Primary Care Networks (PCNs) are part of the BC Ministry of Health Primary Care Strategy. The Province’s aim is to focus on a team-based care approach to delivering primary care.

Read: Primary Care Networks 101

— By Dr. Graham Dodd, Co-chair, Health Leadership Committee

You’re going to hear a lot about Primary Care Networks — what they are, what they aren’t — and it’s time to really familiarize ourselves with PCNs. There’s not a primary health care worker in BC who won’t be affected by the integration of PCNs.

The Kamloops-Thompson Region will be organized into two PCNs, one for Kamloops and one for the Lower Thompson, which is inclusive of our rural communities. The main concern that we’ve heard from a few of our members is how the dollars will flow, and that the funding will not solve all problems. 

Well, divisions don’t control the cash flow. The funds will flow from the BC Ministry of Health (MOH) through the health authorities. Nevertheless, a substantial amount of money is available to fund specific types of resources, with a focus on increased patient attachment. Hopefully, this will also lead to improved patient access to primary care providers as well as the allied health providers in a team setting. The Division’s priorities are for this increased funding to improve access to team-based care, as well as to support primary care in general. Attachment will always be an issue, but access to primary care must be a priority. Sure, recruitment is hard, but it is hard for all communities. At least with the PCN funding we will have some resource dollars available, so that when recruitment opportunities present themselves our community can be ready.

Primary Care Networks are not going to solve all the challenges. We still need to bring in funding through other sources, such as the Family Practice Services Committee (FPSC) and Shared Care, as well as working with our health care and First Nations partners. One such example could be the FPSC-funded, after-hours pilot project. If successful, it could help take pressure off the emergency department by providing access to primary care outside of office hours. Another example is the funding the Division receives through Shared Care that supports specific areas of care, such as maternity, palliative, and oncology.

New resources will bring new challenges, but also new opportunities. Collectively working through the challenges and opportunities with our members and partners is the work ahead of us. The service plan is a START. I think about it as the strategy — what we need for resources, not how we operationalize the resources.

Here’s what we know as of November 2022:

We have a service plan endorsed by our Health Leadership Committee and approved by our Board of Directors. The service plan is being reviewed for endorsement by our First Nation partners. On requirement of the MOH, the service plan must be presented to Interior Health and the FPSC for endorsement. This will occur in early November and then it goes to the MOH for review. The timeline to have everything finalized is not clear, so there’s more information to come.

It's taken years of planning, partner consultations, member engagement and feedback sessions to arrive at this point (the pandemic didn’t help the timing), and right now only one thing seems certain: PCNs are coming to all divisions, including ours. Everything else is a work in progress, which is why it's important to stay informed and participate.

Read: A Prisoner of Hope

— By Dr. Phil Sigalet, Physician Lead, Primary Care Networks

Being part of the Primary Care Network Service Plan Working Group has been a mostly positive experience, but one of the challenges we potentially face is that there are different visions of what the PCN could look like.

I am not getting too fussed about the details as that work won’t come until the service plan is finalized with the Ministry of Health. I’ve been involved in enough projects of this type to know that the result is only going to approximate what has been envisioned. I think it is possible to spend too much time planning for unknowable details that are constantly changing.

A key benefit of the PCN is enhanced communication between providers and enhanced after hours coverage. I think some thought needs to be put into preparing patients’ expectations. We have an opportunity now: There is a better public awareness of the time limitations on family physicians and nurse practitioners. We need to leverage that and educate folks about what conditions warrant an after-hours call. An additional benefit will be resources to support team-based care. Access to nurses, mental health clinicians, and allied health, especially physiotherapists, all of which have been requested in the PCN Service Plan, is very important to primary care providers.

Recruitment is the biggest challenge we face with or without PCNs. I think we need to prioritize the recruits in each discipline to fill the most important roles first. Having said that, hiring can be opportunistic. If you have someone available and wishing to locate in a position considered lower priority, then getting them here might be the first step, and then, adapt the role to fit the skill set.

Looking to the future, I am a prisoner of hope.

Read: PCN Funding and Resources

The region will see funding for two Primary Care Networks: Kamloops, and Lower Thompson. 

The government funds Primary Care Networks using a set of parameters. The result is a four-year operating budget, with a one-time, change-management funding envelope. The funding formula considers the following: 

• Closing the attachment gap
• General population
• Priority populations
• Administration and Governance

The Ministry determines the net new number of Most Responsible Providers (i.e Family Physician, Nurse Practitioners, and Registered Nurses), Indigenous care providers, and allied and mental health professionals that can be requested for our region, with a percentage being allocated to administration and governance. 

Based on the Ministry’s funding parameters and feedback we received from our members, First Nations communities, and health care stakeholders, the Thompson Region Collaborative Services Committee requested resources and supports for the following: 

1. Mental Health Clinicians
2. ​Primary Care Nurses
3. Family Practitioners and Nurse Practitioners
4. Supports to address additional gaps
   • Mild-Moderate access for Physical and Occupational Therapy
   • Aboriginal Patient Navigation
   • Dietician
   • Diabetic Education
   • Discharge/Attachment Coordination
   • Transportation support
5. Urgent Primary Care Centres, targeted for the North Shore
6. Community Health Centres
7. Virtual care

Read: Kamloops-Lower Thompson PCN Engagement Summary

The Thompson Region Division of Family Practice’s (Division) engagement with our members has evolved and broadened over time. Historical project-specific member input has developed into longer term health service planning, including identification of resources to support the Primary Care Networks (PCN) service plan, and conception of the Integrated Health Service Model since 2015. The service plan has been shaped through various targeted and ongoing activities with the Division’s Health Leadership Committee (HLC) and the Board of Directors. As the Thompson Region prepares for its own PCNs, it is important to understand that this work has been years in the making. Have you wondered "How did we get here?" Then read on.

Historic events with member or community feedback that factored into the PCN service plan and/or Integrated Health Service Model:

2015 – Series of engagements to gather member input into a collective vision for family practice and primary care.

2016 – Ministry of Health’s Four Point Action plan released. Member feedback and previous experience lead us to decide to wait until 2019 before pursuing PCN. We opted to work through a few items before pursuing, and aligned Division work to support the following areas: practice readiness, community, allied health, and specialists.

May 2018 – 4 Ps for Practice Survival Event included an overview of the primary care network development. Feedback gathered that would impact service planning included communication between acute and community, community partnerships, and in-practice support. There were 62 attendees, including 32 general members, 6 nurse practitioners, and 24 medical office assistants/office managers.

2018 – Community visioning: heard from more than 750 residents of the Thompson Region about their vision for primary health care in the future. This input factored into the Division’s strategic planning and health service planning with the Collaborative Services Committee (CSC), including PCN resource identification, partnership creation, and further community work.

September 2019 AGM – Formal member approval to go forward with the PCN expression of interest and begin official planning as a Wave 3 PCN community.

September-November 2019 – Deliberative Dialogue Sessions: The Thompson CSC as well as many special invited guests and Division members engaged in 10 deliberative dialogue sessions on: mental health and substance use, cancer care, surgical care, trans care, older adults, palliative care, public health, population health, urgent care and access, and maternity care. The purpose of these sessions was to generate a prioritized list of actionable steps for short, medium, and long-term actions.

February 2020 – Sun Peaks CME: health service planning session with members to provide input into the service plan and network development. Provided opportunities for members not involved in planning to contribute feedback.

October 2020 – Your Vision & Your Voice event with 30 members.

• Members were asked:
  • What do we want the delivery of primary care to look like in the Thompson Region in the next five years considering satisfaction and sustainability in our patient care, practices, and access to specialized services?
  • Where should the Division focus our attention on partnerships? For example, where could we play a larger role influencing, collaborating, and/or owning?
• Members were also able to provide input via an anonymous follow-up survey after the event.

2020-2021 – Member network surveys through COVID-19 pandemic to get input into practice needs and PCN aspects.

2021 – Thompson CSC formed a series of transformation tables to ensure broad engagement across organizations and multiple stakeholders. The intent was to contribute to an overarching Integrated Model for the region. Partners at these tables included Community Health Tables with community agencies, school districts, paramedics, and municipalities. The First Nations Health Director (FNHD) committee was attended by FNHD from across the Secwépemc communities in all three Community Health Service Areas (CHSA). The three Community Health Centres (CHC), longitudinal primary care providers, possible Foundry host organization, Urgent Primary Care and Learning Centre as well as our community private allied health all participated.

March-April 2021 – Integrated Network of Primary Care meetings: Identification of gaps in services and briefing note to the CSC in April 2021 to system gaps for PCN planning.

May 2021 – Health Care Symposium was held with representation from each Community Health Table, First Nations communities, and multiple municipal partners along with Division staff and members and Interior Health to further discuss the Integrated Model of care for the region, access to services, and transportation.

June 2021 – Division-opoly event to introduce and present the Integrated Model to 21 members, which includes the PCN and Specialized Community Services Program as part of the model. Breakout groups discussed Health Data Coalition, Enabling Healthy Communities, and Community Health Centres. Members then provided feedback into prioritization of aspects of the Integrated Model.

November 2021 – Neighbourhood Engagement: Conducted an engagement initiative to gather input into the Proposed Integrated Service Model, with the primary care network resources being part of that model. The model incorporates three main concepts: primary care neighbourhoods, discharge services, and change management commitment. This included two types of engagement: Primary Care Neighbourhoods, and Specialty and Focused Practice.

Read: Clinical Resources

As a result of fulsome engagement (see Kamloops-Lower Thompson PCN Engagement Summary, above), the Collaborative Services Committee (CSC) proposed the following clinical resources for the region’s Primary Care Networks (PCN) plan. The members of the Thompson Region have consistently identified mental health clinicians, primary care nursing and allied health supports time and time again. The plan reflects an intention to bring those and other resources to the region.

Thompson Region Primary Care Networks Clinical Resource Request:

1. Mental health clinicians: To increase access to mental health services and supports for mild-moderate concerns. ​

2. Primary care nurses: To bolster support and provide additional team members for each family physician and nurse practitioner within the region. ​

3. Family physician or nurse practitioner contracts: New Most Responsible Providers are required by the Ministry of Health (MOH) to address the attachment gap as the primary PCN attribute. This could include augmenting current contracts in place, adding additional contracts into vulnerable areas of our community, and provide coverage for extended hours and locum support.

4. Additional resources: Incorporation of other resources in the PCN that address further gaps. Include: access for physical and occupational therapists; Aboriginal patient navigators; dieticians; diabetic educator; attachment and discharge coordinators, and psychologist. Urgent care services, specifically on the North Shore, have been identified as a need, and mentioned in the service plan although the resources for this need will come from separate MOH funding.

5. Resources for members working in the Community Health Centre (CHC) model are included in the overall PCN service plan, although CHCs have been given the opportunity by the MOH to create and submit a plan that meets ministry criteria and aligns with the overarching attributes of the region’s PCN.

6. Virtual care strategy: Specifically, to create sustainable care and improve access within our region.

The CSC chose to equally distribute clinical resources amongst geographic areas and providers to offer support for all members and their patients. It is anticipated that through MOH negotiations, further member engagement, and phased arrival of resources, there will be modifications to the initial allocation at the time of implementation according to need, readiness, and interest.

Total clinical resources proposed in the Thompson Region PCN Plan by Community Health Service Area.
This is inclusive of the Secwépemc Nation communities of Simpcw (North Thompson), Tk’emlups (Kamloops), Stil’qw/Pelltíq’t (Whispering Pines), Sexqeltqín (Adams Lake), Qw7ewt (Little Shuswap), Sk’atsin (Neskonlith), and Skítsesten (Skeetchestn).

	All	North Kamloops (CHSA 1431)	South Kamloops (CHSA 1432)	Lower Thompson (CHSA 1433)	Total
Family Physician	1	6	5	2	14
Nurse Practitioner	5	4	2	3	14
Mental Health Clinician	2	4	3	4	13
Primary Care Nurse		7	4	4	15
Physiotherapist		3	2	3	8
Occupational Therapist		2	3	2	7
Diabetic Educator		1			1
Psychologist	1.5				1.5
Aboriginal Patient Navigator	3				3
Discharge/Attachment Coordinator	3				3
Dietician - Obstetrics	2				2

Read: The Thompson Region and Resource Equity

We asked ourselves, “When the time comes to distribute resources through the new Primary Care Networks, how do we pursue and show equity?” The answer: Develop an equity framework to answer questions around transparency for resource allocation, which the Division’s Collaborative Services Committee created in 2022.  

Definition of Equity:

The BC Patient Safety and Quality Council defines equity in health care as the just distribution of services and benefits according to population need. Equity involves understanding the people being served, focusing on the social determinants of health, overcoming structural barriers, and eliminating systemic oppression such as racism and other forms of discrimination to address gaps in experience and outcome. 

Equity is shown when health systems and health care is delivered in ways that support people to achieve their health and wellness goals regardless of social, economic, or geographic location. It does not mean that everyone must receive the exact same care, because individuals have different experiences, histories and needs. 

Driven by Data:

A desire to have data be foundational to decision-making lead to consultation of population and health equity experts along with an environmental scan of available community patient health data. Precise, current, or complete data is difficult to acquire and is inconsistent based on the complexities of patient coding, panel management, and individual provider habits. Making use of the data available alongside provider experience and knowledge resulted in some high-level recommendations and a three-step process. 

Recommendations: 

- Simple is best, decide on minimal, meaningful criteria.
- Cultural safety must be incorporated into the process and decision-making.
- Decision-making is not objective, provide documentation and methods.

Collaboration and Knowledge Sharing:

When resources are scarce and cannot meet the demand, there are always questions about who gets what and why. Each situation is unique and will require time and effort to determine criteria and valid information to inform decisions. These three steps are meant to guide the decisions:

Step 1: Construct a framework with a short list of criteria that illustrates need in a meaningful way.

• Define need.
• Choose variables that support the need in a meaningful way, and code according to need. 
• This will create a shortlist ranked by need.

Step 2: Engage a small group of stakeholders in discussion to unpack context and discuss criteria that do not fit easily into your framework.

• Discuss criteria like readiness and capacity that are meaningful to service allocation.
• Determine resource allocation to provide greater service where there is greater need that lifts all up.
• Re-rank providers based on discussion.
• Consider existing resources and weight allocation of new services to provide equitable access across clinics who qualify. 

Step 3: Set realistic expectations, goals, and timelines.

• Moving the system towards greater equity takes time and requires consideration of the entire system, the patient, the provider, and the way the service is delivered. If this is not considered, additional service provision may perpetuate the inequities that currently exist.
• Health outcomes should be the goal, and reasonable evaluation of this should follow. 

We look forward to using the equity framework as a foundational decision-making tool in preparation for PCN resource implementation.