONS IN FALL 2017.

Health clinicians based at the local health unit.

•

Integrating community services with family practice—at both the system and interpersonal levels—will simplify processes for GPs, and will streamline patient access to collaborative, comprehensive, and coordinated team-based care.

•

GPs and Island Health clinicians will begin building working relationships through a series of Neighbourhood Development Sessions in Fall 2017.

COE meetings are ongoing to ensure that GPs and Island Health keep working together to shape these new interventions as they develop.

The CSC continues to oversee this work, and is exploring how to expand from a focus only on senior services to one that also includes mental health and substance use.

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2016–17 ANNUAL REPORT

Residential Care Initiative (RCI) The Victoria–South Island Residential Care Initiative (Vic–SI 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 provincially determined Best Practice Expectations and System Level Outcomes, the Vic-SI RCI focuses on: DID YOU KNOW? 80% OF TOTAL RCI FUNDING GOES TOWARD DIRECT PAYMENTS TO PHYSICIANS. THE REMAINING FUNDS SUPPORT PHYSICIAN RESOURCES SUCH AS PARKING PASSES, CLINICAL LEARNING SESSIONS, FACILITY SUPPORT TO IMPROVE PHYSICIAN WORKING CONDITIONS, AND PROGRAM ADMINISTRATION.

“THE MOVE TOWARD IDENTIFYING CORE PHYSICIANS FOR RESIDENTIAL CARE SITES— BE IT THROUGH TORCH OR CORE— IS THE WAY OF THE FUTURE, NOTWITHSTANDING SOME LINGERING CONCERNS I HAVE ABOUT RELINQUISHING CARE OF ‘MY’ PATIENT (WHICH MAY BE MORE ABOUT ME THAN THE PATIENT).”

—DR. DAVID BROOK, VDFP PHYSICIAN MEMBER

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PROVIDING PRACTICE SUPPORT TO ENCOURAGE PARTICIPATION, AND TO REDUCE BARRIERS: •

Quarterly payments to physicians

•

After-Hours call group implementation

•

Clinical Learning Series

•

Billing optimization support

•

Residential Services parking pass

•

Scholarship fund; QI seed fund

DEVELOPING, IMPLEMENTING, AND MAINTAINING MODELS FOR PRACTICE INNOVATION: •

TORCH Physician Model

•

CORE Physician Model

•

Self-organized core group models

VICTORIA DIVISION OF FAMILY PRACTICE

ESTABLISHING AND CONSISTENTLY MEETING EXCELLENT STANDARDS OF CARE: •

Based on Best Practice Expectations and System-Level Outcomes

•

Developing data-driven implementation and accountability strategies

•

Quality Improvement: chart audits, sharing promising practices

HOW DOES THE VIC–SI RCI IMPROVE ACCESS TO PRIMARY CARE? •

It improves the quality and consistency of primary care in residential care contexts through the implementation of best practice expectations and practice supports.

•

It strengthens the residential care physician workforce through provision of financial incentives, resources, and through reducing or removing barriers to practice.

RESIDENTIAL CARE IN VICTORIA AND SOUTH ISLAND

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2016–17 ANNUAL REPORT

74 PHYSICIANS

THAT EQUALS

HAVE OPTED IN TO RCI

40% OF GPs

WHO VISIT RESIDENTS

THEY CARE FOR

81%

OF RESIDENTS

23

MEMBERS JOINED CALL GROUP

Residential Care Initiative (RCI) cont.

2016/17 VIC–SI RCI PROGRAM REVIEW AND EVALUATION In June of 2017, the Vic–SI RCI completed its first annual program review and evaluation, focused on understanding RCI physician engagement, how well best practice expectations are being achieved, the impacts of the RCI, and opportunities for improvement.

VIC-SI RCI ENGAGEMENT There are 74 physicians in Victoria and South Island who have opted-in to the Vic–SI RCI as of July 2017 (40 per cent of all local physicians attending residents in facilities).

These physicians provide medical care for 81 per cent of all local residents.

TO WHAT EXTENT HAVE VIC–SI RCI PHYSICIANS ADOPTED THE BEST PRACTICE EXPECTATIONS?

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VICTORIA DIVISION OF FAMILY PRACTICE

IN

THEY CARE FOR ALL

2867 RESIDENTS

29

RESIDENTIAL CARE FACILITIES

“WITH RESPECT TO THE CALL GROUP, I’M HAPPIER KNOWING THAT MY PATIENTS ARE IN THE CARE OF PHYSICIANS WHO HAVE A DEMONSTRATED INTEREST IN CARING FOR VERY FRAIL NURSING HOME RESIDENTS.” —PHYSICIAN MEMBER

POSITIVE IMPACTS OF THE RCI •

After-hours coverage in Victoria is highly rated by RCI physicians, facility leaders, and facility staff.

In April 2017, the Vic–SI RCI launched a coordinated Residential Care After-Hours coverage call group with 23 RCI physician members. The call group covers all 2,867 residents (not only those attended by RCI physicians) in 29 Victoria residential care sites. The on-call physician is accessible by calling a 1-888 number; prior to calling, facility staff complete an SBAR (Situation Background Assessment Recommendation) form to make best use of physician time. Data from the After-Hours coverage system is monitored on a weekly basis to ensure call volume is manageable, and that calls are clinically appropriate. The call group has received very positive feedback from physicians and facility staff alike.

A key next step involves developing coordinated afterhours coverage at the seven Peninsula residential care sites.

•

RCI Learning Series and other supports: Offering clinical education on residential care topics, the Learning Series is regarded highly by physician and facility attendees alike, with 95 per cent of RCI physicians finding the series valuable or extremely valuable. RCI Learning Series events are open to all Victoria and South Island Division members, and are typically attended by 70 to 80 physicians and facility team members.

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2016–17 ANNUAL REPORT

Residential Care Initiative (RCI) cont.

PHYSICIAN– NURSING AND PHYSICIAN–FACILITY LEADER WORKING RELATIONSHIPS AND TEAM-BASED CARE ARE A SOURCE OF SATISFACTION FOR ALL.

95% RATE

LEARNING SERIES VALUABLE

95%

ARE SATISFIED WITH NURSING STAFF RELATIONSHIP

70% OF RCI GPs SATISFIED WITH PRACTICE

22

•

Physician Satisfaction: 70 per cent of RCI Physicians indicated that overall, they were satisfied or very satisfied with their residential care practice. This level of satisfaction is a marked improvement from when the Victoria Division’s work to improve residential care began in 2012. The Vic–SI RCI has continued address the barriers to residential care practice and improve support and resources for physicians in residential care.

VICTORIA DIVISION OF FAMILY PRACTICE

OPPORTUNITIES FOR IMPROVEMENT •

Attendance at care conferences and meaningful medication reviews on site: Both of these best practices were reported by physicians, facility staff, and facility leadership to be occurring only about 50 per cent of the time.

•

Participation in quality improvement: This best practice was also reported as occurring only about 50 per cent of the time.

•

Inclusion of resident/family perspective in evaluation.

•

Physician accountability to RCI commitments.

These opportunities for improvement provide direction for the RCI program team over the coming year. divisionsbc.ca/victoria/rci

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2016–17 ANNUAL REPORT

Mental Health & Substance Use:

Improving treatment and access for patients with mental health and substance use issues within primary care TEACHING PATIENTS SELF-MANAGEMENT SKILLS THROUGH THE MSP-FUNDED CBT SKILLS GROUP PROGRAM In 2015, Victoria’s family physicians worked closely with local psychiatrists to develop and launch an eight-week group therapy course to address escalating rates of anxiety and depression amongst their patient population. Participants in these Cognitive Behavioural Therapy (CBT) Skills Groups learn skills—through applied exercises in an interactive environment—to better manage their emotional response to challenges in the world around them. They learn that, although we don’t have a choice about the curve balls life throws at us, we do have a choice in how we respond.

CBT SKILLS GROUPS ARE THRIVING AND SPREADING.

The model is designed to spread like a spider web, where one group is facilitated by a psychiatrist with support from a family physician, who simultaneously learns how to run his or her own group with support from another doctor.

For more information about the program and resources, visit divisionsbc.ca/victoria/CBTskillsgroup

SUCCESS AND SPREAD OF THE PROGRAM •

The pilot was co-funded by the Shared Care Committee and the VDFP in March 2015. Nine physicians are now offering regular groups.

24

VICTORIA DIVISION OF FAMILY PRACTICE

•

Nearly 350 physicians from Victoria and the South Island are now making referrals.

•

More than 1800 patients have participated to date, and up

9

FAMILY PHYSICIANS OFFERING GROUPS

to 25 groups are offered in each quarter throughout the year.

•

The course’s satisfaction rating is 92 per cent, with 95 per cent of participants saying they would recommend the program to a friend or family member.

•

350

PHYSICIANS MAKING REFERRALS

Scales of symptom severity show changes consistently over the eight week course, with large or very large effect sizes.

•

Referring physicians have reported that participating patients have a decreased need for more intensive psychiatric referrals and medications, and have described patient empowerment

1800+

PARTICIPANTS TO DATE

and improved social and occupational functioning.

•

The program has now spread to Westshore/Langford, Cowichan, and Vancouver.

•

Cancer patients, youth, women, and seniors are now groups that

92%

SATISFACTION RATE

can provide examples and content specific to those populations.

•

A model for CBT Level I Booster Groups has been developed with ongoing offerings.

•

CBT Level II Group pilots are running specific to CBT for Insomnia

95% WOULD

RECOMMEND

and Mindfulness-Based Cognitive Therapy.

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2016–17 ANNUAL REPORT

“THE PATIENTS WHO HAVE COMPLETED THIS COURSE HAVE TRULY CHANGED THEIR OUTLOOK ON LIFE. I FEEL A HUGE SENSE OF RELIEF WHEN PEOPLE AGREE TO ATTEND, BECAUSE I KNOW THAT THEY WILL ACQUIRE BETTER COPING SKILLS. THEY LEARN THAT THEY ARE NOT ALONE IN THEIR STRUGGLES. MANY WILL REQUIRE FEWER GP VISITS. THIS COURSE BENEFITS PATIENTS, PHYSICIANS, AND THE COMMUNITY.” —DR. ANNA MASON

95%

IMPROVED ABILITY TO MANAGE

MENTAL HEALTH

100% OF GPs ARE

CONFIDENT IN REFERRING

90% SAY CBT

REDUCED NEED FOR SPECIALISTS

26

CBT Skills Group Feedback “ONE OF MY PATIENTS WAS ON THE VERGE OF MEDICAL LEAVE. AFTER ATTENDING THREE CBT SKILLS GROUP SESSIONS, HE BECAME MORE CONFIDENT, AND DID NOT TAKE TIME OFF OR REQUIRE MEDICATION.” —MEMBER GP “ONE PATIENT HAD PREVIOUSLY BEEN REQUESTING ATIVAN ANXIETY. WITH THE CBT SKILLS, SHE HAS NOT REQUESTED FURTHER ATIVAN, AS SHE FEELS SHE CAN MANAGE THROUGH OTHER MEANS.”—MEMBER GP

“PATIENTS ARE VERY HAPPY TO HAVE AN OPTION THAT IS NOT A MEDICATION, AND THAT IS AFFORDABLE.”—MEMBER GP

VICTORIA DIVISION OF FAMILY PRACTICE

PROVIDING CME-ACCREDITED LEARNING OPPORTUNITIES ABOUT THE OPIOID CRISIS, AND HOW TO NAVIGATE OPIOIDS, ADDICTION, AND PAIN WITHIN FAMILY PRACTICE Many lives have been ruined by the opioid crisis, and Victoria physicians are learning what they can do in their offices to prevent

DR. BILL BULLOCK (TOP LEFT), DR. RAMM HERING, AND DR. ANNE NGUYEN (TOP RIGHT) ARE AT THE FOREFRONT OF OPIOD EDUCATION IN VICTORIA. THE VDFP HELD ITS MARCH 2017 EVENT TO DISCUSS AN EXPANDING ROLE FOR FAMILY PHYSICIANS.

more deaths due to this chronic disease.

This year, the Victoria Division brought together more than 100 members on the topic. One event was broad in scope, focusing on how to navigate opioids, addiction, and pain. The other focused on buprenorphine/ naloxone maintenance therapy for Opioid Use

Tackling the Opioid Crisis

Disorder. Both events included a patient story, information about the new provincial opioid disorder treatment guidelines, the College’s new safe prescribing standards, how to understand the diagnosis, management options for Opioid Use Disorder, and opioid reducing and tapering strategies.

Physicians learned practical skills, and reported increased confidence in their ability both to identify patients who have Opioid Use Disorder, and to maintain treatment using buprenorphine/naloxone pre/post event. Both events were recorded for viewing at divisionsbc.ca/victoria/ learningseries, along with package materials and synthesized lists of local community resources for substance use and non-cancer pain.

DR. LAUNETTE RIEB (BOTTOM LEFT), GP AND ADDICTION EXPERT, ANSWERED QUESTIONS FROM MEMBER GPs (BOTTOM RIGHT) AT THE VDFP’S APRIL 2017 EVENT ABOUT NAVIGATING THE WORLD OF OPIOID PRESCRIPTION.

27

2016–17 ANNUAL REPORT

PILOTING COLLABORATIVE CARE WITH OUTREACH SUPPORT FOR PATIENTS WITH PROBLEMATIC SUBSTANCE USE Stigma related to substance use disorder can lead to feelings of shame that prevent people from reaching out for help before their health and lives have deteriorated. The Umbrella Society provides peer support services for patients who have problematic substance use by supporting them in their recovery journey, and by helping them to navigate the substance use system.

In this pilot, family physicians can refer patients struggling with substance use to the Umbrella Society. An Umbrella Society outreach worker THE UMBRELLA SOCIETY’S OUTREACH WORKER JENNY DAGG HAS BECOME A LIFELINE FOR PHYSICIANS, WHO CAN NOW REFER THEIR PATIENTS FOR ONETO-ONE SUPPORT FOR PROBLEMATIC SUBSTANCE USE.

Umbrella Society Pilot Project 28

is dedicated to the project, and provides timely, one-onone support, and ongoing communication with the referring family physician.

This outreach worker is presently supporting 110 patients referred by 71 family physicians.

VICTORIA DIVISION OF FAMILY PRACTICE

VLAT:

Victoria Local Action Team DEVELOPING AN INTEGRATED AND COLLABORATIVE CHILD AND YOUTH MENTAL HEALTH AND SUBSTANCE USE SYSTEM The Child & Youth Mental Health & Substance Use (CYMHSU) Collaborative’s Victoria Local Action Team (VLAT) brings providers together with the aim of improving both the system, and the experiences of children, youth, and families who are in need of support. The VLAT is a dynamic team comprised of almost 60 representatives from Island Health, the Ministry of Children & Family Development, School District 61, multiple community agencies, youth, family members, pediatricians, child/youth psychiatrists, and family physicians.

The VLAT has taken careful and concerted strides to nurture the strong, trusting relationships that have emerged among CYMHSU providers.

This achievement to date will serve as a strong foundation for, and a commitment to, ongoing work to improve access for children, youth, and families.

The VLAT has also supported educational efforts with school counsellors and family physicians regarding key issues like suicide prevention and youth substance use. Suicide Prevention Toolkits for youth, parents/caregivers, and professionals have been modified for the Greater Victoria area. A referral matrix for family physicians and ;a pathway for care is currently in development.

29

2016–17 ANNUAL REPORT

Transitions in Care (TiC) Evaluation—Two Division-level evaluation activities have been completed: Social Network Analysis and Engagement Analysis SOCIAL NETWORK ANALYSIS: •

Since 2012, we have engaged with 106 unique organizations or individual key stakeholders.

•

Our biggest partners are the South Island Division, the GPSC, and Island Health.

•

Opportunities exist to build stronger relationships with UBC and UVIC medical schools (which presently comprise only one per cent of our contacts with external organizations), and with community resources (only four of 106 connections were local community resources).

eNOTIFICATION eNotification was our very first Transitions in Care project. Sustained through Island Health in 2015, this year the health authority also committed support to GPs experiencing trouble accessing the service. With this transition, eNotification has officially become 100 per cent sustainable! With the help of the Collaborative Services Committee, we were able to find a home for every piece of work related to eNotification, ensuring that the service will be wellmaintained far into the future. Truly a success story for the year!

PRE-DISCHARGE ALERT Our partners in Island Health’s Access and Transitions area continue to support the spread of pre-discharge alerts, first piloted by Transitions in Care in Spring 2016. Uptake is increasing across Royal Jubilee and Victoria General Hospital medical units, each with 50–75 per cent of expected discharges including a pre-discharge alert. Island Health is committed to monitor the spread of alerts until they become embedded in routine practice.

30

VICTORIA DIVISION OF FAMILY PRACTICE

PA TI

EN

T

SU

M

M AR

IE

S

PATIENT SUMMARIES In 2016/17, we expanded our patient summaries pilot from 46 to 101 physicians in the Greater Victoria Area. Streamlined processes at Island Health made it much easier for physicians to submit summaries upon receiving notification of admission: between November 2016 and April 2017, and they sent in almost 1,000 summaries to RJH and

100% OF

HOSPITALISTS USED PATIENT SUMMARIES

VGH. Staff on all wards in both hospitals are now quite familiar with GP summaries. Hospitalists and allied health professionals report using the summaries to assist in patient care and discharge planning.

Island Health recognizes the value of these summaries as the first

100%

OF GPs RATED THE PILOT VALUABLE

chapter of a broader shared care plan that could align with its Primary Care Network goals. Our IMIT partners are working hard to enable summary scanning into PowerChart for increased accessibility.

Hospitalists, for example, can now access patient summaries while dictating discharge summaries, without requiring access to the

65%* SAW ≼ ONE

SUMMARY IN PAST 4 WEEKS

physical chart.

The pilot was funded by the Shared Care Committee, and we believe that this research is evidence that the summaries add value to patient care, prevent adverse events, and improve transitions between community and acute settings. Our comprehensive Briefing Note to GPSC (July 2017) outlines the importance of this work, and advocates for expanded existing fee codes that include preparing summaries.

48%* USED

SUMMARIES TO IMPROVE CARE *OF PHARMACISTS + SPEECH PATHOLOGISTS

31

2016–17 ANNUAL REPORT

FAMILIAR FACES AND OTHER ER WORK Our ERP–GP Working Group has focused its attention on improving care for frequent users of emergency services. Often, these Familiar Faces benefit from a care plan that ensures a consistent response when they present to the ED for the same health concern.

The group researched multiple care plan options before deciding to expand the model presently being implemented at Saanich Peninsula Hospital. Nursing and social work staff are helping to identify and remove obstacles to using care plans, and we are working to ensure that family physicians are welcomed into the care planning process.

We are fortunate to have Family Practice Resident Leigh Sadler working with us, taking the lead with Emergency Physician Dr. Fred Voon and Nurse Manager Amanda Adams to identify patients and their GPs who might benefit from an emergency care plan.

OTHER EMERGENCY DEPARTMENT WORK •

Continuing to develop Tips and Tricks for the ER (published online and in our Newsflash).

•

Developing a postcard campaign to encourage ERPs to use pens that transfer well through the triplicate ER Encounter sheet, while developing ways to get details about ER Encounters to GPs.

•

Creating a mini poster that describes how patients are triaged when they arrive at the ED.

32

VICTORIA DIVISION OF FAMILY PRACTICE

SECURE MESSAGING Our highly anticipated secure messaging project got off to a slow start due to contractual, technical, privacy, and Ethics Board issues. Despite challenges, the leadership team’s resilience was even recognized at the B.C. Health Leaders Conference, and two of its members were invited to co-present a plenary session with counterparts from the Collaborative Services Committee.

We initiated technical testing of the technology in the summer of 2017, and a large-scale pilot is anticipated early in the coming year.

JOIN THE SECURE MESSAGING PILOT LAUNCHING IN 2018

GP CONTACTS IN POWERCHART The Victoria Division celebrated a big win with our Island Health partners this year by getting GP fax numbers displayed in PowerChart.

The health authority has also committed to begin collecting direct GP phone numbers (e.g. back office numbers) for PowerChart.

This system makes it easier for hospital-based physicians to reach community GPs directly, using a phone number where they can leave a message for a call-back; often, only front office numbers are listed, some of which do not include a voicemail option.

33

2016–17 ANNUAL REPORT

Walk-in Clinics WALK-IN CLINICS PROJECT GROUP For two years, the VDFP hosted a Walk-in Clinics (WIC) Project Group, holding space for WIC owners, medical directors, and workers to come together and discuss issues of common concern. We: •

consulted on Island Health questions about how best to identify primary care providers and distribute reports;

•

implemented a new referral form from WICs to ER so that WIC physicians could close the loop on patients they referred;

•

supported our ER colleagues by providing them with advance notice of WIC closures over the Christmas holidays; and,

•

worked with the University of Victoria on a study of patients and providers (analysis in progress).

The WIC Project Group’s Terms of Reference ended in Spring 2017; however, members who were engaged through that group have gone on to join other projects in the areas of Transitions in Care and Networks. We continue to receive feedback from colleagues around the province noting that the VDFP is leading the way in including WIC providers within Division work, and that WIC providers are well-represented within Division leadership. There is an overarching acknowledgement of the important role that WICs play in our current health system.

34

VICTORIA DIVISION OF FAMILY PRACTICE

Walk-in Clinic Survey Results WHO

uses walkin clinics?

are non-white:

15% 6% Asian

45% are attached 88%

3% Indigenous

of unattached patients would like a family doctor

household 27% have incomes <$25,000*

46 = average age

66% are women

*unattached patients are more likely to be living in poverty

STATISTICALLY SIGNIFICANT RESULTS ARE ILLUSTRATED HERE.

WHAT

do patients say about walk-in clinic care?

WHY

do patients use walk-in clinics?

satisfied or very satisfied with 84% are the care they receive at walk-in clinics

arrive with an illness, injury, or sudden onset of symptoms

56% unattached: more likely to arrive with a chronic health issue,

prescription renewal, or to fill a form, and more likely to have visited a walk-in clinic seven+ times in past year

attached patients: 31%

WHERE would patients go if there were no walk-in clinics?

IN 2016, THE VDFP COLLABORATED WITH RESEARCHERS AT THE UNIVERSITY OF VICTORIA TO SURVEY WALK-IN CLINIC USERS ABOUT THEIR NEEDS AND EXPERIENCES.

family doctor wait times are too long

doctor’s 25% family office closed clinic 22% walk-in more convenient

attached patients:

unattached patients:

their 41% see family doctor

54% go to the ER

32% go to the ER 18% stay home

“Wait.”

18% stay home

“Panic!”

12% look for help online

35

2016–17 ANNUAL REPORT

Pathways 328

ACTIVATED VDFP MEMBER USERS

The vast majority of member GP offices are now using Pathways to connect health care providers, and we are receiving very positive feedback across the board. Uptake of the system continues steadily, with ongoing requests for activation support. GPs appreciate having

161 VDFP GP USERS

one accurate, updated provincial source for specialist information, forms, resources, news, and other essential data. Some GPs are beginning to utilize Pathways’ ability to upload EMR-friendly forms for Intrahealth and Oscar.

More specialists are requesting MOA access keys, and are reporting

51

having received GP referrals via Pathways. Information from roughly 20 specialists—mostly imminent retirees—remains outstanding.

MOA USERS Pathways also provides the framework to allow GPs to move fluidly from one Division to another: without having to learn another piece of

22

LOCUM USERS

36

software, they can effectively and immediately explore local specialists and clinics.

VICTORIA DIVISION OF FAMILY PRACTICE

257 LOCAL

SPECIALISTS LISTED

1481 DIGITAL

PATIENT RESOURCES

1000 –2000 LOCAL WEEKLY PAGE VIEWS

250 –350 LOCAL WEEKLY

≈100 LOCAL WEEKLY USER ID LOGINS

SESSIONS

Since its launch, Pathways has been improved continuously, with new features like the search engine, uploaded forms features, and an improved administrative system for easier and more comprehensive data entry. Specialty Areas of Practice is constantly being refined and expanded.

The Provincial Resource Team meets monthly to review suggestions for new resources, to remove any outdated or duplicate resources, and to improve the display of resources. Over the Summer, 152 new resources were added out of the 216 resources that were suggested.

The team receives feedback regarding new resources from about a dozen different physicians each month. While all resources are checked automatically for dead links twice monthly, feedback about difficulties with links is still appreciated.

21

LOCAL FORMS UPLOADED

102

NEWS ITEMS POSTED IN 9 MONTHS

52,000+ TOTAL PAGE VIEWS SINCE LAUNCH

79% OF VIEWS FROM GP OFFICES

37

highlights: October 2016 –September 2017 2016 OCTOBER 2016

DECEMBER 2016

NOVEMBER 2016

• More than 750 patients have

• Family

participated in the CBT Skills Group Program, with 1400+ referrals

• Inter-divisional CSC | Nanaimo

• CYMHSU Collaborative

Learning Session | Vancouver

• Practice Support Event:

Understanding and Refining your Patient Panel

• Dine & Learn:

Pediatric Medley

• Finalized

the Vic–SI RCI vision, mission, and key focus areas

• RCI Learning Series: P.I.E.C.E.S. Dementia Training for Physicians

• TIC Secure Messaging Event & Patient Summaries Extended Pilot Launch

• First test of P–DOC (Physician Department of Operations) during ShakeOut BC

Holiday Social

• PSP 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 R E S I D E N T I A L C A R E I N I T I AT I V E L E A R N I N G S E R I E S E V E N T

Management of Infections

• A GP for Me Provincial

IN RESIDENTIAL CARE

Saturday November 19th 2016 9am SHARP to 1pm Light breakfast served at 8:30am

Summit | Vancouver

Island Medical Program (IMP) Lecture Hall University of Victoria Medical Sciences Building

RSVP by Tuesday November 15th victoriaevents@divisionsbc.ca 1.877.790.8492 ext 6

• Agents of Change practice

Who should attend?

Victoria

& VDFP Fifth Birthday

Management of Infections

Services Committee Visioning Session

• GPSC Fall Summit • RCI Launched CORE physician model at Gorge Rd. Hospital

Coleen Mayhew, Provincial Academic Detailing Team: UTI & Antibiotics

•

Dr. E. Partlow: SSTI in the Elderly

•

Dr. W. Ghesquiere: Clostridium Difficile (C Diff)Treatment: A Quick Review

Learning Mainpro+ credits.

• RCI Learning Series:

• Victoria Collaborative

Dr. K. Hammond: Pneumonia in the Nursing Home Patient

•

CME Accreditation This presentation has been certified for 3 Group

• Annual General Meeting

Surgery

•

This training is for physicians and allied health professionals practicing in residential care.

and feedback calls begin (until December)

• RCI 24/7 Coverage Workshop • Dine & Learn: General

Join Infectious Disease Specialists to learn about a variety of ID topics for people living in residential care:

Victoria

South Island

South Island

2017 JANUARY 2017

FEBRUARY 2017

MARCH 2017

• Dine & Learn: Physiatry • RCI After-Hours Coverage Event

• RCI Learning Series:

Management of Skin Care

• CBC Radio interview about

the CBT Skills Group Program

• Oscar User Group session • Patient Medical Home/

Primary Care Home member engagement event

• RCI Learning Series: Palliative Care & Pain Treatment

• Umbrella Outreach

Worker supporting 18 family physicians and 39 of their patients who have problematic substance use

• Educational event for all

school and youth/family counsellors on the topic of anxiety

• Developed Residential Carespecific parking pass with Island Health

• JCC Quality Forum • MHSU Event: Family

Physicians and the Opioid Crisis—You Have a Role to Play

• Dine & Learn:

Wound Care & Infection

• Three EMR User Group sessions

• RCI After-Hours

Call Group Orientation

• RCI Learning Series: Issues

in Medication Management

• Established RCI Excellent Care working group

highlights: October 2016 –September 2017 2017 APRIL 2017

MAY 2017

• RCI Learning

Series: Management of Late Stage Dementia and Parkinson’s

• Dine & Learn:

Gastroenterology Roundtable

• MHSU: CARES Focus Group • Transitions in Care Hospitalist & GP brainstorming session

• GP Networks Greenhouse Group

• Residents

JUNE 2017

• Care of the Elderly working

group: VDFP and Island Health partner for Physician Connector prototype

• RCI Learning Series: Common Geriatric Psychiatry Issues

& Learners Greenhouse Group

• Dine & Learn: Family Practice Roundtable for Residents & Medical Students

• Dine & Learn: Paediatric Psychiatry Roundtable

• 2300+ referrals to the • MHSU Event: Navigating Opioids, Pain, and Addiction—The Patient, The Physician, and The College

• RCI Launches Victoria

After-Hours Call Group

• RCI Implements First

Annual Program Review & Evaluation

• CORE physician model

launched at Luther Court

CBT Skills Group Program by 333 physicians

• Umbrella Outreach Worker

supporting 71 family physicians and 110 of their patients who have problematic substance use

• Launched RCI Quality

Improvement Seed Fund to support initiatives that remove facility-level barriers to meeting best practice expectations

• GPSC Spring Summit • RCI Learning Series: Polypharmacy Risk Reduction at Ayre Manor

• Residents

& Learners Greenhouse Group followup

• New CBT

Skills Group Workbook published

• RCI Leadership Dinner

with Physicians and Facility Leaders

• CORE physician model

launched at James Bay Care Centre

JULY 2017

AUGUST 2017

• Care of the Elderly working group & Island Health partners meet to finalize learning sessions for neighborhood hubs

• CSC begins work on MHSU • First meeting of Patient

Medical Home Steering Committee

working group to support integration between Island Health Community teams and Family Practice

• Resident/

• The Divisions of Family

• First

• Suicide Prevention Toolkit

Mentor BBQ cohosted by VDFP and SIDFP meeting Cross-Coverage working group

• CBC Radio interview about the Opioid Crisis and Response Strategies from Family Physicians

SEPTEMBER 2017

• GP Network Group • Oak Bay/Gordon Head

Neighbourhood Development Session #1

• Dine & Learn:

Paediatric Roundtable

Practice Patient’s Medical Home Steering Committee created to support physician to physician networks and collaboration for youth, caregivers, and professionals modified for Greater Victoria

• RCI

introduces Quality Improvement toolkit

• Annual General Meeting & VDFP Sixth Birthday

• Saanich Neighbourhood

Development Session #1

• Victoria Neighbourhood

Development Session #1

• CBT Skills Groups being piloted for cancer patients, youth, seniors, and women

• CBT Skills Groups being offered in Vancouver and Cowichan

• CBT Skills Level II groups being piloted on CBT for Insomnia, and on Mindfulness-Based Cognitive Therapy

• RCI physicians now

provide medical care for 81% of residents

-

2016â&#x20AC;&#x201C;17 ANNUAL REPORT

Financial Statements STATEMENT OF FINANCIAL POSITION March 31, 2017, with comparative information for 2016

2017

2016

Current assets:

Cash and cash equivalents

Term deposits (note 2)

Accounts receivable

Inventories

Prepaid expenses

$ 1,573,690 20,005 251,139 2,661 3,019 1,850,514

$ 1,672,405 20,005 223,455 793 1,916,658

Equipment (note 3)

3,002 $ 1,853,516

6,005 $ 1,922,663

$ 342,421 1,484,052 1,826,473 3,002 24,041

$ 334,181 1,571,136 1,905,317 6,005 11,341

$ 1,853,516

$ 1,922,663

Assets

Liabilities and Net Assets Current liabilities:

Accounts payable and accrued liabilities (note 4)

Deferred revenue (note 5)

Deferred capital contributions (note 6) Net assets Commitments (note 7) Economic dependence (note 8) Guarantees (note 9)

See accompanying notes to financial statements.

42

VICTORIA DIVISION OF FAMILY PRACTICE

STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS Year ended March 31, 2017, with comparative information for 2016 2017

2016

$ 1,204,023 941,112 378,585 346,956 247,764 105,150 94,939 58,987 13,759 3,003 2,767 - - 3,397,045

$ 956,452 436,834 616,629 345,331 263,368 59,701 24,819 3,002 5,175 2,109 52,425 2,765,845

1,034,799 731,374 615,897 486,184 229,523 149,660 59,360 28,877 28,317 17,351 3,003 3,384,345

439,501 739,053 335,061 862,863 146,216 137,524 71,851 31,604 3,002 2,766,675

Excess (deficiency) of revenue over expenses

12,700

(830)

Net assets, beginning of year

11,341

12,171

$ 24,041

$ 11,341

Revenues:

Infrastructure

Residential Care Initiative

A GP For Me

MHSU

Transitions in Care

Regional Retention & Recruitment

CYMHSU

Primary Care Home

MHSU Publication Sales

Recognition of deferred capital contributions

Interest

Provincial Retention & Recruitment

Other funding

Expenditures:

Wages and benefits

Physicians

RCI payments

Contractors

Administration

Event expenses

Meeting expenses

Conference expenses

Travel expenses

Other program expenses

Amortization

Net assets, end of year See accompanying notes to financial statements.

43

2016â&#x20AC;&#x201C;17 ANNUAL REPORT

Financial Statements (cont).

STATEMENT OF CASH FLOWS Year ended March 31, 2017, with comparative information for 2016

2017

2016

$ 12,700

$ (830)

Cash provided by (used in):

Operations:

Excess (deficiency) of revenue over expenses

Items not involving cash:

Amortization of equipment

Amortization of deferred capital contributions

Changes in non-cash operating working capital:

Decrease in term deposits

Increase in accounts receivable

Increase in inventories

Decrease (increase) in prepaid expenses

Increase (decrease) in accounts payable and accrued liabilities

Increase (decrease) in deferred revenue

Financing:

Increase in deferred capital contributions

Investing:

Purchase of equipment

Increase (decrease) in cash and cash equivalents Cash and cash equivalents, beginning of year Cash and cash equivalents, end of year See accompanying notes to financial statements.

44

3,003 (3,003) 12,700

3,002 (3,002) (830)

- (27,684) (2,661) (2,226) 8,240 (87,084) (98,715)

610,000 (197,205) 5,596 (128,128) 1,181,551 1,470,984

-

9,007

-

(9,007)

(98,715)

1,470,984

1,672,405

201,421

$ 1,573,690

$ 1,672,405

VICTORIA DIVISION OF FAMILY PRACTICE

NOTES TO FINANCIAL STATEMENTS (CONTINUED) Year ended March 31, 2017

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

balance

Net funding received

Interfund Revenue transfers recognized

Ending balance

Infrastructure

$ 246,469

$ 1,083,415

$ 52,133 $ (1,204,023)

$ 177,994

A GP for Me

418,614

7,104

(47,133) (378,585)

-

Transition in Care

111,168

273,543

- (247,764)

136,947

Provincial Retention

& Recruitment

5,386

(5,386)

Regional Retention

& Recruitment

140,299

CYMHSU Collaborative

-

-

-

(5,000) (105,150)

30,149

38,181

100,000

- (94,939)

43,242

MHSU

99,669

395,356

- (346,956)

148,069

Residential Care

Initiatives

511,350

1,346,400

- (941,112)

916,638

-

90,000

- (58,987)

31,013

$ 1,571,136

$ 3,290,432

Primary Care Home

-

$-

$ (3,377,516)

$ 1,484,052

45

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