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:
- 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.
- 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.
- 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.
- 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
- 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.