I had the privilege of speaking with Julius Halaschek-Wiener, the KB PCN Lead and Erin Fazzino, KB Clinical Operations Manager prior to Julius’ departure in June back to his home country Austria. I asked for their thoughts on the development and progress of our PCN and any words of wisdom for those who follow their lead.
For those of you unfamiliar with the term Primary Care Network (PCN), the definition provided by the Ministry of Health [MS1] is: “A PCN is a clinical network of local primary care service providers located in a geographical area, with patient medical homes as the foundation. In a PCN, physicians, nurse practitioners, nurses, allied health care providers, health authority service providers, and community organizations work together to provide all the primary care services a local population requires.”
The KB PCN work began in 2019 with a service plan, and our region was among the first wave to receive funding from the Ministry to begin the work of building robust team-based care. This included hiring additional registered nurses and nurse practitioners; social workers; physical, occupational, and respiratory therapists; a clinical pharmacist and aboriginal health coordinators. Thirteen of the 26 practices in the KB indicated readiness to engage in this endeavor which required willingness to shift to a different model of providing care, including quality improvement efforts, and having space to include additional care providers. The KB PCN is now in its 5th year of operation and, although much work remains to assist the remaining 13 practices and Boundary Proof of Concept in their journey toward team-based care. As funding becomes available, the Collaborative Services Committee and PCN steering committee will work to ensure that all patients have access to a medical home.
Both Julius and Erin stressed that the most important aspects of developing and sustaining a PCN are strong relationships between partners and a shared goal towards meeting the attributes of a high-quality primary care delivery system. Supportive leadership from the Health Authority (HA) and the creation of a Change (implementation) Team were key to this effort. The ability to change was also supported by the establishment of a Learning Lab, where team members from participating practices met for educational sessions, to find solutions to problems together, and to integrate culturally-safe care. The stable leadership over the past 5 years and the tripartite leadership of Interior Health (IH), Divisions of Family Practice (FP) and First Nations partners were vitally important for ensuring that all perspectives were respected and considered.
The challenges of engaging in this work were nothing short of monumental. There was no template for creating a PCN, no process for collaborative hiring or creating contracts, no established workflow or processes to enable team members to work together, and no scope-of-practice documents. Despite this, Julius noted that the KB was well positioned to begin this work as we already had strong, established relationships with many of the partners in addition to division expertise with quality improvement and practice support outreach. Sitting together and working through these issues allowed for the creation of combined clinical positions providing services in new ways and innovative space solutions. Julius was awed by the passion for supporting patients and full engagement that was brought by every single person who joined the PCN team.
As a result, the KB PCN completed 96% of their initial hiring with over 50 new staff members who provided over 60,000 patient encounters since 2019. This work has been instrumental in limiting new unattachment and in attaching the most vulnerable patients to clinicians through the Health Connect registry. Other initiatives include establishing the KB Health (Online) Clinic (https://kbhealthonline.ca) and a second health screening (Online) clinic to help unattached patients receive health screening (https://www.kbscreen.ca). Erin is particularly proud of the PCN’s support of COINS (https://coinations.net, 1-877-904-2634) through strong Aboriginal partnerships.
Their advice regarding future efforts for strengthening the KB PCN are to be more inclusive of all healthcare and community (e.g., patient) partners, moving beyond the goal of full attachment (everybody has a family doctor or nurse practitioner) and focusing on achieving meaningful access to services for the entire community. Options might include Provincial episodic care services, more Nurse Practitioner resources, expanding KB Health Online, virtual care options for IH clinics, Community Health Centers and more regional PCN staff. Options like sitting with an Elder, grandmother or community volunteer, known as “social prescribing”, to solicit support and advice, expanding paraprofessionals such as life skills workers and kinesiologists, and increasing numbers of patient navigators. There can also be greater efficiencies in the current system with better triage so patients are directed to the best care option for a given health need. Finally, we need to explore other sources of funding (e.g., Columbia Basin Trust, local industry) besides the Ministry of Health.
Julius concluded by emphasizing that without meaningful and strong relationships, there is no trust and nothing gets done. Deep listening and honoring your partnerships (HA, Division of FP, PACC, Aboriginal partners) have been instrumental for advancing this work. We will need to continue to work closely with the Ministry of Health to support local solutions; many health care programs are designed with an urban lens in mind and those often do not work in rural and remote areas. He also emphasized that how we show up to this work has an effect and lasting progress requires true collaboration.
[MS1]https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/heath-care-partners/health-newsletter/context-pcn-december-2019.pdf
Mindy Smith, MD, MS; PACC member
