Why Urgent and Primary Care Centres may not be beneficial for rural communities

Urgent and Primary Care Centres (UPCCs) were first introduced to the province in 2018, with the creation of five UPCCs in the West Shore (Langford), Vancouver, Quesnel, Surrey and Kamloops. An additional five were launched by summer 2019. The Ministry has set a target of an additional 10 UPCCs to be opened across BC in 2019/20 – primarily in urban settings. A further 10 will be added in 2020/21.

According to the Ministry of Health (MoH) Policy Directive, the goal of UPCCs is to provide a flexible resource to meet both the urgent and ongoing primary care needs of people in communities  (primarily in larger urban settings) across the  province.

Furthermore, the Policy states that UPCCs will:

  • address urgent primary care needs in the community
  • provide immediate attachment for patients who do not have a family physician or nurse practitioner
  • provide interim attachment for those who may not fit into the traditional model of primary care and for higher needs complex populations 
  • act as a vehicle to attach patients to other practices/Patient Medical Homes within the Primary Care Network as capacity is identified.

The following are several concerns regarding UPCCs placed in rural communities:

  • they are urban based and provide little or no service to rural communities;  their purpose is essentially to provide urgent care to patients and reduce the high demand found in urban emergency departments and do little to reduce emergency department demand in rural communities
  • they focus primarily on episodic care, not longitudinal care
  • practitioners working in UPCCs earn higher salaries and have fewer responsibilities than practitioners in rural settings, which has the potential to attract rural healthcare professionals into UPCCs
  • there are communities where UPCCs have been or will be established that see them as competition against the model of care that they would like to see in their community.

UPCCs are a “made in BC” solution to a very complex problem. To my knowledge there has been no assessment completed as to the efficacy of the UPCC model. On the other hand, the Community Health Centre model  has abundant evidence to show that it is a highly effective approach to primary care delivery, however it receives little or no support. And yet, it appears that the MoH policy is to continue  establishing UPCCs in urban centres throughout the province.

Although the MoH has indicated that they plan to enhance the provision of longitudinal care in the UPCC model, anecdotal evidence suggests that there has been little movement in this direction to date and concerns have been raised about how effective these adjustments will be. 

The other major issue is that this is an urban solution to a provincial problem. For thousands of people living in rural and remote BC, UPCCs will only widen the health equity gap, partly because their location makes access difficult or, in some cases, impossible and partially because it has the potential to siphon doctors away from rural communities into urban-based UPCCs where salaries are higher and responsibilities lower.

The following outlines my position on Urgent and Primary Care Centres:

  1. The best care is longitudinal care, that places the patient at the centre of their care, takes into account the context of the patient’s family and wider social environment, and develops a healthy relationship with a team of healthcare providers.
  2. The backbone of a team-based primary care system should be a major expansion of Community Health Centres (CHCs) which are non-profit, community-governed primary care centres that emphasize long-term, relationship-based care delivered by an interdisciplinary team of practitioners.
  3. Why In rural communities where UPCCs presently exist, effort shall be made to incorporate as many of the five criteria of the Community Health Centre (CHC) model as possible.
  4. UPCCs risk widening the health equity gap between urban and rural British Columbians. Rural BC residents require a model of care that addresses their distinctive needs, e.g. Community Health Centres. Urgent and Primary Care Centres (UPCCs) will provide primary care services to populations of select communities throughout British Columbia, particularly in metro and urban areas
  5. One of the objectives of the UPCC is to increase attachment to a GP/NP. However there is no evidence to indicate that this has happened. A broader policy needs to be developed that addresses rural patient attachment in an effective and sustainable way.

https://www.healthlinkbc.ca/services-and-resources/upcc

https://www.pcnbc.ca/media/pcn/PCN_UPCC_Revised_Policy_October2019_V5.pdf

https://vancouversun.com/news/local-news/fact-checking-the-throne-speech-inflated-numbers-on-doctors-and-nurse-practitioners-at-urgent-care-clinics-govt-admits

Nienke Klaver

Letter: Visiting MD impressed with Princeton and its people

Locums – visiting doctors – give support to Princeton General Hospital and Cascade Medical Centre.

This letter was received by the municipality earlier this month.

November, 2020

Dear Mayor Coyne:
Thank you for the personal visit when I started my locum period in Princeton, and the very generous gift bag and basket.
I very much appreciated your taking the time to swing by. I enjoyed all the goodies and also took advantage of the invitation from Rick Watson to do some bicycling in the area.
We actually ran into each other (not literally) up on China Ridge and I was impressed hearing about the features of the area.
I have done many locums and this is the warmest welcome I’ve received. It makes a difference starting in a new community to feel appreciated. It relieves some of the stress of figuring out the new computer system and local protocols and how the place is organized.
The doctors, nurses and staff at the clinic and hospital were all helpful and welcoming.
I went twice to Cool Beanz and the second time was called by name. That was a realy nice bonus.
I enjoyed my time in Princeton and will be happy to locum in your community in the future. Thank you again.
Dr. David Singleton

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Interested in creating actions together to increase patient engagement in policy?

November 24 & 26, 2020
5:00 PM – 7:30 PM
(should be able to attend both sessions)

– Are you a patient living with two or more chronic health conditions?
– See two or more health care providers in the community, that work together?
or:
– Are you a caregiver (significant other, family member, friend) that lives in BC and provides care for a patient as described above?
– Are you interested in discussing how patients and caregivers could be involved in building, applying and evaluating policies related to primary health care teams?

If interested, please email Azmita Rai at azmi@alumni.ubc.ca
or Nelly Oelke at nelly.oelke@ubc.ca

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BC Rural Health Network November Newsletter

A selection of what is in this issue:

– Questions we asked our politicians
– Presentation by Dr. Wachtel: pandemics, vaccination, public health planning and rural health
– Citizen Patient Engagement – Interview with Ed Staples and Nienke Klaver
– A variety of articles on Long Term Care and Home Support

Download the Newsletter (below) or scroll through the screenshots.

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A bridge to action

October 23, 2020
[Excerpt] One day on a walk with my daughter and our dog in my hometown of Princeton, we stopped to look at our local “Bridge of Dreams”.

While standing there, my daughter pointed to graffiti done with a black sharpie on the bridge and asked me what it meant.There were racist, sexist and homophobic slurs as well as many symbols associated with Nazism. I felt shocked and responded hesitantly as I was forced to have a difficult conversation right then and there with my girl around inequality in our society which included the concept of genocide. This conversation was not easy as I tried to tone it to the innocence of my child.

Please click on the link to read the full blog. https://news.interiorhealth.ca/news/a-bridge-to-action/…

About the author
Erin Traverse
Erin is a nurse at Princeton General Hospital. She’s also a mother and a community member who wants to speak up about social justice.

Boundary-Similkameen Candidates answer SOHC’s health care questions.

Questions to Boundary-Similkameen candidates.

  1. What will your party do to relieve the financial hardship of travel for medical care?
  2. What will your party do to increase specialist services in rural areas?
  3. What will your party do to provide family physicians in areas that have none?
  4. If elected, what will your party do to ensure adequate financial and planning support is provided to rural communities expressing an interest in establishing a Community Health Centre?
  5. If elected, what will your party do to ensure continued funding for existing Community Health Centres?
  6. If elected, how will physicians be paid in Community Health Centres?
  7. What is your party’s position on private, for-profit healthcare?
  8. What is your party prepared to do to defend further challenges to Canada’s public health care system?
  9. What would you and your party do to improve long term care in BC?
  10. What is your party’s position on P3s in healthcare?
  11. As a candidate in the provincial election, what are you and your party prepared to do to address these barriers to mental health and addictions services in rural BC communities? (transportation and out-of-pocket costs, small town stigma, physical distancing)