Victoria Division of Family Practice 2017-18 Annual Report

THE FUTURE OF FAMILY PRACTICE

Victoria

ANNUAL REPORT 2017/18

CONTENTS

01

20

CO-CHAIRS’ REPORT

COLLABORATIVE SERVICES COMMITTEE

03

24

INTERIM EXECUTIVE DIRECTOR’S REPORT

VIC–SI RESIDENTIAL CARE INITIATIVE

06

30

MEMBER ENGAGEMENT

TRANSITIONS IN CARE

07

38

STRATEGIC PLAN

MENTAL HEALTH & SUBSTANCE USE

08

42

OUR MISSION

CBT SKILLS GROUPS

09

47

OUR VISION

PATHWAYS

10

51

PATIENT MEDICAL HOME

DINE + LEARN

12

53

GP NETWORKS

VIC–SI RESIDENT WORKING GROUP

16

56

NEIGHBOURHOOD TEAMS

TIMELINE

18

60

PHYSICIAN CONNECTORS

FINANCIAL STATEMENTS

4

VICTORIA DIVISION OF FAMILY PRACTICE

CO-CHAIRS’ REPORT DR. STEVE GOODCHILD

DR. KATHARINE MCKEEN

The Co-Chairs’ Report is an opportunity to reflect on past work, and to look to the future. The Victoria Division has expanded considerably over the past seven years, in terms of both operating budget and scope of work. Throughout this growth, we have remained steadfast to our physician-led, grassroots approach that is essential to our success. The Division has, and will continue, to support your needs and to seek your direction.

It has been a very exciting and productive year. We are amazed by what has been accomplished by our members, Board, and dedicated staff. With your help and participation, we have continued to improve primary care by recognizing and empowering the voice of family physicians.

We continue this important work to solve the challenges you have identified. Our programs and projects are designed to help GPs improve patient care, and to make practice easier and more sustainable. There are many examples of our initiatives that support these goals while effecting health system quality improvement.

EXAMPLES OF OUR WORK

We’ve learned that we cannot make

• Residential Care Initiative (RCI)

the changes we require by working

• Dine & Learns

alone. Therefore, we continue the

• Physician Connectors

process of building relationships with

• Patient Summaries project

partners, and most significantly, with

• Cognitive Behavioural Therapy (CBT)

Island Health.

Skills Groups • Familiar Faces project

WHAT HAPPENS NEXT?

• Neighbourhood Development

The discussion regarding primary

Sessions

care reform is underway in British

• Pathways

Columbia, and with it comes new

• Secure Messaging Pilot

opportunities for GPs to improve

• South Island RACE Service

both their working lives, and the care delivered to their patients.

2017–18 ANNUAL REPORT

1

CO-CHAIRS’ REPORT CONT.

CONTINUED FROM P. 1

We are embarking upon a Division-

YOUR PARTICIPATION IS KEY

wide engagement strategy to talk

We are on the cusp of making changes

with you about how primary care

to the system that will facilitate your

delivery might evolve. Over the next

ability to deliver care, and improve

few months, we will be meeting with

access for your patients. Your

you to gather your input on how we

participation is crucial at this time, and

can help physicians in their offices

is greatly valued. Please continue to

to mitigate ongoing administrative

provide your feedback at our events,

burden, to care for complex patients,

working groups, and other meetings.

to develop team-based care, and to form GP Networks.

We have formed a Patient Medical

Thank you for your willingness to commit your time and energy to the Division.

Home Steering Committee of member physicians to provide direction and oversight for Patient Medical Home activities.

At the same time, the Victoria Collaborative Services Committee (CSC)—the productive partnership between the Victoria Division and Island Health—is developing a plan

It is not our objective to reinvent the wheel. We already have Patient Medical Homes—they are called physician offices.

Our aim is to support that structure in order to improve it.

Primary Care Networks also exist:

for our participation in the provincial

many established networks thrive among

Primary Care Networks initiative.

the physician population. Island Health

The CSC aims to submit this plan to the B.C. Ministry of Health in early 2019, and needs your input.

is working to strengthen its support of these networks.

We want to avoid making change for the sake of change. We want to help evolve practices toward a more supported way of practicing family medicine, based on team-based care, if they so choose.

2

VICTORIA DIVISION OF FAMILY PRACTICE

INTERIM

EXECUTIVE DIRECTOR’S REPORT

As noted by the Co-Chairs in their report, the Victoria Division of Family Practice looks different today, in terms of size and scope, than it did back at the beginning in 2011. However, at its heart it is still the same: an organization supporting the local community of GPs, whose priorities, actions, and ongoing operations are driven by member needs.

I hope this Annual Report will provide you with a solid overview of our Division’s accomplishments throughout the past year. On the following pages, you’ll find a summary of the milestones that have stood out for me.

2017–18 VDFP BOARD OF DIRECTORS [LEFT TO RIGHT]:

DR. GEOFF INMAN, DR. BILL BULLOCK, DR. KATHY DABRUS, DR. IAN BEKKER, DR. STEVE GOODCHILD (CO-CHAIR), DR. KATHARINE MCKEEN (CO-CHAIR), DR. TIM TROUGHTON (TREASURER), DR. VALERIE EHASOO (SECRETARY), PETER LOCKIE

2017–18 ANNUAL REPORT

3

INTERIM EXECUTIVE DIRECTOR’S REPORT CONT.

AT ITS HEART, [THE VICTORIA DIVISION] IS STILL THE SAME: AN ORGANIZATION SUPPORTING THE LOCAL COMMUNITY OF GPs, WHOSE PRIORITIES, ACTIONS, AND ONGOING OPERATIONS ARE DRIVEN BY MEMBER NEEDS.

CONTINUED FROM P. 3

PHYSICIAN CONNECTORS The implementation and uptake in utilization of the Physician Connectors. This new role was co-designed by GPs and Island Health colleagues meeting together at the Care of Elderly working group. These talented and experienced LPNs connect physicians, MOAs, and patients with the myriad of supports that are available through Island Health, as well as in the community.

LANSDOWNE GP NETWORK The progress made to form a GP Network amongst the 30 physicians who practice in 14 clinics at the Lansdowne Professional Centre. This group is exploring options for cross-coverage, extended hours of care, equipment and resource sharing, MOA support, and adding other clinicians to the team to support patient care. Lessons learned from their experiences are informing our future work to support Patient Medical Homes and Networks.

VIC–SI RESIDENTIAL CARE INITIATIVE (RCI) The continued growth and development of the Vic–SI Residential Care Initiative (RCI). RCI is now active at all 38 local residential care sites, with 82 RCI physicians acting as MRP for 88 per cent of all 3,416 residents. Most notably, 100 per cent of residents in local facilities are now covered by coordinated after-hours call groups. RCI physicians and care home staff report that improvement in after-hours coverage has been the most notable impact of the RCI.

TRANSITIONS IN CARE (TIC) The improvements in clinical communication through our Transitions in Care (TIC) initiatives, as patients move from community to hospital, and back to community.

The secure messaging pilot is being evaluated, with results helping to shape future work. The GP Patient Summaries project has entered a second phase, with 100 GPs participating, and summaries rolling in to the hospital. The TIC team continues to work on having accessible GP contact information in the hospital information system so that inpatient providers can reach out to community GPs about their patients.

4

VICTORIA DIVISION OF FAMILY PRACTICE

Focusing forward, the future of family practice seems brighter, with new opportunities for GPs to improve their working lives through Patient Medical Homes and Primary Care Networks.

Our partnership with Island Health is strong, producing results both at a policy or system level, and for patient care. I remain cautiously optimistic about things to come.

In closing, I would like to thank the VDFP Co-Chairs and Board of Directors, the physician leads of the many Division projects and programs, the members involved in committees and projects, and particularly the experienced and dedicated Division staff and contractors. Collectively, you have made all of the work completed over the past year possible.

As always, please don’t hesitate to contact me if you wish to discuss anything, or would like to get more involved in any of the initiatives you read about in this report.

CATRIONA PARK

Interim Executive Director cpark@divisionsbc.ca

2017–18 ANNUAL REPORT

5

MEMBER ENGAGEMENT

HIGHLY ENGAGED ENGAGED

12%

21%

ACCESSING SERVICES

INFORMED

AWARE OF WHO WE ARE & WHAT WE DO RECEIVING COMMUNICATION

INFORMED + ACCESSING SERVICES, SUCH AS: • RCI BEST PRACTICES PAYMENTS • REFERRING TO CBT • USING PATHWAYS

34%

17%

PARTICIPATING

COLLABORATING

ACCESSING SERVICES + ATTENDING ONE OR MORE EVENTS, WORKSHOPS, OR LEARNING SERIES SESSIONS

PARTICIPATING + ACTIVELY INVOLVED IN PRACTICE CHANGE SUCH AS ENROLLING IN PILOT PROJECTS OR NEW MODELS OF PRACTICE (E.G. TORCH)

14%

LEADING

COLLABORATING

+ SITTING ON A WORKING GROUP, STEERING COMMITTEE, OR ON THE VDFP BOARD

ENGAGEMENT HAS INCREASED COMPARED TO LAST YEAR Member engagement is measured by examining committee

Members accessing

membership, participation in

services or more

77% vs 72%

projects and programs, and attendance at events for the 2017–18 fiscal year.

Members not yet collaborating or leading who have come to events,

VDFP defines engagement along

learning series sessions,

a spectrum, recognizing that not

or workshops

34% vs 28%

every member needs, wants, or is able to engage at every level.

Members actively involved in leading our work [stable during the two years we have measured engagement]

6

VICTORIA DIVISION OF FAMILY PRACTICE

31%

STRATEGIC PLAN AND OUR PROJECTS

In this second of our three-year strategic plan, we continued focusing on the key elements, ensuring that GPs provide quality care in their practice, that GPs support primary care in Victoria, and that GP voices and experiences influence system decisionmaking. Division projects and programs are grounded within at least one, if not all three, of these strategic priorities.

PATIENT CARE IS KEY

BUILDING BRIDGES

Supporting GPs to care for their

We are strengthening primary care in

patients remains a cornerstone of

Victoria by building bridges between

our work. The Physician Connectors,

family doctors, service providers in

Pathways, our Patient Medical

Island Health, and other community

Home (PMH) and Network initiatives,

stakeholders. Examples include

our Secure Messaging Pilot, and

our Patient Summaries work, the

the South Island RACE Service are

CBT Skills Groups, the Familiar

examples of how we are helping GPs

Faces project, our Residential Care

to improve the care they deliver in

Initiative (RCI), the Neighbourhood

their offices.

Development Sessions, and the developing Primary Care Networks (PCN). We know we are stronger together.

INFLUENCING THE SYSTEM VDFP physician leaders work side by side with leaders in other Divisions on the island, and with Island Health, Doctors of BC, and the Ministry of Health to ensure emerging policies reflect the importance of primary care, and that the system is designed to include and support family physicians.

2017–18 ANNUAL REPORT

7

OUR MISSION

THE VDFP SUPPORTS THE COMMUNITY OF PHYSICIANS TO IMPROVE PATIENT CARE AND POPULATION HEALTH, BY:

FOSTERING PHYSICIAN ENGAGEMENT AND PROFESSIONAL FULFILLMENT

INFLUENCING DECISIONS THAT IMPACT PATIENT AND PRIMARY CARE PROVIDERS

PARTNERING TO FACILITATE AN EFFECTIVE AND SUSTAINABLE HEALTH SYSTEM

SUPPORTING PHYSICIAN LEADERSHIP

8

VICTORIA DIVISION OF FAMILY PRACTICE

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 PRACTICEAND RESEARCH-BASED EVIDENCE. WE STRIVE TO EFFECT NEEDED CHANGES IN OUR COMMUNITY AND HEALTH SYSTEM, AND TO DEMONSTRATE RESPONSIBLE STEWARDSHIP OF PUBLIC RESOURCES.

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 INFLUENCE 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

2017–18 ANNUAL REPORT

9

DR. JAMES HOUSTON, DR. STEVE GOODCHILD, AND DR. KATHY DABRUS REVIEW POTENTIAL PMH GEOGRAPHIC AREAS THAT COULD BE USED TO GROUP GP OFFICES AND WALK-IN CLINICS WITHIN COMMUNITY HEALTH SERVICE AREAS.

10

VICTORIA DIVISION OF FAMILY PRACTICE

PATIENT MEDICAL HOME Together, we are working hard to support transitions to the team-based Patient Medical Home (PMH) model for primary care. These integrated environments will be designed to better support GPs, to provide patients with a continuum of care and a spectrum of services.

PMH STEERING COMMITTEE

PMH GEOGRAPHIC AREAS

The Victoria Division of Family Practice

The Victoria Division and Island

struck a Patient Medical Home

Health have completed an extensive

Steering Committee (PMH-SC) in

mapping project that will help to

2018. Comprised of 12 community

organize our 300 + community GPs

physicians and Division staff, this

into PMH geographic areas, taking

group provides oversight to the

into consideration GP offices and

Victoria Division Board of Directors for

GPs, community health service areas,

PMH funding and resulting activities.

walk-in clinics, and potential patient

This committee will also inform the

populations.

Victoria CSC as it works to complete the Primary Care Network Expression of Interest (see below). Engagement sessions with Division members are underway.

PATIENTS WILL HAVE THAT PATIENT MEDICAL HOME NOT JUST ASSOCIATED WITH ONE PHYSICIAN, BUT AS PART OF A TEAM-BASED, WELL-SUPPORTED NETWORK WHERE THEY KNOW THEY CAN GET GOOD CARE. DR. ARLO GREEN

The Victoria Division of Family Practice and Island Health have created a Primary Care Network Working Group (PCN-WG) as a subcommittee of the Collaborative Services Committee (CSC). The PCN-WG is comprised of community GPs, Island Health and Victoria Division staff, and representation from the First Nations Health Authority.

This team will oversee the Expression of Interest process with the Ministry of Health, which will confirm to the Ministry that Victoria is interested in participating in the PCN rollout process.

2017–18 ANNUAL REPORT

11

“GP NETWORKS ARE SEEN AS ONE OF THE BUILDING BLOCKS FOR THE PRIMARY CARE NETWORK MODEL.”

DR. AARON CHILDS, GP, LANSDOWNE PROFESSIONAL CENTRE

12

VICTORIA DIVISION OF FAMILY PRACTICE

GP NETWORKS

In the years of surveying Division members, one thing most family physicians can agree upon is that the more systems are able to support GPs in working with colleagues within their own geographic areas, the better patient needs can be met.

Providing coverage for one another, offering extended hours of care, and leveraging the economic advantages of bulk ordering from suppliers are all areas where family physicians can take advantage of operating more formally together. And when it comes to overall satisfaction with work, increased collegiality is certainly the much needed cherry on top.

LANSDOWNE EXPLORING NETWORK PERKS

things we can do that we will actually

With that in mind, early progress has

pursuing the concept.”

been made to form a GP Network

benefit from. There is good interest in Childs says it’s been beneficial to

amongst the 30 physicians who

begin learning more about colleagues

practice in 14 clinics at Victoria’s

who are in the building. “It’s great for

Lansdowne Professional Centre. All

us to develop a list of those doctors

physicians have completed the GPSC

with specific clinical skills and interests,

PMH Assessment, and are actively

so that we can refer our own patients,”

exploring areas of cross-coverage

he says. “For example, some family

and extended hours of care models.

doctors do a lot of IUD insertions.”

These physicians have also piloted activities including an MOA Network,

OUTSIDE EXPERTISE

a locum coverage program, and a

The group has been looking to

cross-coverage pilot.

others—such as the City of Richmond

“There has been sustained interest

and the Alberta Primary Care

in the idea,” says DR. AARON CHILDS,

Network— for outside expertise from

who hosted initial smaller meetings

those who have had similar success.

in his own office reception area. “We

“We’ve had some discussions

have had half a dozen meetings,

to learn what they did, and how it

and we are exploring the tangible

worked for them,” he says.

2017–18 ANNUAL REPORT

13

MEMBERS OF THE NEW LANSDOWNE GP NETWORK, WITH SUPPORTERS FROM ISLAND HEALTH AND THE VICTORIA DIVISION, CELEBRATE THEIR PLANS TO WORK TOGETHER. [CLOCKWISE, FROM CENTRE]: KAROLINA DUDZIK, JO-ANNE BEEREN-PARSONS, DR. KATE KUSS, DR. ANTHONY NIELSEN, DR. NAZ MERALI, DR. TEJINDER SIDHU, DR. AARON CHILDS, DR. LISA VERES, MELODY MURRAY, DR. MICHAEL DAVISON, MERLYN MALESCHUK, DR. JACK SHAW, HELEN WELCH, DR. KAREN PALMER, AND AYDEN LOUGHLIN.

CONTINUED FROM P. 13

RANGE OF SUPPORTS REQUIRED

launch of the Lansdowne GP Network

In order for GP Networks to really

a survey, and publishing an initial

thrive, Childs says a number of

newsletter.

by arranging meetings, conducting

supports will need to be put into place. Appropriate meeting space

COLLEGIALITY BOOST

that can house larger groups, a

“The collegiality piece is really nice,”

convenient time for everyone to meet,

says Childs. “We’re getting to know

administrative support, and funding

those people we’ve seen in the

to sustain the work all hover at the top

parkade for years, and until now have

of his colleagues’ wish list. “The main

just waved. Now we are meeting face-

thing is that funding really needs to be

to-face, learning how we are relevant

in place to make it really sustainable.”

to each other’s work, and figuring

Childs credits the Division’s Helen Welch, who has been intrinsic to the

14

out how we can help each other by working together.”

VICTORIA DIVISION OF FAMILY PRACTICE

GP NETWORKS CONT.

SUCCESS A MATTER OF FUNDING It’s been two decades since

never get enough doctors in one

DR. EUGENE LEDUC shifted his

place to even begin a discussion. The

Kootenay practice to Victoria for the

funding got the doctors in one room

opportunities it afforded his children.

together to talk.”

A member of the Board of Directors

Leduc says it still too early to tell

of the Doctors of BC, Leduc has

where the GP Network initiative

long been an advocate within the

will go, and emphasizes the need

medical community, and is especially

for robust provincial investment to

passionate about Health IT.

support general practice. “I think it’s great that we’re

“I’ve seen, over the years, the progression of electronic medical records to the point where they are now,” says the GP who is

“I THINK IT’S GREAT THAT WE’RE GETTING TOGETHER AND PLANNING. IT’S GOOD TO SEE PEOPLE BEING CREATIVE...IT BOILS DOWN TO SUSTAINABLE FUNDING.”

getting together

DR. EUGENE LEDUC, GP, LANSDOWNE PROFESSIONAL CENTRE

seeing what we can

on his third brand of EMR. “Obviously, nothing is perfect, and there are issues. We are constantly

and planning. It’s good to see people being creative, and come up with for our building,” he says. “It

boils down to sustainable funds.”

“We’ve got something very

trying to improve weaknesses in the

beneficial in our health care system,

electronic system, and in the transfer

and that’s a strong primary care

of information.”

system where family doctors are

It was funding from the Division that

coordinating care, and are providing

prompted Leduc to get involved with

that personal longitudinal relationship

the Lansdowne Professional Centre GP

with patients,” he says, citing the ability

Network. “For us to have a meeting to

to develop good relationships with

discuss collaboration, this is something

patients as being the number one skill

we’d never done,” he says. “You could

that tomorrow’s physicians will need.

2017–18 ANNUAL REPORT

15

NEIGHBOURHOOD TEAMS

Prior to 2015, Island Health’s program management model relied on various silos often providing care for similar populations. At a meeting to discuss geographic restructuring of care providers, one elderly woman stood up. In her hand was a photo of her refrigerator, with seven Island Health cards on it. “She said, ‘I just want to know who to call,” recalls VICTORIA POWER, Director, Urban Greater Victoria and Regional Rehabilitation Quality at Island Health. “Who is on my neighbourhood team?” And at that very moment, she had coined the term.

The Neighbourhood Team

found more than 200 people with at

concept coincided with a provincial

least five case managers,” says Power.

directive for health authorities to

“We got to work doing things like

design an integrated system that

collapsing 12 different silos into one.”

would be understandable to patients

Urban Victoria now has eight

and primary care providers alike. The

Neighbourhood Teams within three

Greater Victoria regions pledged to

Community Hubs. “Now, we have all

work together, and quickly brought

the functions of those former teams,

the Victoria Division into the fold.

but they are people sitting together,

Neighbourhood Teams aim to

working together, and having a

serve patients living in a particular

huddle every morning on the care

neighbourhood, so the working

they are doing with their patients.”

group had to identify the populations

Whereas this work was a

they were serving, where they live,

collaboration co-designed between

and where were they receiving

Island Health and the Victoria Division

health services. “We plotted all family

via the Care of the Elderly Working

physician patient panels,” says Power,

Group, Power says future phases will

who found that the average Victoria

see the concept roll out to mental

physician often has patients in Sidney,

health and maternity populations,

Sooke, and even Cowichan.

with the long term vision seeing

“We discovered up to 17 different acronyms interacting with people, and

all medical services addressed in a neighbourhood model.

2017–18 ANNUAL REPORT

17

“JUST WANTED TO GIVE SOME FEEDBACK ON WHAT AN EXCELLENT JOB IS BEING DONE

BY THESE ANGELS OF MERCY. THEY ARE POLITE, KNOWLEDGEABLE AND WELL INFORMED. THEY HAVE PERFECTED THE ART OF LISTENING, AND CUTTING TO THE CHASE. THEY ALSO HAVE ACCESS TO RESOURCES THAT I CAN ONLY DREAM OF.” DR. TEJINDER SIDHU [WHO RECALLS SIMILAR POSITIVE EXPERIENCES USING THE PREVIOUS ENHANCED RESPONSE FOR GP REFERRALS LINE, THE SARIN PROGRAM, AND THE INTEGRATED HEALTH NETWORK TEAM]

18

MEET THE FACES BEHIND THE SOLUTIONS, [FROM LEFT]: APRIL, KARA, AND CAITLIN, YOUR PHYSICIAN CONNECTORS.

VICTORIA DIVISION OF FAMILY PRACTICE

PHYSICIAN CONNECTORS

The Physician Connectors essentially operate a hotline to connect physicians with a myriad of supports for their patients. The new role emerged in response to physician need to better understand what supports are available through Island Health and in the community. Services and their respective referral forms change or evolve, and many were underutilized simply for a lack of broad awareness.

The three Connectors—APRIL, KARA, and CAITLIN—are all LPNs

who were intake clinicians before

I LOVE YOU GUYS, BUT NOT IN A CREEPY WAY.

GP FEEDBACK

transitioning into the Connector role.

They arrived with knowledge from

JILL FISHER, Acting Manager for

jobs in home support or home care

Community Access, says the clinicians

nursing and began to amass their

conduct telephone assessments that

goldmine of local health resources.

often uncover other issues. “They

“If a patient is struggling, but

are very skilled at asking the right

you’re not sure how to help them,

questions to determine client needs,”

we try to connect them to resources,”

she says.

says Caitlin, who always finds a way

The Connectors encourage initial

to help, which often means doing

phone conversations with physicians

more research and connecting back.

to identify underlying issues, and to

They will manage referrals, and even

build more rapport.

communicate directly with patients so that physicians can attend to others.

Many calls surround Island Health

To spread the word about the service, they have conducted a number of GP office visits, and have

services such as wound care, rehab

attended a variety of events where

assessment, or palliative care, but they

they could interact with physicians.

also connect patients to both public

Feedback has been so great that the

and private support like counselling,

Connectors have a board in the office

mental health and addiction services,

where they share positive quotes from

and housing resources.

those they have served.

2017–18 ANNUAL REPORT

19

COLLABORATIVE SERVICES COMMITTEE [CSC] DR. RICHARD CROW, EXECUTIVE MEDICAL DIRECTOR FOR POPULATION AND COMMUNITY HEALTH, AND VICTORIA POWER, DIRECTOR, URBAN GREATER VICTORIA & REGIONAL REHABILITATION QUALITY, ARE THE ISLAND HEALTH CSC CO-CHAIRS. DR. STEVE GOODCHILD AND DR. KATHARINE MCKEEN ARE THE VDFP CSC CO-CHAIRS.

A COMMON END GOAL: THE INTERESTS OF THE PATIENT There was a time when B.C.’s health authorities and primary care doctors had limited opportunity to understand and impact each other’s work. But since the Ministry of Health and Doctors of BC joined forces to create the General Practice Services Committee (GPSC), it was clear that a platform for collaboration between Island Health and family physicians was essential to significant health system improvement. The Victoria Collaborative Services Committee (CSC) became the new venue through which Victoria Division physicians and administrators could meet with Island Health to move their respective priorities forward together.

DR. RICHARD CROW represents Island Health on the CSC, along with Victoria Power.

With Island Health, Crow is Executive Medical Director for Population and Community Health—a role that oversees Mental Health and Substance Use; Seniors Health; Child, Youth, and Family Health; Public Health; and, Community Health and Care for the island. A long time senior executive health administrator (who was also the first curriculum site lead when UBC first expanded its medical residency program to UVIC in the early Nineties), Crow’s background as a family physician continues to serve him well. “I think it’s really good to have a family medicine background when you’re in these types of administrative roles, because you see the big picture,” he says.

THE VICTORIA COLLABORATIVE SERVICES COMMITTEE (CSC) IS THE VEHICLE THROUGH WHICH VICTORIA FAMILY PHYSICIANS, REPRESENTED

BY THE VICTORIA DIVISION, COLLABORATE WITH PARTNERS IN THE LOCAL PRIMARY CARE SYSTEM, INCLUDING ISLAND HEALTH. EVERY DIVISION HAS A CSC WITH ITS RESPECTIVE HEALTH AUTHORITY.

FOCUS ON PRIMARY CARE Crow is pleased that population health and primary care are now Ministry priorities. “To see that shift— recognition of the importance of primary care and community-based health rather than acute, hospitalbased care—it’s a transition I am thrilled to see,” he says.

20

VICTORIA DIVISION OF FAMILY PRACTICE

ENGAGING WITH COMMUNITY GPS Crow considered the CSC role because it enabled a venue to work with community-based physicians.

“First, you have the Divisions of Family Practice, which enable [family physicians] to organize together, then the CSC was a perfect venue for us to jointly meet and share our concerns, and to work together on solving issues,” he says. “Here was a venue where we could finally engage with community based physicians.”

SOLID WORKING RELATIONSHIP As for the Victoria CSC’s reputation for being highly functional and productive within the province, Crow credits the solid working relationship, deep trust, openness, and transparency between the parties that has been built over time. “Rather than being secretive, we really try to explain what our limitations are, and how our budgets work,” he says. “Each of us can gain understanding of the others’ perspective.

“THE DIVISIONS ARE REALLY MAKING A DIFFERENCE IN TERMS OF HAVING INPUT INTO THE DIRECTIONS WE ARE WORKING TOWARD. ISLAND HEALTH IS LEARNING FROM THE DIVISIONS—FROM COMMUNITY-BASED PHYSICIANS—IN TERMS OF WHAT IS NEEDED, BECAUSE THEY ARE EXPERTS IN THAT AREA. THE CSC IS THE VENUE THROUGH WHICH WE CAN WORK TOGETHER TO MAKE IMPROVEMENTS, AND THAT’S ABSOLUTELY KEY.” DR. RICHARD CROW, CO-CHAIR COLLABORATIVE SERVICES COMMITTEE AND EXECUTIVE MEDICAL DIRECTOR FOR POPULATION AND COMMUNITY HEALTH, ISLAND HEALTH

COLLABORATIVE SERVICES COMMITTEE (CSC) CONT.

CONTINUED FROM P. 21

“Not all of our priorities overlap,

Use and Care of the Elderly are two

“IT’S A HUGE ISSUE FOR THE NUMBER OF PATIENTS WE CAN ATTACH IN OUR COMMUNITY. WE WILL BE ABLE TO STRATEGIZE JOINTLY TO RECRUIT MORE GPS AND NURSE PRACTITIONERS, AND TO PROVIDE TEAM-BASED CARE.”

key examples of shared priority

DR. RICHARD CROW

but a lot of them do,” says Crow, “and by recognizing our shared work we have really been able to move forward.” Mental Health and Substance

populations.

NEIGHBOURHOODS

PRIMARY CARE NETWORK

Much of what the CSC is focusing on

Crow is excited about the chance to

nowadays is planning for the creation

implement what he calls the best parts

of Primary Care Networks. Within that

of the Primary Care Network concept.

umbrella, Island Health’s Victoria Power

The CSC team will soon submit an

and Dr. William Cunningham are also

Expression of Interest to the Ministry

working with the Division on the

of Health about its desire to participate

creation of neighbourhoods, and on

in the PCN project, followed by a joint

realigning services within Island Health

service plan that will detail the nuts

to better link with GPs to better care

and bolts of tailoring overall Ministry

for the shared population.

goals within the Victoria landscape.

“That’s our greatest opportunity, because it will come with additional resourcing,” he explains. “It’s a huge issue for the number of patients we can attach in our community. We will be able to strategize jointly to recruit more GPs and Nurse Practitioners, and to provide team-based care.”

22

VICTORIA DIVISION OF FAMILY PRACTICE

The creation of an environment that

TEAM-BASED CARE

THE FUTURE OF FAMILY PRACTICE

supports team-based care is a key

As for Dr. Crow, he remains optimistic

piece in the puzzle.

about the future, especially now that

“Younger GPs want to work in

the Ministry has prioritized primary

team-based care, but there just aren’t

care, and that Island Health’s new

large team-based practices for them to

CEO, Kathy MacNeil, is indicating a

join,” he says. “We would create larger

similar focus on community services.

centres so that individual doctors

“The transition is real. In fact, the

don’t have to provide all the care

sustainability of the whole health care

themselves. They will have other GPs

system will depend on primary care

working in a more collaborative joint

being strengthened,” he says. “We can’t

office, with other team members to

sustain just acute, episodic, hospital-

share the workload.”

based care.”

The plans are all designed to

He hopes new doctors will focus on

provide better care for the CSC’s

population health, community needs,

shared population. In the end, Crow

and prevention. “It’s exciting times for

says that’s the end goal shared by both

me, because even as a resident, my

Island Health and the Victoria Division.

projects were always on prevention and population health.”

“I do see that family physicians are looking at broader than just the patient in front of them,” he says.

“Obviously, their key priority is to care for their immediate patient, but more and more, they are starting to look at the needs of their patient population.

I think that’s a positive move, to look at those broader needs.”

2017–18 ANNUAL REPORT

23

“THE REGULAR RCI PHYSICIANS ARE GENUINE MEMBERS OF THE COMMUNITY AT THE FACILITY. THEY KNOW THE RESIDENTS, THEIR FAMILIES, AND THE STAFF.” FACILITY STAFF MANAGER

24

VICTORIA DIVISION OF FAMILY PRACTICE

VIC–SI RESIDENTIAL CARE INITIATIVE [RCI] HIGHER PATIENT TO PHYSICIAN RATIO IS KEY VIC-SI RCI physician lead DR. IAN BEKKER came to appreciate Victoria during high school and studies for his first degree in engineering. When his wife was offered a position as legal counsel for the B.C. government that coincided with a six month fellowship in Care of the Elderly for Bekker, the pair began to establish their island roots.

With a unique combined education in engineering, business, and medicine, Bekker has an intrinsic need to solve problems, both for his patients and at the system level.

“Sometimes the problems are really challenging, and it’s fun to lift the big rocks,” he says. “I feel inspired to put all those skills to good use. I can’t just sit on the sidelines.”

Bekker took on the RCI leadership

what they are doing is good enough,”

role because the frail, elderly, and

he says. “I’d like to see deeper analysis

institutionalized population is under

into the quality of care we’re providing,

served and under appreciated.

and an increase in the patient to

“They are vulnerable people who need attention and system change

physician ratio.”

He would love for GPs to come into

to get them the care they deserve,”

residential care who can take on a

he says. “I did my training in this area,

panel of 20 to 30 patients immediately,

so I am a strong advocate.”

allowing them to become embedded

TORCH success, the city-wide call system, and the RCI Learning Series

quickly into the team, culture, and relationships with patients.

(which is also available online), are all

Bekker sees the new care home—

sources of pride for Bekker. He credits

The Summit at Quadra Village that will

the intelligent application of solid

replace Oak Bay Lodge and Mount

resources for RCI success so far.

Tolmie Hospital—as hope on the

“Problem solving and system change is hard, but if you’re super well resourced, it gets a lot easier,” he says.

Still, there is work to be done. “I want to get past everyone’s assumption that

horizon.

“That’s a chance to start from scratch, and to implement a model that’s got a higher density and more physician focus.”

2017–18 ANNUAL REPORT

25

“THE PATIENT MEDICAL HOME, IN ITS FULL GLORY, IS A PLACE WHERE WE PROBABLY NEED TO GO.” DR. TOM BAILEY,

MEDICAL DIRECTOR, RESIDENTIAL SERVICES, ISLAND HEALTH AND CO-CHAIR, VIC–SI RESIDENTIAL CARE INITIATIVE, VICTORIA & SOUTH ISLAND DIVISIONS OF FAMILY PRACTICE

DR. TOM BAILEY wears a lot of hats. As Medical Director of Residential Services for

Island Health, he is also Co-Chair of the Vic–SI Residential Care Initiative (RCI). He still maintains the family practice he launched here 40 years ago, when he returned to the place where he had spent his childhood.

“I love the work. You learn something new every day,” he says,

approach to providing coverage. It has worked, and worked well.”

The TORCH model has led the way

noting that the multi-generational relationships he has built feel very

for more facilities to establish a core

special. “I have at least 20 mothers that

group of dedicated physicians. “It’s

I delivered, and then later delivered

an integrated, shared care model that

their babies, which is a unique and

has allowed physicians with other

privileged position to be in.”

clinical interests to become involved

Bailey was invited to Co-Chair the

in residential care,” he says, while

RCI as a logical extension of his other

acknowledging that more physicians

work. “I can interface as a liaison

need to come on board.

between the health authority and the

“Our greatest need is for all facilities

Division because I have an active foot

to have a small group of physicians

in both camps, and I’m passionate

working there, that really looks

about the kind of change that the RCI

and acts like a team—even if the

can potentially deliver.”

physicians themselves never see each

So far, the launch of the after hours

other,” he says. “When the physician

call group has felt like a big win for

walks into the facility, is seen as part

Bailey. “It’s one I promoted from early

of the team, and everyone knows who

on, and it afforded an opportunity

they are and vice versa, that looks like

to create a much more integrated

success.”

26

VICTORIA DIVISION OF FAMILY PRACTICE

RESIDENTIAL CARE INITIATIVE [RCI] CONT.

HIGHLIGHTS •

THE FUTURE OF FAMILY PRACTICE

The Vic–SI RCI works to unite physicians, facilities, residents, and families for quality care.

Dr. Bailey feels physicians will need to be far more engaged in teams,

•

Emphasis is on improving

whether in a group practice, or

medical care for all residents in

practicing with other professionals

care homes, through engaging

cohesively. “Where there is still the

and supporting physicians to

sense of attachment between the

meet the provincial RCI Best

patient and their physician, so people

Practice Expectations (BPEs),

actually say, ‘That’s my doctor,’ and the

and facilitating collaborative

care is more integrated,” he says.

system change with physicians,

Better remuneration and the swift

residential care

creation of team-based models will

site teams, and

help to attract new physicians. “Older,

Island Health.

experienced physicians have to be prepared to move in and get those

82%

OF RCI GPs SATISFIED WITH THEIR PRACTICE

things off the ground,” he says, so that new grads can learn from mentors.

Team-based care will require a new mindset. “Not just thinking, ‘This is how I practice.’ Realizing that now I have to

NOW ACTIVE IN ALL

38

FACILITIES

82

PHYSICIANS ACTING AS MRP

work with others to manage the care of a population as a team,” he says, adding that understanding population health, and the social determinants of health, will really help family medicine.

“Certainly the approach taken in primary care—ideally establishing a long term relationship with a patient and the population—there is so much evidence that this is the most efficient way to provide health care.”

88%

OF ALL 3,416 RESIDENTS COVERED

BY RCI

180%

INCREASE IN CARE CONFERENCE ATTENDANCE

100%

OF RESIDENTS COVERED BY AFTER-HOURS CALL GROUPS

5

TEAMS RECEIVED Q.I. SEED FUNDING

2017–18 ANNUAL REPORT

27

RESIDENTIAL CARE INITIATIVE [RCI] CONT.

EVERY RESIDENT NOW COVERED

BY AFTER-HOURS CALL GROUP One of RCI’s greatest wins has been

This high level of preparedness and

the new 24-member After-Hours Call

assessment has made a big difference

Group, which now covers 100 per cent

for everyone involved.”

After-hours runs from 5pm to 7am

of residents throughout Victoria.

“After-hours coverage, especially

Monday to Friday, and during all

for physicians with young families,

weekend hours. Two physicians are

was a key barrier for taking patients

on call during peak times—weekday

in residential care,” says RCI project

evenings and weekend days—with

manager JUNA CIZMAN. “Now, we have

one physician for the region during

a dedicated group willing to respond.”

off-peak.

The structure puts each physician

A single phone number was established for all facilities to access

on call roughly eight periods per year

the on-call physician via a dispatch

(either Monday to Thursday, or Friday

service. “That was the biggest

to Sunday), with a couple of months

streamlining event,” recalls DR.

between periods. Call volume is low:

MARGARET MANVILLE. The service

11pm to 7am Monday to Thursday

screens calls using a new SBAR

sees an average of only 0.8 calls.

“Volume is very low when people

(Situation, Background, Assessment, and Recommendation) form to ensure

are trained and using it for appropriate

calls are appropriate.

reasons,” says Cizman.

The Victoria Division handles all of

“Now, nurses are prepared when they get the physician on the line,”

the scheduling and sends physicians

says Cizman—a process that, in 95

reminders in advance of shifts. GPs

per cent of cases, has been whittled

also complete post-shift assessments

down to taking less than one minute.

to gauge appropriateness, and if

Roughly 80 per cent of these calls can

they believe a call was able to avoid a

be managed over the phone.

transfer to emergency. “I think it’s this

Manville agrees, “Most physicians

level of support from administrative

now feel that the quality of the calls

staff that has been crucial to success,”

reflects the severity of the illness.

says Manville.

28

VICTORIA DIVISION OF FAMILY PRACTICE

“I THINK THE RCI HAS ACCOMPLISHED A LOT IN A SHORT TIME. IT IS TERRIFIC ON A NUMBER OF LEVELS. COORDINATED PRACTICE MODELS OPEN DOORS TO QI INITIATIVES, AND EVEN RESEARCH PROJECTS. I PLAN TO EXPAND MY ROLE IN FACILITIES.” RCI PHYSICIAN

2017–18 ANNUAL REPORT

29

TRANSITIONS IN CARE [TIC]

IT’S ENJOYABLE WORK, AND THE TIC TEAM IS FANTASTIC. I BELIEVE IN THE PROJECTS AND IN WHAT THE TIC TEAM IS TRYING TO ACHIEVE. GP FEEDBACK

[LEFT] ER TIPS + TRICKS WAS CREATED TO HELP GPs DETERMINE IF A PATIENT SHOULD BE ADMITTED TO THE EMERGENCY DEPARTMENT. [RIGHT] EVALUATION OF THE SECURE MESSAGING PILOT IS NOW UNDERWAY.

THE TRANSITIONS IN CARE INITIATIVE HAS ITS ROOTS IN THE NEED TO IMPROVE COMMUNICATION BETWEEN ACUTE AND COMMUNITY CARE SETTINGS.

30

VICTORIA DIVISION OF FAMILY PRACTICE

TIC PHYSICIAN LEAD DR. LAURA PHILLIPS, PROJECT MANAGER KRISTIN ATWOOD, HOSPITALIST LEAD DR. MATT BILLINGHURST, PHYSICIAN LEAD DR. LISA VERES, AND CLINIC MANAGER JO-ANNE BEEREN-PARSONS.

HIGHLIGHTS

• Together, TIC and Island Health streamlined the Patient Summary

• Phase 3 work focused on completing the ER Tips and Tricks,

submission process. Island

expanding Patient Summaries

Health approved a central fax

pilot work, and designing and

number, and in August 2017

implementing a brand new secure

began scanning summaries

messaging pilot.

into PowerChart. GP summary information is now available to

• The TIC Committee was first in

allied health providers during

B.C. to pilot a secure messaging

inpatient stays and discharge.

solution that included GPs not

Hospitalists can now access

associated with a health authority.

summaries for discharge planning electronically, from wherever they

• The B.C. Health Leaders Conference

are conducting dictations.

plenary session in October 2017 highlighted the TIC Committee’s

• Phase 4 work launched in Spring

history of shared leadership and

2018, continuing improvement

partnership between the VDFP, the

to the Patient Summaries process,

SIDFP, the Shared Care Committee

while expanding work to improve

(funding partner), and Island

community connections for the

Health.

Familiar Faces project, and to address residential care transitions.

• The Familiar Faces project allows

252

PHYSICIANS ENGAGED IN PROJECTS

>$1.3

MILLION IN TIC PROJECT FUNDS OVER

5 YEARS

two family practice residents

92%

annually to complete their

OF ISLAND HEALTH GPs CAN ACCESS

research requirements while

eNOTIFICATION

volume users of ER services.

101

GPs SENT 1156 PATIENT SUMMARIES ON ADMISSION

improving care for vulnerable, high

18

5

86%

ER TIPS + TEAMS SAY PATIENT TRICKS GOT RECEIVED SUMMARIES Q.I. SEED 500 PAGE HITS HAD POSITIVE 2017–18 ANNUAL REPORT FUNDING IN 2017 IMPACT

31

DR. LISA VERES came

DR. LAURA PHILLIPS

to locum for a friend in

started out as a home

BILLINGHURST arrived

1995 and loved Victoria

support worker, but

from Montreal to

so much she decided

headed to medical

complete his residency

to stay, taking over a

school to quench her

in 2009. He and his wife,

friend’s practice after

thirst for more mentally

an interior designer,

five more years of being

challenging work.

were searching for a

a locum.

Between her

new hometown that

husband’s lifelong ties

would be smaller than

boring as I thought it

and her love for the city,

Montreal, but large

would be. You have

Victoria was Phillips’ first

enough to sustain them

the university, opera,

choice after working

both.

the symphony, the

rurally in both Gold

jazz festival, and an

River and Chase. She

elementary school in

immigrant population,”

launched her practice in

Cobble Hill and had

says Veres. “The other

2007 in the Lansdowne

some aunts on the

big drawing card is that

Professional Centre, and

island.

I could get into nature

shares her office with

quickly.”

two other physicians.

“Victoria wasn’t as

“We worked really hard to stay in this building, because we wanted to be a part of the primary care networking that is going on here,” says Phillips.

32

VICTORIA DIVISION OF FAMILY PRACTICE

Hospitalist DR. MATT

He’d attended

“Victoria fit the criteria,” he says. They’ve been in the city now since 2012.

TRANSITIONS IN CARE CONT.

A REPUTATION FOR SOLVING COMMUNICATION IT ISSUES It was back in 2012 when Phillips attended a Division meeting and resonated with a talk, from Veres, about a new project to improve digital communication between hospitals and family physicians—specifically surrounding hospital admissions, discharges, and death. Phillips had seen, firsthand, fallout from flaws in the system. One of her patients had been discharged from hospital without being treated for the condition she had been sent in for. “It was the perfect storm of communication,” she remembers. “When I heard Lisa Veres, I thought, ‘this is exactly what I’m here for.’”

Veres spearheaded the project

and other stakeholders to identify

because she could see the gaps.

communication gaps and needs.

With Phillips on board, the pair

The team had worked with

spent the next six months delving

programmers to develop the complex

into the issue on their own, before

IT system that would coordinate

a colleague suggested they seek a

hospital data with Excelleris, and with

project manager, funding, and other

the many physician EMRs to transmit

support through the Victoria Division.

timely patient hospital transition

That alliance was a natural fit, and

details to their family physicians.

by the fall of 2013 the Division had

Within one hour of launch, the first

received funding from the Shared

notification about a patient’s transition

Care Committee. Transitions in Care

to hospital was successfully dispatched

was born. With Division backing and

and received.

project manager Kristin Atwood in

The design and rollout of

place, the team’s vision began to gain

eNotification remains the biggest

some real traction.

feather in the TIC team’s cap. “Getting

In early July 2014, the Victoria and

eNotification was a big thrill,” says

South Island Divisions, in partnership

Veres. “And when that spread to other

with Island Health, launched the

hospitals in the province—I get them

eNotification pilot. That was the

from all over the place when my

result of months of consultation with

patients are travelling around—that’s

more than 50 member physicians

a proud moment.”

2017–18 ANNUAL REPORT

33

TRANSITIONS IN CARE [TIC] CONT.

CONTINUED FROM P. 33

Phillips says getting to work directly

•

Patient Summaries: Tandem

with system developers makes a huge

projects, including basic

difference. “If the people creating

summaries and proactive

these solutions don’t truly understand,

summaries. Encourages GPs

they can create something completely

to submit information when

inappropriate,” she says. “For them to

patients are admitted, or to send

understand what we do and what we

summaries in advance if the GP

need, that’s some of the greatest work

believes a patient has a higher

we have done.”

probability to be admitted to hospital in the future.

Billinghurst joined the Transitions in Care team three years ago, and saw

•

RCI Project: Will look into

it as a natural fit. Having practiced in

communication around residents

the community, he now spends the

at care facilities.

bulk of his time as a hospitalist. “I have straddled both sides of the fence, so it

Veres says all this Health IT work has

made sense for me to be involved in

garnered the TIC team a reputation

discussions around easing transitions

within the physician community. “It

to and from the hospital,” he says.

feels good when people, in particular

The team now has a formidable

GPs, approach our group with

collection of irons in the fire:

problems” she says. “They actually

•

Secure Messaging: Aims to

think we might be able to solve them.

allow practitioners to text patient

Folks within the hospital are starting to

information in an encrypted and

reach out to us, and they think about

secure format. In the evaluation

us when they are doing something

and information sharing stage.

that might involve GPs.”

•

Familiar Faces: Looks at frequent

Billinghurst says seeing ideas

visitors to the emergency

come to fruition that many said were

department and tries to improve

impossible is very exciting. “When

patient information for providers.

we were looking at getting Patient

A collaboration with the CoolAid

Summaries scanned into PowerChart,

Society and the Portland Hotel

we were told it would never be

Society.

possible. Then you start talking to the

34

VICTORIA DIVISION OF FAMILY PRACTICE

MODERATOR ED MCKENZIE, TRANSITIONS IN CARE PHYSICIAN LEAD DR. LISA VERES, ISLAND HEALTH DIRECTOR VICTORIA POWER, VDFP CO-CHAIR DR. KATHARINE MCKEEN, AND ISLAND HEALTH PHARMACIST DR. SEAN SPINA PREPARE FOR THEIR PLENARY SESSION AT THE B.C. HEALTH LEADERS CONFERENCE IN OCTOBER 2017

right people, and in months you’re

patient summaries, and residential

having discussions about where we

care projects, and on the emergency

actually want those scans to appear

care working group. The team is also

in PowerChart. That’s a highlight.”

looking for a physician from the South

The team agrees that success

Island to join the steering committee.

has been a combination of stable

“I would always favour more

leadership, a passion to keep seeking

family physician involvement,” says

solutions, widespread support, and

Billinghurst, adding that diverse voices

that all sides can see the benefits.

from family medicine are critical to

Veres says she has been advocating

reflect GP needs, and to getting it right

for she and her colleagues to be more

when designing solutions for family

valued for their work, so that doctors

doctors.

can get paid for their efforts.

“All of this communication work requires so much time. There’s not much acknowledgment of how much

The team says there are a lot of benefits to getting involved in Division work.

“It was concern for my patients that

time and effort good communication

got me into this in the first place, but

takes,” she says. “With the advent of the

I’ve really been surprised at how much

PMHs and the PCNs, we will only need

the Division’s work actually energizes

more communication, and I’d like to

me, and makes me want to do more,”

see this topic front and centre of the

says Phillips.

dialogue.”

The TIC has room for more

Veres agrees, “The collegiality amongst family physicians has

physicians to get involved, both in

improved a lot. I suspect we’d all be

committee work, and with sharing

a lot more stressed if we didn’t have

their voices. Opportunities exist

the knowledge that we are out there

within the discharge planning,

supporting each other.”

2017–18 ANNUAL REPORT

35

TRANSITIONS IN CARE [TIC] CONT.

THE FUTURE OF FAMILY PRACTICE Veres has some dire warnings about

are spent, they don’t always reflect

the future. “Outside my office is a

that priority.”

walk-in clinic. Every morning, there is

Provincial investment, he says, must

a lineup of 10 to 20 people, increasing

make working in a clinic financially

over the past two years. Now, people

feasible in today’s environment,

are starting to bring camping chairs

especially with the cost of living

at 8 a.m. To me, that’s a crisis,” she says.

in Victoria. “People say, ‘just move

When Veres’ office took on a new

elsewhere to work,’ but obviously

physician two years ago, he was

Victoria needs doctors, so how do we

completely full within a few weeks.

build in mechanisms whereby a young

“I am asked every day if I will take

physician can work here?”

“I’m a hospitalist, but in my view,

someone’s mother or friend, and I have to say no. That’s painful for me. I still

initiatives from the government

love my job, but it’s reached the point

should be toward making primary

where the remuneration is completely

care better, because that’s going to

inadequate for the overhead. Unless

improve the system as a whole. That’s

there is a serious influx of money to us

going to keep people out of the

in some way, primary care is going to

hospital.”

He worries about the repercussions

look a lot different in 10 years.”

Phillips agrees, “It’s like a small,

of physician burnout. “If that family

burning spark that is trying to heat a

doctor leaves practice, all of a sudden

large area. There is a strong base that

there are 1000 orphaned patients.”

Phillips says the family physicians

is dedicated to practicing, but we are trying to care for a population that

of tomorrow will have to have a

is too large for us to take care of. I’m

passion for what they are doing, while

thankful that the Division has formed,

Billinghurst says listening and integrity

and continues to flourish to keep that

are essential. “Really being able to

flame alive.”

listen to what a patient is telling you is

For Billinghurst, it also comes down

important, and knowing what’s right

to funding primary care. “There is a lot

and wrong and being willing to stand

of talk about how important it is, but

by that, I think those will both continue

in terms of where time and money

to be really essential.”

36

VICTORIA DIVISION OF FAMILY PRACTICE

“I TRY TO THINK ABOUT WHAT CHANGES IN PATIENT CARE WOULD BE HELPFUL FOR A FAMILY PHYSICIAN TO KNOW, SUCH AS DETAILS OF WHY A MEDICATION WAS DISCONTINUED.” HOSPITALIST

2017–18 ANNUAL REPORT

37

“ONE OF THE GREATEST NEEDS IS FOR FAMILY PHYSICIANS WHO WILL TAKE AN INTEREST IN TREATING PEOPLE WITH SUBSTANCE USE DISORDERS. THESE ARE CHRONIC ILLNESSES THAT REQUIRE LONG TERM MONITORING AND SUPPORT. FAMILY PHYSICIANS ARE IN THE BEST POSITION TO PROVIDE THAT, BUT RIGHT NOW, THEY LACK THE TRAINING.” DR. BILL BULLOCK

VDFP BOARD MEMBER CO-CHAIR OF THE MENTAL HEALTH & SUBSTANCE USE STEERING COMMITTEE, AND VICTORIA COMMUNITY DETOX PHYSICIAN

MENTAL HEALTH + SUBSTANCE USE [MHSU] DIVISION COMMITTEE WORK BOOSTS WORK-LIFE SATISFACTION It’s been almost 20 years since DR. BILL BULLOCK and his wife, psychiatrist DR. WANDA CROUSE, packed up their Hamilton, Ontario life and headed west to Victoria. They

were seeking a change, a better climate, and a slower lifestyle. “It’s beautiful city of a manageable size,” he says. “It was a great decision, and I’m sorry we didn’t do it earlier.”

Bullock, who is a Division board

needed a place to refer, and help for

member, lead physician with the

patients with moderate illnesses. The

Mental Health and Substance

CBT program filled that niche.”

Use initiative, and physician at

He says there is still a huge need for

Victoria Community Detox, says the

educational MHSU events, and that

connections he has made through

the Division is open to considering

committee work have fueled a much

smaller formats and mentoring

more satisfying professional life.

opportunities for practicing physicians.

“General practice can be very

Often working with Island Health

isolating,” he says, recalling the

to redesign existing programs and to

opportunity to be involved in the

plan new ones, Bullock can provide

MHSU working group when the

a two-pronged perspective. “I wear

Victoria Division was taking shape. “We

two hats. I am representing the detox

were looking at setting priorities for

unit, which functions at the crossroads

the Division, and I enjoyed that work.

of many substance use services. And

It’s been a really good move for me.”

through the Division, I can represent

Between being involved in CBT Skills Group program groundwork

the interests of family doctors.”

His mantra? “GPs need ways to

and supporting the rollout of several

make their lives easier, not more

educational events on addiction and

complicated,” he says, lamenting a

mental health, Bullock and the MHSU

shortage of physicians able to sit on

team have a lot to be proud of.

advisory committees and working

“The CBT Skills project is an

groups. “My hat goes off to doctors

ingenious way to meet an unmet

who are in full-time practice and still

need,” he explains. “Family doctors

manage to do all of these things.”

2017–18 ANNUAL REPORT

39

MENTAL HEALTH + SUBSTANCE USE CONT.

THE FUTURE OF FAMILY PRACTICE Bullock says the future is a mystery, but that with so many family doctors retiring in the next two decades, family practice will surely look much different.

Far more teamwork, both with colleagues and with the health authority, is certainly on the horizon.

“The health authority is realizing that it makes sense to support good primary care, because it helps to avoid hospitalization, to contain the costs of hospital-based care, and to reduce re-admission rates,” he says, noting the strong collaboration that has evolved between the Victoria Division and Island Health via the Collaborative Services Committee (CSC).

With the future moving toward health care teams via the Patient Medical Home collaborative model, Bullock says students will require great team skills.

He believes that younger doctors are more tech savvy, and looks forward

PEER OUTREACH WORKER JENNY DAGG OPERATED THE UMBRELLA SOCIETY PILOT PROGRAM FOR PHYSICIANS.

to a world of better interconnectivity between EMRs, hosptials, and community labs.

“I also think that the Division is the greatest thing that has happened to family practice in B.C., and I’m hoping it will carry on, and continue to flourish,” he says.

40

VICTORIA DIVISION OF FAMILY PRACTICE

THE MOST VALUABLE THING I LEARNED DURING THE RECOVERY LEARNING EVENT IS THE CONCEPT THAT RECOVERY IS A LIFE-LONG ISSUE. GP FEEDBACK

HIGHLIGHTS •

•

and Substance Use (CYMHSU)

Relapse Prevention: A Family

Collaborative, completed

Physician’s Role event, March

December 2017.

2018. This event highlighted the roles of shame, stigma, and

•

completed April 2018.

resources and self-help groups, and included strategies to manage chronic conditions.

•

designed a resource matrix to assist family physicians to

investigating the feasibility of

navigate the CYMH system

team-based care for patients

in Victoria.

with problematic

146

substance use, completed

•

LE MA

The CYMHSU Collaborative Victoria Local Action team

December 2017.

designed a pathway to care in order to help parents navigate

*Dec 2016–Nov 2017

100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

The CYMHSU Collaborative Victoria Local Action team

Umbrella Society pilot project,

CLIENTS SERVED VIA UMBRELLA SOCIETY GP PROGRAM*

Mental Health and Substance Use Partners in Care project,

trauma, provided detail on local

•

Child and Youth Mental Health

Addiction, Recovery, and

the CYMH system in Victoria.

PHYSICIAN PROGRAM PEER OUTREACH PROGRAM

L E E AL HO E TIV ILY FEM ALCO US PPOR AM F U S

LY MIO R FAC T O D

UMBRELLA SOCIETY PILOT PROJECT:

COMPARISON OF PHYSICIAN PROGRAM TO PEER OUTREACH PROGRAM PARTICIPANTS

S ED LES OY E.I. ME PLO N HO EM R O

S OW SH NO

2017–18 ANNUAL REPORT

41

Overcoming fears is as important for CBT Skills Group participants as it is for facilitators. In line with the philosophy that everyone has struggles, and that everyone can use CBT, DR. WANDA CROUSE agreed to tackle her greatest fear this Spring during a community session for CBT Level 2 graduates. The Royal B.C. Museum’s Entomology Collections Manager and Researcher Claudia Copley brought spiders of various sizes, and

FEEL THE FEAR. AND DO IT ANYWAY.

Crouse employed CBT skills to cope with them walking on her hands!

CBT SPREADING LIKE A SPIDER’S WEB Just three years ago, psychiatrists and family physicians—supported by the Victoria Division—launched discussions about designing the CBT Skills Group program. In that time, several local GPs have joined training programs, demand for the completely revised Workbook continues to grow, more than 25 groups are running each quarter in Victoria, and several other communities are following suit.

THIS COURSE HAS BEEN INVALUABLE. I WISH I COULD HAVE LEARNED THESE THINGS EARLIER IN LIFE. CBT SKILLS GROUP PARTICIPANT

CBT IN THE COMMUNITY Now that the CBT Skills Groups have graduated almost 1800 participants, lead facilitator and psychiatrist DR. WANDA CROUSE is focused on

empowering those grads to build

LEVEL 2 GROUPS

and lead their own community-based

For those who have completed the

support network.

eight-week Level 1 course, physicians

“There are quite a few people who

can now refer their patients to Level 2

want to get peer facilitator training,”

groups launched this year for boosters,

says Crouse. “They would then operate

mindfulness-based cognitive therapy,

groups for people who want to

insomnia, and cancer.

continue to talk about CBT specifics.”

42

VICTORIA DIVISION OF FAMILY PRACTICE

CBT SKILLS GROUPS [COGNITIVE BEHAVIOURAL THERAPY]

CONTINUED FROM P. 42

chronic conditions helps patients learn

This year, Crouse has begun to offer

more about self care, and how they

large group sessions for those who

can do more for themselves. In the

have completed Level 2 sessions, such

long term, the healthiest thing is for

as a booster groups or mindfulness-

participants to be responsible, and free

based cognitive therapy. These

to do what’s best for them, not coming

sessions zero in on one aspect

from a professional,” says Crouse.

of CBT, and encourage brainstorming for other initiatives that can help

WEBSITE + BLOG

grads to support each other. Coffee

Crouse has launched a website and

meetups, a book club, a music group

blog this to support this community-

and choir, cycling excursions, and a

based spread:

buddy system are all gaining traction.

cbtboosters.wordpress.com

Crouse is working to identify leaders, groups to be participant run.

CME AVAILABLE FOR PHYSICIANS IN CBT GROUPS

“We have all kinds of people with all

Physicians wishing to experience a CBT

kinds of knowledge and backgrounds,

Skills group—to gain skills themselves,

and I want to use that,” she says.

and to better communicate the

“Over time, some of these people can

benefits to their patients—can now

become presenters. For example, we

do so. While not MSP-funded, they can

have a retired vet who can speak to

receive 36 CME credits for 12 hours

people about how CBT skills can help

of participation (i.e. eight sessions x

with emotional distress in pets.”

1.5-hours each).

“With this wider community

“That’s a huge number of credits,”

network in place, if folks can’t get into

says Crouse. “Family doctors have really

a group, or when they need more, it’s

been stunned to learn that. So it’s a

out there for them without depending

great opportunity for people, but we

on the formal process of a CBT group,”

can only take so many people at any

she says. “This self-management of

time.”

and to pass on the reigns to allow the

2017–18 ANNUAL REPORT

43

CONTINUED FROM P. 43

GP FACILITATOR TRAINING

one training with a psychiatrist. “Most

Family physicians who are interested in

GPs in training have wanted to do four,

becoming a facilitator are encouraged

five, even six groups, where they work

to observe an eight-week session with

one-on-one with the psychiatrist to

one of the facilitators as a first step to

learn the content and group process

certification. “Observers are able to

skills,” she explains.

take some specific skills back to their

Dr. Crouse would like to see the day

offices,” says Crouse. “In order to start,

when she can step away from training,

simply get in touch with the office and

but so far, demand continues to drive

ask about the status of observation

her commitment and enthusiasm.

openings at that point.” CME credits are

“Level 2 groups are in very high

also available for observers.

demand. They fill up within hours with

“In order to receive our stamp to

waiting lists.”

be fully trained would be at least two more levels of training. Co-facilitating

SPREAD OF THE PROGRAM

in a minor roll would see the GP come

The CBT Skills groups sprouted wings

in and work with the psychiatrist,

this year, spreading their reach to

while beginning to learn about group

Langford, Duncan, Nanaimo, and

process and about the content itself.”

Vancouver. “Dr. Erin Burrell has done

Level 2 training sees family

a huge job of getting things in place

physicians in a greater role to co-

in Vancouver, and has taken a bunch

facilitate with the psychiatrist, with the

of doctors and psychiatrists through

psychiatrist evaluating the progress.

the program,” says Crouse. Six groups

Skill development is in line with the

are now running in Vancouver at any

College of Family Physicians of Canada.

given time.

“They have well-defined roles that

Since funding for the initial project

family physicians are expected to work

wrapped up in April 2018, the Shared

toward,” says Crouse. “We have used

Care Committee has stepped up to

those to define the training. Once they

drive spread throughout the province.

have completed this more major co-

“The kudos go to DRS. ERIN

facilitation, we should be able to says

BURRELL and JOANNA CHEEK. Add on

that this GP has a particular set of skills,

CHRISSY TOMORI as the brains behind

and is therefore capable of running

getting the funding in place and

groups using the model we have

pulling it all together,” says Crouse.

developed.”

“It’s been fantastic and exciting

The year-long accreditation for

for me to be a part of this, and to see

group training allows family doctors

it as part of the end of my career is

the unique opportunity for one-on-

awesome.

44

VICTORIA DIVISION OF FAMILY PRACTICE

PATIENT VOICES NETWORK

CBT SKILLS GROUPS CONT.

patientvoicesbc.ca

RYAN SIDORCHUK, Engagement

Leader with the B.C. Patient Safety and Quality Council, is working to encourage CBT grads to become health system partners within the

HIGHLIGHTS •

to South Island, including

Patient Voices Network (PVN). The

Langford and Sidney.

PVN offers resources and training to patients so that they can most effectively tell their story in order

•

CBT Skills Groups spread to Vancouver, Nanaimo,

to effect system improvements.

and Salt Spring Island.

“Essentially, we are looking at ways that we can utilize a person’s

CBT Skills Groups expanded

•

Island Health partnership

experience with the health care

launched to sustain the CBT

system in order to improve it for the

Skills program post-project.

next person,” says Sidorchuk, who is hopeful that more CBT grads will register online with the PVN. Sidorchuk says these grads, who are taking ownership for their own mental

•

The Shared Care Committee is supporting the development of a provincial spread plan for the program.

wellness by completing the CBT Skills group programs, present unique perspectives for B.C.’s health system.

“They are unique insofar as they had the insight that something wasn’t

>5200

REFERRALS BY >500 GPs

>2800 PATIENTS REFERRED

working for them in their lives, and they made a decision to try and do something about that. A lot of us never get there.”

63%

COMPLETION RATE (6 OF 8 SESSIONS)

>400

VANCOUVER PATIENTS REFERRED BY >140 GPs

25–29

GROUPS EACH QUARTER. 2–4 MONTH WAITLIST

13

YYJ AND YVR GPs TRAINED TO FACILITATE GROUPS

2017–18 ANNUAL REPORT

45

“ALL OF THE ELEMENTS COMBINED IN MAGICAL WAYS. IT REALLY WAS AMAZING. BEFORE WE KNEW IT, WE HAD A MEETING, AND THE DIVISION SAID, ‘YOU’RE BASICALLY PROPOSING A SOLUTION TO OUR BIGGEST PROBLEM.’ SO IT WAS REALLY GOOD TIMING.” DR. ERIN BURRELL, LEAD PSYCHIATRIST, CBT SKILLS GROUP PILOT PROGRAM

DR. ERIN BURRELL fell in love with

THE FUTURE OF FAMILY PRACTICE

Victoria during psychiatry training,

When Burrell looks to the future,

and launched her practice here in

patient empowerment and self-

2012. Having spearheaded the CBT

management come to mind.

Skills Group program three years ago,

“I think about equipping people

she and a team of psychiatrists, family

to manage their own health, or

physicians, and Victoria Division staff

humane medicine. What I mean

have worked tirelessly to bring the

by that—especially within mental

concept to fruition. Burrell has recently

health—is acknowledging that we

relocated to Vancouver, in part to help

all struggle, and that we all have

spread the groups there.

resources,” she says. “It’s not that I

It was a combination of perfect

provide the cure for the sick people,

ingredients that sparked the idea for

but that I am a human being who

the program: in training and while

encounters other human beings, and

working at UVIC, she had run groups

in that encounter there is healing.”

around patient empowerment

She says new grads will need

that had been well received; family

the capacity for renewal, and for

physicians had expressed their lack of

connecting with their own humanity

mental health resources; and, the Joint

as physicians. “In this burnout

Collaborative Committee had shown

epidemic, part of the struggle is that

an appetite for innovation.

we believe we have to practice in ways

She says participant feedback on

that aren’t in keeping with our values,

the last day is very rewarding. “I feel

and that is so demoralizing. Internal

so proud of the family physicians

renewal happens when I am working

that I have trained, who have taken

in a way that aligns with my values.

their own steps to become top notch

I feel energized, and that helps me

facilitators. I am also really proud of

in every way of my medical practice.”

the Workbook and materials we’ve

She sees immense value in physicians

produced; we hear over and over how

connecting to what’s important, and

high quality and useful they are.”

in staying connected to it in their work.

46

VICTORIA DIVISION OF FAMILY PRACTICE

PATHWAYS

SPECIALIST REFERRALS, MADE EASY It was not long ago when GPs still relied on a myriad of their own notes for connecting with specialists for patient referrals. Contact information, specialist expertise, and referral requirements were difficult to keep up-to-date. The province-wide Pathways system—designed by doctors in the Fraser Northwest Division of Family Practice— has changed all of that. This secure online tool provides GPs with access to reliable and current referral information about more than 400 local specialists and clinics, along with wait times, referral form requirements, investigations needed, clinical tools and guidelines, and community services. Pathways also includes health resources that have been vetted by GPs, and allows for information to be emailed directly to patients.

Full access to Pathways is free for all Victoria Division members and their MOAs.

PATHWAYS HAS BEEN INVALUABLE IN HELPING ME TO NAVIGATE AND GET TO KNOW THE VICTORIA HEALTH CARE COMMUNITY. NEW PHYSICIAN

Victoria family physician DR. ANNA

MASON is passionate about sharing the benefits of Pathways with her peers. She has presented demonstrations to both GPs and specialists at events such as the Dine + Learn series.

2017–18 ANNUAL REPORT

47

PATHWAYS CONT.

“YOU CAN GET INFORMATION IN PATHWAYS THAT WOULD TAKE YOU YEARS TO RESEARCH, OR TO GET BY OSMOSIS.” DR. KATHY DABRUS,

LEAD PHYSICIAN, PATHWAYS VICTORIA

INTUITIVE PATHWAYS SYSTEM LOADED WITH TRUSTED GEMS Pathways physician lead DR. KATHY DABRUS wrapped up her internship

in Victoria at a time when only interns were being granted billing numbers, so decided to stay. It was 1989, she had

She credits the coding team for

local family ties, loved the community,

much of Pathways’ success. “They

and appreciated how medicine was

seem really engaged in wanting to

being practiced here.

help people, to make things happen

When Pathways launched in Victoria,

so that patients are better served.”

it was a combination of her leadership training, years of experience as a

ELECTRONIC REFERRAL

Division board member, and interest

Dabrus looks forward to the

in the project that made her a natural

electronic referral process that is due

choice to lead the local arm.

to be released early in the new year.

Dabrus recalls a pivotal moment

Physicians, MOAs, and patients will

in the project’s spread during the

all have the ability to track the status

Pathways Dine + Learn. “Doctors

of referrals online. The platform is

worked through different cases, and

presently at the pilot phase in Surrey

were surprised and impressed with

and Whiterock.

how many resources are in there, and

She would love to see more family

with how deeply they could dive in,”

physicians get involved in peer-to-peer

she says, adding that the intuitive

mentoring of Pathways. “It’s a matter of

design requires very little training or

people having protected time to share

skill. “Just a little time to understand

some of the things they have found

just how much is available.”

most useful in there,” she says.

48

VICTORIA DIVISION OF FAMILY PRACTICE

THE FUTURE OF FAMILY PRACTICE Dabrus emphasizes that the health system must value the relationships that build over time between family physicians and patients. “The foundation on which a person’s wellbeing is built has a lot to do with their primary care, and if that is crumbling, everything else tends to fall apart,” she says.

At the global level, Dabrus admires the Danish model, which focuses on ensuring each individual’s societal value. Within Canada itself, she says we can learn from Alberta’s payment structure, which compensates for complexity and time spent, ensures

SINCE THE GPs HAVE STARTED USING PATHWAYS, REFERRALS TO THE SPECIALISTS IN OUR OFFICE HAVE BECOME EASIER TO TRIAGE. I FIND I DO NOT NEED TO SEND THEM BACK FOR MORE INFORMATION OR REDIRECTION. SPECIALISTS’ OFFICE MOA

quick access for urgent problems, and has minimized physician burnout.

Dabrus says the most important skills will have nothing to do with how many facts new physicians know, how quickly they can calculate, how much they have memorized, or how fast their hands can move.

“Building relationships and rapport with patients will be important,” she says, “as well as understanding what factors and skills they need to be resilient and at their personal best.”

2017–18 ANNUAL REPORT

49

PATHWAYS CONT.

HIGHLIGHTS •

Local specialist and clinic data is reviewed biannually by the Victoria Division’s Pathways Administrator.

•

Referral forms are kept current.

•

New specialists and clinics are added constantly.

•

The Pathways homepage is continuously updated.

•

Every Victoria Division GP office with Pathways access is using Pathways daily, in some capacity.

•

GP office staff and MOAs are essential to keeping content current by providing real time feedback to the Pathways Administrator.

434

LOCAL SPECIALIST CLINIC LISTINGS

2250

PHYSICIANVETTED RESOURCES

Pathways Administrator CHERITH

GOLIGHTLY played the Cowardly Lion during a fun Wizard of Oz themed quiz night Dine + Learn designed to educate GPs about Pathways through a series of case studies.

50

VICTORIA DIVISION OF FAMILY PRACTICE

I HAVE PATHWAYS RUNNING ON MY LAPTOP 24/7, AND USE IT ALL THE TIME. AS A LOCUM, IT ALLOWS ME TO HAVE EVERYTHING AT MY FINGERTIPS, INSTEAD OF SEARCHING IN A NEW WORKSPACE. LOCUM

DINE + LEARN POPULAR CME EVENTS CONTINUE EXPANSION

“DOCTORS ARE GENERALLY PRETTY KEEN TO LEARN.” DR. CAITLIN HARMON, GP (GROW HEALTH), AND DINE + LEARN CO-ORGANIZER

Having tested local waters during

appreciate the social opportunities

medical school and residency, DR.

and the platform that nurtures in-

CAITLIN HARMON liked Victoria

person relationships with each other.

enough to stay on as a locum. She

Dine + Learns have grown in recent

is part of the group practice at Grow

years, having launched as 30-person

Health, which focuses on family,

dinner presentations in unique local

maternity, and paediatric care.

restaurants. The team now books

Together, Harmon, Dr. Tara

larger hotel venues to give more GPs

Mogentale, and Dr. Jessica Fry organize

the opportunity to participate, and

the Victoria Division’s Dine + Learn

to accommodate the popular round

events. These monthly gatherings

table format. This growth also means

usually feature several specialists from

there is room for more GPs to come on

one particular field, each who presents

board to assist with the coordination

an angle of their specialty to small

of specialists for the events.

groups of GPs at round tables.

CME for her colleagues. “It’s pretty

THE FUTURE OF FAMILY PRACTICE

social. You’re emceeing the events,

Harmon says Victoria’s maternity

helping to pick the topics, and

system is a great model for the Patient

coordinating with the specialists.”

Medical Home concept. “We’ll see

Harmon loves helping to organize

It’s a lot of work, but Harmon says

more group coordinated care, where

knowing how everyone clamours

doctors cover each other’s patients,

to get a seat makes it worthwhile.

and coordinate with allied health

The Dine + Learns have a reputation

services.” Grow Health already includes

for selling out quickly with a wait

maternity-specific professionals such

list. “Feedback is 90 per cent super

as lactation consultants and public

positive, so people seem to be really

health nurses.

happy with them in general,” she says.

In addition to robust knowledge transfer, GPs and specialists alike

“Everywhere is going that way, but there’s not that many places already doing it,” says Harmon.

2017–18 ANNUAL REPORT

51

DINE + LEARN CONT.

IT’S GREAT TO MEET COLLEAGUES, DISCUSS COMMON PROBLEMS AND APPROACHES, AND REFER TO SPECIALISTS FOR EXPERT OPINION.

HIGHLIGHTS

•

GP FEEDBACK

Collaboration with the Practice Support Program (PSP) on CBT Skills, MHSU Recovery, and Pathways events.

•

Pathways demonstration at every Dine + Learn showing the topic being presented, i.e., the specialists’ page, the referral process, and resources available.

•

Events covered Neurology, General Surgery, Pathways, Urology, Gastroenterology, Paediatrics, CBT Skills, Orthopaedics, and Family Practice Primer (for residents and students).

•

Evaluations confirm that attendees love the interactive round table format, meeting specialists face-to-face, and being able to ask questions directly.

9

DINE + LEARN EVENTS HELD

52

140

MEMBERS (32%) ATTENDED DINE + LEARNS

Allergist DR. AMANDA JAGDIS conducts one of several short presentations to small groups of family physicians during a Victoria Division Dine + Learn Roundtable event.

VICTORIA DIVISION OF FAMILY PRACTICE

VIC–SI RESIDENT WORKING GROUP

MEMBERSHIP IN THE VIC–SI RWG INCLUDES GP BOARD MEMBERS/ PROJECT CO-LEADS, RESIDENT BOARD MEMBERS, AND PROJECT COORDINATORS FROM BOTH THE VICTORIA AND SOUTH ISLAND DIVISIONS, AS WELL AS A FACULTY RESIDENT COORDINATOR

HIGHLIGHTS

•

The Victoria–South Island

Several annual events connect

Resident Working Group (VI–SI

residents to Divisions and GPs:

RWG) acts proactively to support Greater Victoria’s medical school

•

Divisions: Annual Presentation

Provides input, oversight,

Divisions and how they assist

and leadership to implement

residents during residency.

activities.

•

November—Society of General Practitioners (SGP) Billing Session: Billing 101, introduction

Island and Victoria Division

to locum opportunities, financial

boards, and represents the

implications of practicing in

interests of Division members,

Victoria, network opportunities.

other stakeholders.

•

of the project, the work, and the responsibilities of group members.

April—The Business of Family Practice: Panel discussion featuring local GPs

A guide has been created to establish shared understanding

to R1 and R2 residents about

Accountable to both South

partners, patients, families, and

•

October—Introduction to

residents.

supportive Division events and

•

•

•

May—Resident Dine + Learn

•

June—Annual Survey

•

July—Resident Welcome BBQ

2017–18 ANNUAL REPORT

53

VIC–SI RESIDENT WORKING GROUP CONT.

IT IS MY HOPE THAT ENGAGEMENT CONTINUES, AND THAT [RESIDENTS] ALWAYS HAVE A SPACE AT THE TABLE. DR. ARLO GREEN

RESIDENTS SEEKING TEAM-BASED MODELS, FINANCIAL INCENTIVES DR. ARLO GREEN has been practicing for just a few months, but his experience as a

member of the Vic–SI Resident Working Group last year provided him with a broad view of the local medical system, and the desire to improve it.

Having grown up in Vancouver, Green initially considered a career in finance.

When a Toronto position in banking left him feeling devoid of human interaction, he decided to pursue medicine, and completed medical school at McMaster University with the goal of pursuing family medicine back on the west coast.

“Victoria was a great place to do that, with a very strong residency program,” he says.

Green now calls himself a ‘permalocum’—at least for the coming year—at Peninsula Medical in Saanich, and conducts weekly inpatient care at Saanich Peninsula Hospital.

“There’s a lot of room for the system

supported group practices and a team

to improve here,” he says, adding that

dynamic, where you can take some

strategies are necessary to encourage

vacation time and have coverage. You

doctors to remain in Victoria after

can have a family and work three days

residency. “Physicians get extra

a week if that’s your choice.”

Green wrapped up a year of

reimbursement and financial help for practicing rurally, but people are

participation in the Resident Working

very much struggling to find family

Group upon graduation in June 2018,

physicians in urban areas as well. The

handed the reigns to new current

fee structure doesn’t encourage them

residents, and has joined the Patient

to stay in urban areas. The high cost of

Medical Home steering committee.

“I am really trying to address those

living is driving physicians out.”

He says the old model of physicians

issues and be a part of the change,” he

running solo practices and working

says, “We’re looking at how to guide

in their own silos doesn’t appeal to

the transformation of sustainable

new grads and residents. “They want

primary care in Victoria.”

54

VICTORIA DIVISION OF FAMILY PRACTICE

A great example of two Divisions Working Group looks at ways to build

THE FUTURE OF FAMILY PRACTICE

stronger connections with residents.

Green says the big shift will be to

working together, the Resident

Now, between this group, and with

the team-based model, and that

permanent positions for residents on

physicians from all ages and levels

both the Victoria and South Island

of experience favour that.

boards, those ties are improving.

“For their own wellbeing to limit

Various events around education,

burnout, and for the patients to

fun, and networking have also been

receive consistent patient care when

built into the residents’ schedule that

their doctors are away,” he says,

support the Division mandate.

“patients will have that Patient Medical

“That was a big win, and it’s going

Home not just associated with one

to be ongoing,” says Green. “There are

physician, but as part of a team-based,

a handful of sessions now each year as

well-supported network where they

a part of our academic half days, which

know they can get good care.”

is the teaching component of the residency program.”

Green says it’s important to include

Green sees doctors who are operating in solo practices and having a hard time finding others to take over

voices from the younger generation

so that they can retire. “If they were

throughout all Division activities.

associated with a team-based clinic,

“With the changes to primary

it would provide consistency, and

care and the Patient Medical Home

patients would be familiar to the clinic

concepts, it’s not the doctors who

and to the other doctors.”

are practicing now who will be

He sees communication at the heart

impacted most,” he says. “The younger

of that change. “Communication will

generation will feel the impact of

come to play between colleagues,” he

those changes, so it is my hope that

says. “It is will become an even more

engagement continues, and that they

important skill as we build those teams

always have a space at the table.”

into integrated networks of care.”

2017–18 ANNUAL REPORT

55

TIMELINE

[OCTOBER 2017 TO NOVEMBER 2018] OCTOBER 2017

• Interdivisional CSC • Neighbourhood Development Session #2 | Oak Bay/Gordon Head • Neighbourhood Development Session #2 | Victoria • Neighbourhood Development Session #2 | Saanich • Dine + Learn: CBT Skills Roundtable • RCI Learning Series: Practical Skills for Palliative Care • Island Health’s Victoria Power, and Drs. Katharine McKeen, Lisa Veres, and Sean Spina present at a plenary session along with Collaborative Services Committee representatives at the provincial Canadian College of Health Leaders Conference Victoria

56

NOVEMBER 2017

• Neighbourhood Development Session #3: Oak Bay | Gordon Head • Dine + Learn: Orthopaedic Roundtable • Third Meeting of Lansdowne Professional Centre GP Network • Neighbourhood Development Session #3 | Saanich • Neighbourhood Development Session #3 | Victoria • RCI Quality Improvement (QI) Seed Fund: Program Launch/ 2018 Applications Due

VICTORIA DIVISION OF FAMILY PRACTICE

DECEMBER 2017

• Family Holiday Social Oaklands Community Centre • Joint SIDFP/VDFP Board Social hosted by Dr. Robin Saunders • Care of the Elderly Working Group • RCI Learning Series: Wounds and Urinary Tract Infections • SIDFP and VDFP Divisions and Residents Working Group • TIC presents to the Island Health EHR Quality Council

JANUARY 2018

• Dine + Learn: Neurology Roundtable • Board Strategy and Planning Session • CBT Skills Facilitator CPD Workshop • Victoria CSC half-day Visioning Session • Victoria CSC MHSU working group inaugural meeting • SGP Billing Workshop hosted by SIDFP and VDFP

FEBRUARY 2018

• RCI and After Hours Call on the Saanich Peninsula • RCI Learning Series: Serious Illness Conversations • JCC/BCPSQC Quality Forum • Dine + Learn: General Surgery Roundtable • TIC/RCI Collaborative Physician Event on Residential Care Transitions

MARCH 2018

• MHSU Learning Series: Addiction, Recovery, and Relapse Prevention: A Family Physician’s Role • RCI Learning Series: Management of Infections • Dine + Learn: Pathways Interactive Event • TIC Secure Messaging Pilot Launch

• RCI Quality Improvement (QI) Seed Fund: Launch and first of five QI Small Group Learning Sessions with 5 funded QI project teams • RCI Learning Series: Dementia Behaviour Management • SIDFP/VDFP Resident Working Group • Completion of TIC Tips and Tricks from the ER • TIC Team presents at Island Health Research Ethics Board Educational Day | Victoria

2017–18 ANNUAL REPORT

57

TIMELINE CONT. OCTOBER 2017 TO NOVEMBER 2018

APRIL 2018

• Dine + Learn: Urology Roundtable • TIC/RCI: Improving Acute to Residential Care Transitions event • Lansdowne Professional Centre GP Network Quarterly Meeting • GPSC Spring Summit.

Presentations by VDFP • TIC/RCI Collaborative Multi-disciplinary Event on Residential Care Transitions

MAY 2018

• RCI Small Group Learning Session: Quality Improvement Session #3 • Dine + Learn: Residents and Medical Students—Everything You Wanted to Know about Starting a Career in Family Practice • RCI Learning Series: Treating Pain • MHSU Stigma workshop at Royal Roads • Interdivisional CSC Nanaimo • SIDFP and VDFP Resident Locum matching event

58

VICTORIA DIVISION OF FAMILY PRACTICE

JUNE 2018

• Board Strategy and Planning Day (followup from January) • Doctors Technology Office Privacy Workshop • Dine + Learn: Gastroenterology Roundtable • TIC: Familiar Faces Kick-off Meeting • RCI: Saanich Peninsula After-Hours Call Group Launch • TIC initiates partnership with Island Health’s EMR Connect Project

JULY 2018

AUGUST 2018

• SIDFP and VDFP Resident Welcome event

• Victoria CSC Primary Care Network Working Group

• RCI Annual Program Review Survey (completed by 44 RCI physicians and 481 care home staff)

• Resurrection of VDFP Patient Medical Home Steering Committee

SEPTEMBER 2018

• Victoria CSC Primary Care Network Working Group • Lansdowne Professional Centre GP Network Quarterly Meeting • Lansdowne Professional Centre GP Network MOA event • RCI Leadership Dinner + Evaluation Results Review • Dine + Learn: Allergy & Immunology Roundtable • TIC Residential Care Transitions Project Launch • TIC Patient Summaries Scanning Pilot launches

OCTOBER 2018

• RCI Learning Series: Management of Late Stage Dementia and Parkinson’s

NOVEMBER 2018

• Annual General Meeting

• TIC Proactive Summaries Pilot Launch

2017–18 ANNUAL REPORT

59

FINANCIAL STATEMENTS

STATEMENT OF FINANCIAL POSITION March 31, 2018, with comparative information for 2017

2018

2017

$ 1,725,659 - 125,990 - 3,019

$ 1,573,695 20,000 251,139 2,661 3,019

Assets Current assets:

Cash and cash equivalents

Term deposits (note 2)

Accounts receivable

Inventories

Prepaid expenses

Equipment (note 3)

1,854,668

1,850,514

1,449

3,002

$ 1,856,117

$ 1,853,516

$ 484,051 1,343,746

$ 342,421 1,484,052

1,827,797 1,449 26,871

1,826,473 3,002 24,041

Liabilities and Net Assets Current liabilities:

Accounts payable and accrued liabilities (note 3)

Deferred revenue (note 4)

Deferred capital contributions (note 5) Net assets Commitments (note 6) Economic dependence (note 7)

$ 1,856,117

See accompanying notes to financial statements.

60

VICTORIA DIVISION OF FAMILY PRACTICE

$ 1,853,516

STATEMENT OF OPERATIONS AND CHANGES IN NET ASSETS Year ended March 31, 2018, with comparative information for 2017

2018

2017

Revenues:

Infrastructure Residential Care Initiative A GP For Me MHSU Transitions in Care Regional Retention & Recruitment CYMHSU Patient Medical Home MHSU Publication Sales Recognition of deferred capital contributions Interest Cost recoveries from other Divisions

$ 1,252,637 1,234,344 - 360,579 206,210 19,203 43,242 110,036 29,720 3,727 2,830 8,300

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

3,270,828

3,397,045

1,276,176 507,751 860,049 221,712 187,544 87,867 69,393 22,889 10,017 20,873 3,727

1,034,799 706,374 641,199 486,184 229,221 149,660 59,360 28,877 28,317 17,351 3,003

3,267,998

3,384,345

Expenditures:

Wages and benefits Physicians RCI payments Contractors Administration Event expenses Meeting expenses Conference expenses Travel expenses Other program expenses Amortization

Excess (deficiency) of revenue over expenses Net assets, beginning of year Net assets, end of year

2,830

12,700

24,041

11,341

$ 26,871

$ 24,041

See accompanying notes to financial statements.

2017–18 ANNUAL REPORT

61

62

VICTORIA DIVISION OF FAMILY PRACTICE

FINANCIAL STATEMENTS CONT.

NOTES TO FINANCIAL STATEMENTS (CONTINUED) Year ended March 31, 2018

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 balance received

Ending balance

$ (1,252,637)

$ 139,832

$ 177,994

Transition in Care

136,947

138,654

-

(206,210)

69,391

Regional Retention

& Recruitment

30,149

-

-

(19,203)

10,946

CYMHSU Collaborative

43,242

-

-

(43,242)

-

MHSU

148,069

261,416

-

(360,579)

48,906

Residential Care

Initiatives

916,638

1,346,400

-

(1,234,344)

1,028,694

31,013

125,000

-

(110,036)

45,977

$ 1,484,052

$ 3,085,945

-

$ (3,226,251)

$ 1,343,746

-

Revenue recognized

Infrastructure

Primary Care Home

$ 1,214,475

Interfund transfers

2017–18 ANNUAL REPORT

63

VICTORIA DIVISION OF FAMILY PRACTICE PO BOX 8418 VICTORIA MAIN VICTORIA, BC V8W 3S1 PHONE 1.877.790.8492 FAX 778.265.0298 DIVISIONSBC.CA/VICTORIA FACEBOOK.COM/VICDIVFP

ANNUAL REPORT 2017/18 PUBLISHED NOVEMBER 2018

WRITING, EDITING + DESIGN: CRYSTAL SAWYER, TRIVENI WEST COMMUNICATION + DESIGN INC. PHOTOGRAPHY: TERRANCE LAM, ANDREW DODD, QUINTON GORDON