Letters

Letter to the Honourable Adrian Dix, M.L.A. Minister of Health

February 26, 2019

The Honourable Adrian Dix, M.L.A. Minister of Health
Province of British Columbia

Dear Honourable Adrian Dix, M.L.A., Minister of Health

As Chair of the Board of Directors of the British Columbia Rural Health Network, I am writing to congratulate you on raising the profile of rural health issues during your mandate. In this letter, I intend to introduce the work we are doing through our pan- provincial, community-based network. I believe our Network is well positioned to work together with you to advance BC’s rural health agenda and improve population health outcomes for all residents of the province.

I was delighted to see you at the Provincial Healthcare Partners Planning Retreat in Vancouver January 27th and 28th and struck by your understanding of the importance of partnerships in health services planning and delivery. As you stated in your remarks, this is a “moment of opportunity” to address the challenges of primary care transformation. Placing the “community first” resonates well with people in rural BC who understand the value of consultation and engagement in order to identify each community’s individual needs.

The BCRHN is a nascent organization which came to fruition last year in response to a recognition by rural communities across BC that many local health care challenges are shared challenges and that there is great advantage in working together to solve them. We currently have 19 member communities officially represented in the network, a number that is increasing as we gain both momentum and reputation. We are also expanding our reach through collaborative involvement with key stakeholder groups including the Rural Coordination Centre of BC, the BC Rural Health Research Centre, the BC Health Coalition, and the BC Association of Community Health Centres. We are presently in discussion with several other groups to determine congruence of purpose and goals. This inter-community networking extends also to understanding shared health service priorities of rural citizen-patients so we can better advocate to meet the needs of rural communities.

Some of the key values underscoring our work include the recognition that rural is not smaller urban but instead has characteristics and qualities that are unique to small communities. We also appreciate the innovation that occurs in rural settings out of necessity may be transferable to urban health care settings, turning the usual rural ‘deficit thinking’ on its head. We strongly prioritize citizen-patient voices, alongside other key stakeholders, in contributing to decisions and solutions about sustainable rural health care.

We applaud the focus on rural health care that the NDP government has prioritised, including the provision of team-based primary care, the substantial investment in community paramedicine, increases in medical travel allowance for those who must travel for care and the over-arching commitment to improve rural health services, recognizing pathways of care through the Primary Care Networks when a higher level of care is required. The significant investment your government has made in virtual care compliments and enhances the work of the PCNs in a way that provides direct benefit to rural communities. Additionally, we recognize and honour your commitment to improving health services for First Nations and Indigenous peoples.

As a result of our involvement in the Ministry of Health consultation process to develop policy on Community Health Centres, our membership has developed an interest in the CHC model and its potential to improve access to healthcare services in our communities. We look forward to future involvement in this consultation process as the Ministry moves to implement this policy.

We present to you that our consensus-based process for articulating a rural health care priority agenda, along with the values propositions that underscore our work, provides an opportunity for us to contribute authentic and diverse rural perspectives to other areas of health care planning. For example, our membership has considered the efficacy of Urgent Primary Care Centres through a rural lens, recognizing the potential danger of recruiting from a geographically-limited and often over-extended supply of local care providers to work at a higher rate than made through a typical fee-for-service payment model.

We contend that having an authentic and consolidated rural citizen-patient perspective on health service priorities will be value-added to provincial planning processes: we recognize the potential strength in broad-based rural community insight that the BCRHN can contribute. Working effectively with existing Health Authority and provincial processes is the most effective way to ensure equitable access to services for all British Columbians. Given the close alignment between the current government and rural health priorities, we are keen to discuss potential synergies and look forward to an opportunity to build these bridges.

Sincerely,

Edward Staples, Chair BCRHN Board of Directors

Response from Ministry of Health
Joanna Richards

 Dear Mr. Staples, 

I am writing in response to your email received February 26, 2019, regarding the BC Rural Health Network (BCRHN) and primary care services in rural communities in British Columbia. I am pleased to respond on behalf of the Honourable Adrian Dix, Minister of Health. 

 I appreciate learning more about BCRHN and your mandate. The Ministry of Health welcomes BCRHN’s support of the provincial Primary Care Network (PCN) and Patient Medical Home (PMH) initiatives. As you know, improving the delivery of rural health services in BC is a current strategic focus of the Ministry. As part of this focus, and to better support both patients and providers, we have been working with our partners to establish PMHs, PCNs, and Community Health Centres (CHCs), and to expand urgent primary care services as the foundation for an integrated system of primary and community care. As we move forward, we continue to value community input as we explore options to tailor these initiatives to local needs, and in consideration of rurality. 

 As expressed by the Minister during the Provincial Healthcare Partners Planning Retreat in January, the Ministry values the importance of partnerships, including those locally, in health services planning and delivery. This extends to PCN planning and development. Through the PCN planning process, we are working with stakeholders to better understand how to best support rural communities in meeting their primary care needs. This is especially important considering that the majority of our upcoming PCN Wave 2 communities are considered rural. 

 The Ministry recognizes that PCN planning and development must consider the unique contexts of BC’s rural communities, and how these considerations impact the delivery of primary care. These considerations include, but are not limited to: Accessibility, geographic isolation, human resources challenges (e.g. the recruitment and retention of health care professionals), and rural demographics in relation to inequities in social determinants and disparities in health outcomes. One of the ways we are encouraging engagement in PCN process is through the Rural Sounding Board, a group that provides advice on how to adapt PCN policy to best meet the needs of BC’s rural communities. One of our main goals is to ensure team-based services are available as close to home as possible while also developing a sustainable system of care. 

 In response to your interest in the CHC model of care, the Ministry appreciates your participation in the policy consultation process and continued engagement in policy development. My colleague, Krystyna Adams, Senior Policy Analyst, will be in touch to discuss ongoing opportunities for BCRHN’s participation in the enhancement of the CHC model across BC. 

In particular, the Ministry will be working closely with participants from the policy consultation process to discuss a policy implementation strategy. We hope BCRHN will continue providing insight into the development of primary care strategies that address the priorities of rural and remote communities. We are committed to exploring innovative solutions, and welcome the opportunity to discuss further. 

Once again, thank you for your support and commitment to people living in rural communities. 

Sincerely, 

Joanna Richards 
A/Executive Director 
Primary Health Care