1. Attachment Update Divisions Provincial Roundtable May 31, 2012

2. Timeline 2 *Program design *Prototype selection *Development funding June 2010 *Research *Good enough definition *Engage CSC *Develop plan *Year 1 Implementation funding March 2011 *Practice payments using algorithm *Research and finalize plans, implement *Engage docs, HA and local partners *Year 2 Implementation funding March 2012 *Connect and strengthen *Practice payments using algorithm *Test My GP, refine definition *Evaluate

3. Innovations to share Practice Assessment Survey Integrated practice supports Practice payments and PIA Multidisciplinary grants Community survey of patients Community level gaps analysis Community engagement Primary care clinic with distribution focus Patient engagement Definition of attachment Patient confirmation process – primary care provider 3

4. Evaluating the Issue: Unattached Patients Prince George Estimated unattached patient population: 15,000 variation according to life circumstance and chronic conditions White Rock–South Surrey 5 to 35% of population unattached: Hospital discharges: 5-20% ER: 10-35% Cowichan Valley 5% (4,143) Unattached Patients 40% (33,148) Poorly Attached Patients 4

5. Attachment Strategies: Enhancing capacity of the local primary care system: Practice coaching Recruitment and locum coverage Making coordination of care easier – technology, Integration Recognizing and rewarding longitudinal care provision Creating multidisciplinary care models Stand-alone clinics with assessment and distribution functions In-practice enhancement of non-physician providers Enabling access to phychiatrist, pharmacist, other providers Improving health of population overall to reduce demand Community-level collaboration with public health, municipalities 5

6. PGDoFP Strategic Directions 6

7. Prince George - Attaching Patients Current activities Unattached patient clinic – opened May 2008 Inpatient Primary Care Program (for unattached patients) Managing retirements Analysis of Practice Assessment Survey Data Recruitment Supporting practice effectiveness Next Steps Primary health care clinic (will incorporate UPC) Opening July 2012 Increase support for practice effectiveness and capacity 7

8. Cowichan Initiatives Provincial Attachment Working Group Family Practice Hospital Support Program Cowichan Maternity Clinic Aboriginal Health Working Group Chronic Pain Working Group Warmland Health Services: Unattached Patient Services End of Life/Palliative Care Working Group CVDFP Attachment Working Group Current Initiatives: Proposed Initiatives: Practice Coaching Locum Coordinator

9. Cowichan - The synergistic effect of taking a mixed approach… 9 … allows the community to develop an overall vision and then implement portions of the vision as funding and resources allow.

10. White Rock-South Surrey - Attachment Strategies 10 Increase Capacity & Support Strength of Attachment Develop &/Support Targeted Programs for Vulnerable Populations Increase Public & Patient Understanding of Attachment

11. White Rock-South Surrey 11

12. Results to Date WRSS: 2500 patients attached 900 through 2 new doctors 600 through PCAC PG: 3771 patients attached Recruitment (3192) Residential care (114) IPC (465) Cowichan: 575 patients attached Maternity clinic (133) Hospital support program (21) Locum program (421) 12

13. Risks and Challenges No Physician Master Agreement, resulting in funding uncertainty Administrative stability (staff turn-over) Hospital care pressures Physician burnout Patient inflow Unrealistic stakeholder expectations Accommodating patient choice Physician office space limitations Difficulty recruiting new physicians to some communities Difficulty staffing clinics 13

14. Thank you.... Questions? 14