When the College’s Regional Tour visited St. Albert to listen and learn about local issues, we came away intrigued by the high praise from public attendees for the primary care services in their community, and the value physicians at the table placed on working within a network of health professionals.
This was a story we wanted to share. “The St. Albert and Sturgeon primary care network exemplifies what’s best about PCNs,” says CPSA Registrar Dr. Trevor Theman. “They focus on meeting the specific needs of the populations they serve, and their use of other health professionals ensures patients get the right kind of care at the right time from the right provider.”
In part 1 of this special 3-part series, we ask two physician members why this PCN is so successful and what’s needed for a strong future.
Comprehensive care, more efficiently
The St. Albert and Sturgeon primary care network (PCN) was not Alberta’s first, but is arguably one of the most successful. It was created in 2006 by a group of 35 physicians, three years after the provincial government, Alberta Medical Association and regional health authorities (now Alberta Health Services) launched the Primary Care Initiative.
Today, the network comprises 67 physicians in 17 medical clinics, and two office sites – one in St. Albert and another in Morinville. There are also 21 allied health staff members (17.2 full-time equivalent positions), including registered nurses with specialized training, dietitians, pharmacists and a social worker.
Dr. Darryl LaBuick and Dr. Jim Bell are both original members of the PCN and share practice space at the Grandin Medical Clinic. Dr. LaBuick was the inaugural president and Dr. Bell is the Primary Care Nursing and Nutrition Lead.
For these physicians, being members of the PCN is a win-win situation for their patients and their practice. It enables them to focus on providing excellent medical care, while calling on clinical staff to support patients with additional health services when appropriate.
“It allows me to quickly provide the care that is needed without patients having to experience unnecessary delays, and allows me to delegate some of my job so that I can remain efficient.” explains Dr. Bell.
Dr. LaBuick concurs: “The clinical resources allow for more comprehensive primary care management in a more efficient fashion.”
Founding members of the St. Albert and Sturgeon PCN, Dr. Darryl LaBuick (left), and Primary Care Nursing and Nutrition Lead Dr. Jim Bell
Connecting physicians in solo practice
The Primary Care Initiative was originally conceived as a way to support community-based family physicians, and PCNs are a great way to do this says CPSA Registrar Dr. Trevor Theman.
“When you’re a PCN member, you and your patients gain access to resources you wouldn’t otherwise have,” he explains. “The clinical resources of the PCN complement the expertise of the average family physician.”
Physicians in solo practice who join a network are also connected with medical colleagues, and enjoy the opportunity to attend sponsored educational sessions and other events that foster collegiality and offer the opportunity to learn and grow in their practices.
It`s a hard-to-beat package. Today, almost all the community-based primary care physicians in the St. Albert and Sturgeon region belong to the PCN.
Good leadership and integration with AHS and community resources are key
The board of the St. Albert and Sturgeon primary care network comprises seven physician members, one public member and two AHS representatives. All are elected except the AHS representatives. “It’s a well-functioning board,” says Dr. Bell, adding, “There is a lot of leadership within the group.”
Quality-driven and proactive, the board has spent time identifying gaps in skills and knowledge within its own ranks and acting strategically to fill them. For example, in 2015 the board actively recruited its first non-physician public member to strengthen the business management side of the table. A second public member is now being considered.
In Dr. Bell’s view, having a community member on the board is extremely useful. “That community connection keeps the board focused on the needs of the community, which is really a large part of the job.”
The board also enjoys good relationships with its two AHS representatives. This liaison has improved coordination of transitions to home care, emergency services, long-term care and chronic disease management, and provided opportunities to co-sponsor educational sessions in the community.
Strong operational leadership is provided by Executive Director Dena Pedersen and Clinical Manager Heather Neumann, and business advice and support are available from the Alberta Medical Association, which runs the PCN program management office and Practice Management Program.
What’s missing? A long-term vision and stable funding for primary care
With all the positives, there are still some difficulties to overcome. At the top of Dr. LaBuick`s wish list is the need for clear strategic direction from government.
“With all the instability [in Alberta’s healthcare system] in recent years, there’s been no long-term vision for primary care. We need to see the vision to be able to plan three to five years ahead,” he says.
There are also weaknesses in the funding model for primary care networks, according to Drs. Bell and LaBuick. Alberta Health provides operational funding on a per-capita basis, based on enrolment lists of patients assigned to each participating physician.
This money is used to cover the administrative costs of the PCN, including overhead, evaluation services, clinic support services and the salaries of PCN staff. However, Dr. LaBuick notes the funding is not able to cover the overhead costs of PCN staff who work in the medical clinics – three to five staff on any given day. The medical clinics provide the PCN staff with office space and administrative support, bearing these costs without compensation.
The fee-for-service billing structure for physicians is also out-of-step with collaborative care. “The current billing system only pays for the work the physician does and requires the physician to see the patient in order to be paid for the service,” explains Dr. Bell. “It means that work done by allied health professionals does not get compensated unless the physician also sees the patient. This is inefficient and limits the roles of the allied health professionals.”
The issues are solvable, both physicians believe, and will ultimately lead to a stronger healthcare system.
“PCNs are a major and necessary component to improving primary care in the province,” says Dr. LaBuick. “As PCNs continue to grow in importance and complexity, it will be vital to look for more opportunities to integrate with certain programs with AHS. PCNs may also be better served by looking at more stable funding models that allow for better long term strategic planning.”
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