Survey data show the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average
Dr. Rita McCracken, Dr. Mei-ling Wiedmeyer, Ruth Lavergne Publishing date:Apr 01, 2019 • April 1, 2019
For many British Columbians who don’t have a regular doctor or can’t see their doctor when they need to, getting day-to-day primary care means waiting at a walk-in clinic. Often this means telling your whole medical story in a short appointment focused on a single problem. Yet, lacking continuity of care can lead to worse health outcomes and more trips to hospital. Strong evidence shows investing in primary care leads to better health for patients. Primary care provides a first point of access, a continuous relationship over time, and, importantly, co-ordination as patients move through the health system.
Since last summer, the Ministry of Health has announced six new urgent primary care centres and promised at least four more. UPCCs offer same-day visits for patients who aren’t experiencing emergencies but should be seen within 24 hours, much like walk-in clinics. UPCCs do not offer relationship-based care over time or play a co-ordinating role for patients needing to navigate the system. More than $20 million has already been invested in building centres in Vancouver, Surrey and the West Shore and running them for the first year. An extra $2.9 million is projected for a centre in Burnaby announced last month.
When a new UPCC opened in Langford last fall, patients lined up outside. While some were looking for an urgent appointment, many hoped to find a regular place to go for primary care. Survey data show that the percentage of British Columbians who have a regular health care provider is significantly lower than the Canadian average. While the number of family doctors per person in B.C. is higher than ever, an increasing number of family doctors working in private walk-in clinics — and now UPCCs — are not providing continuous care.
In B.C., the main option for new family doctors to provide continuous care is to set up and manage their own fee-for-service practices. Fee-for-service payment can be a barrier to team-based, preventative care since it only pays doctors and does not encourage the prevention of illness. It also means doctors have to spend time running a business. For some doctors this model works, but research tells us that most new family medicine graduates want to work in team-based practices that do not require running a business.
Community health centres is a team-based primary care model that the B.C. government included in its May 2018 primary care strategy. These non-profit centres provide team-based care, offering access to social workers, family physicians, nurse practitioners, dieticians, counsellors and others and connect patients to other resources.
Importantly, CHCs are governed by a board that ensures they are responsive to the communities they serve. In Ontario, these centres have helped reduce hospital emergency department use by improving access to care — a B.C. government priority. While UPCCs also might seem like a good way to take pressure off emergency departments, studies show that it’s not patients who could visit UPCCs who contribute to delays and crowding but rather patients with more complex medical conditions who need a hospital bed.
We are concerned that UPCCs are diverting funding and health care providers away from models like community health centres and primary care networks with the greatest potential to provide the quality primary care patients need.
Urgent care services have a place in our system but it’s the wrong prescription for B.C.’s primary care ailments. Primary care reform takes time and we need to be thoughtful to ensure policies align with the evidence. What we need are attractive new community-based practice opportunities, like those found in community health centres for the new generation of family doctors.
Drs. Rita McCracken and Mei-ling Wiedmeyer are family physicians; Ruth Lavergne is an assistant professor in the faculty of health sciences at Simon Fraser University.