GPSC Backgrounder (PDF)

In the mid-1990s, family practice in British Columbia was on the decline. Family doctors reported feeling overburdened and dissatisfied, and many began giving up the role of a full-service family physician (limiting their practices, giving up hospital privileges, and dropping maternity care).

In BC, primary health care is provided primarily in the offices of family doctors, and a strong system of primary care is seen as key to the sustainability of our public health system.

To address the increasing challenges facing primary care, the BC Medical Association and the BC Ministry of Health established the General Practice Services Committee (GPSC) in 2002. The mandate of this joint committee is to support the provision of full-service family practice and improve patient care.

Starting in 2003 with a number of disease-based financial incentives for care management of target patient populations, the GPSC moved forward in 2004/05 by holding province-wide consultations with approximately 1000 GPs whose message was clear and consistent: “Value us, pay us, train us, and support us.”

The GPSC responded, developing a collection of innovative, dynamic programs to improve physician morale, remuneration, and patient care. In the past 9 years, GPSC initiatives have evolved from disease-based financial incentives to include training in clinical and practice management; facilitation of GP collaboration to address physician isolation and gaps in patient care; and strategies to expand the capacity of family practice, with the goal of increasing the number of British Columbians who have a family physician.

These current initiatives have been well-recieved by physicians (80% of GPs using GPSC programs and fees report an improved overall professional satisfaction[1]) and include:

Full-service Family Practice Incentive Program

The inaugural initiative of the GPSC, the incentive program provided financial incentives to enhance maternity care and the delivery of guideline-based management of diabetes and congestive heart disease. Today there are more than 15 different financial incentives that compensate physicians for the additional time and effort required to deliver quality primary care to certain patient populations, including incentives for treatment of patients with COPD, mental health issues, comorbidities, and palliative care needs.

Significant achievements of the program:

• Estimated $10 million cost avoidance through mental health initiatives that support family physician delivery of guideline-based mental health care.[2]
• Estimated $41 million cost avoidance due to incentive-based care of patients with hypertension.[3]
• Hospitalization days for diabetes patients of physicians using Chronic Disease Management incentives are less than half the number for those of physicians not using the incentives.[4]
• More than 90% of the province’s GPs participate in the Family Practice incentive Program.[5]

Practice Support Program

Since 2007, the PSP has provided focused training sessions and extensive tools and resources for physicians and their MOAs to help improve practice efficiency and support enhanced delivery of patient care.

The program began with four learning modules (Advanced Access, Chronic Disease Management, Group Medical Visits, and Patient Self-management) and now also offers modules on adult mental health and end of life. Additional modules on child and youth mental health and a shared system of care for patients with COPD and heart failure are currently in development.Significant achievements of the PSP:

• Practices that use PSP Advanced Access scheduling processes have reduced wait times for appointments from 5.2 to 1.8 days.[6]
• 61% of family physicians report their patients’ ability to return to work has improved following cognitive behavioural interventions included in the PSP Mental Health module.[7]
• More than 60% of the province’s family physicians have participated in PSP learning modules.[8]
• More than 30% of physicians using Advanced Access processes have been able to increase the number of patients they are able to treat.[9]
• 88.9% of physicians who have participated in the Chronic Disease Management module feel they are now able to take better care of their patients.[10]

Divisions of Family Practice

Divisions of Family Practice are community-based affiliations of family physicians working together to achieve common health care goals.

The Divisions initiative provides physicians with a stronger collective voice in their community while supporting them to improve their clinical practices, offer comprehensive patient services, and engage with their local health authority to enhance their ability to deliver care.

There are currently 29 Divisions of Family Practice in BC that encompass 109 communities, and discussions are under way in up to another eight areas of the province.

Community Healthcare Resource Directory (CHARD)

CHARD is a free, secure web-based database for health care providers designed to provide comprehensive, up-to-date listings for community health care referral resources, searchable by type of service or geographic proximity.

The directory contains information for nearly 80% of the referral resources accessed by family physicians, including programs and services, as well as BC’s 6000 specialist physicians and nearly 18 000 allied health professionals in cancer, cardiac, mental health and addiction, musculoskeletal, neurodegenerative, palliative, renal, and respiratory care.

Many listings include a description of services, hours of operation, maps and parking details, patient eligibility criteria, referral forms, and patient information materials.

Attachment

Recent research shows that British Columbians who are “attached” to a family physician have better health care outcomes and lower overall health care costs, especially patients with several chronic diseases ($85 million cost avoidance for chronic disease patients; cost avoidance is due primarily to the reduction of hospitalizations[11]).

With this in mind, the GPSC’s Attachment initiative aims to increase the number of British Columbians who have access to a family doctor.

Divisions of Family Practice in the communities of Prince George, White Rock/South Surrey, and Cowichan are currently prototyping this initiative, working to ensure that residents of their communities have access to the benefits of primary care.

1. 2010 BCMA member survey. Presentation of results. p.16.

2. Hollander MJ, Tessaro A. Evaluation of the Full Service Family Practice Incentive Program and the Practice Support Program. Draft report: Mental health incentives: Fiscal 2009/10. April 2011. p.19. Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.

3. Hollander MJ, Tessaro A. Evaluation of the Full Service Family Practice Incentive Program and the Practice Support Program. Final report: Evaluation of chronic disease management payment incentives. June 2011. p.45. Source: British Columbia Ministry of Health Services, Primary Care Data Repository, Fiscal 2009/10.

4. Chaudhry M. An evaluation of diabetes incentive payments in BC. Presentation to GPSC, 19 April 2010.

5. Hollander MJ, Tessaro A. Evaluation of the Full Service Family Practice Incentive Program and the Practice Support Program. Final report: The uptake of incentive payments for the Full Service Family Practice Incentive Program: Fiscal 2009/10. p.2.

6. Hollander M, Kadlec H. Evaluation of the Practice Support Program. Final report: End of module surveys–Report on the original four learning modules for the period March 1, 2008 to March 31, 2011. September 2011. p.30.

7. Hollander M, Kadlec H. Evaluation of the Practice Support Program. Final report: Third report on the adult mental health end of module evaluation surveys (surveys received to March 31,2011) and synthesis report. September 2011. p.38.

8. Practice Support Program update to GPSC. February 2012. (2218 discrete GPs out of 3600 majority source of care GPs = 62%.)

9. Hollander M, Kadlec H. Evaluation of the Practice Support Program. Final report: End of module surveys–Report on the original four learning modules for the period March 1, 2008 to March 31, 2011. September 2011. p.31.

10. Hollander M, Miller J. Evaluation of the Full Service Family Practice Incentive Program and the Practice Support Program. Final report on the end of module surveys. 27 February 2009. p.17.

11. Hollander MJ, Kadlec H, Hamdi R, et al. Increasing value for money in the Canadian healthcare system: New findings on the contribution of primary care services. Healthcare Quarterly Vol.12, No.4. 2009. Hollander MJ. Overview of key findings from the evaluation of the Full Service Family Practice Incentive Program and the Practice Support Program. Presented to the General Practice Services Committee. Kelowna, BC. 14 June 2011.