PCN Evolution is an innovative process designed to involve physicians and other stakeholders in shaping the way PCNs will continue to improve upon patient care delivery, as well as align with the provincial health care strategy.

Among its key initiatives, PCN Evolution is laying the groundwork for every Albertan to have a health “home” anchored by a physician with the support of a broader health care team for improved access, increased services and ultimately better care.

PCN Evolution involves participation from the following stakeholders: the Alberta Medical Association (AMA), Alberta Health (AH), and Alberta Health Services (AHS). These parties are developing a report, outlining the framework or vision for the health-home model of primary care, which will be presented to the minister of health by December 31.

The name PCN Evolution may be new, but the concept is not. PCN Evolution is actually the culmination of many ideas discussed over the years including the AMA’s Vision for Primary and Chronic Care paper based on the College of Family Physicians of Canada medical home model. It also aligns with the AH primary health care strategy.

Participation in PCN Evolution is voluntary for both physicians and PCNs. Although, once signed on and committed as a participant in the PCN, there is a responsibility to meet the professional obligations of the goals and objectives of the PCN, including PCN Evolution.

The first PCNs in Alberta were formed eight years ago and today more than 40 operate across the province. They vary in size and scope, providing services ranging from anti-coagulation management to diabetes clinics to preventative health screening.

Yet, stakeholders recognize that more can be done to share best PCN practices and innovations, and better align individual networks with the overall vision of a health home model.

Individual PCNs are already evolving by refining their programs, processes and accountabilities. PCN Evolution is a provincial, system-wide initiative that builds on past successes and provides a coordinated approach to continue that progress.

The PCN Evolution Steering Committee is a trilateral committee of physicians and other professionals in the primary health care field. The committee is supported by resources from the AMA, AH and AHS. They are consulting with primary care physicians, PCN executive directors, patients and other stakeholder groups throughout the process.

PCN evolution Steering Committee members:

• Dr. Tobias N.M. Gelber, steering committee chairman; President, Section of Rural Medicine
• Dr. Phillip W. van der Merwe, PCN Physician Lead Executive
• Dr. James R. Adams, PCN Physician Lead Executive
• Dr. Peter J. Bouch, PCN Physician Lead Executive
• Dr. Johannes (Vicci) L. Fourie, PCN Physician Lead Executive
• Dr. Peter S. McKernan, PCN Physician Lead Executive
• Dr. Ann R. Vaidya, President, Section of General Practice
• Dr. Peter C. Jamieson, Section of General Practice alternate representative
• Dr. Catherine L. Scrimshaw, Alberta College of Family Physicians
• University of Calgary, academic representative
• Joan Berezanski, Executive Director, Primary Health Care, Alberta Health
• Line Porfon, Executive Lead, Primary Health Care Initiative, Alberta Health
• Dr. Richard Z. Lewanczuk, Alberta Health Services
• Dr. Nicholas J. Myers, Alberta Health Services

The PCN Evolution Steering Committee is currently considering a number of strategies that may help guide the evolution of primary care. These strategies are still being developed and even the terminology remains "under construction." Some possibilities include:

• Expanding access to primary care: Extend clinic hours and offer group visits to provide timely appointments for patients; make better use of technology such as email, video conferencing and websites to streamline patient access and information.
• Building enhanced teams: Allow team members to work to their full scope of practice; provide patients with opportunities to reach health care professionals at multiple access points while being anchored by a primary care physician.
• Enhancing accountability: Monitor the outcomes for patients related to the health care services provided and develop basic standards of measurement for PCN performance.
• Integrating with population health services: Develop a pooled community approach for health promotion and preventative programs such as smoking cessation, health screening and lifestyle programs.
• Encouraging public engagement with PCNs: Empower patients to take a more active role in their health and quality of life; offer Albertans the opportunity to share ideas for improved health care.
• Improving governance: Ensure appropriate governance and operational decision-making structures and processes are in place; clearly define roles and responsibilities for PCN administration and management.
• Introducing formal linkages between patients and physicians: Provide each patient with timely access to a primary care physician and a health home; define physician-patient relationships.
• Improving coordination with other primary care services, specialty and tertiary care: Coordinate more efficient patient care with community agencies and services, as well as specialists and specialty services.
• Establishing standards and measures: Develop standardized PCN health services and evaluate for consistency and quality; define funding agreements with clear accountability provisions and targets.
• Coordinating and integrating information management and technology: Ensure all team members have access to electronic health records when necessary; electronic medical records infrastructure and support is available; identify core sustainable requirements aimed to improve business and clinical decision making.
• Identifying funding needs and possible options to better support primary care: Primary care will remain publicly funded and supported. However, additional investments of time and resources at the clinic and PCN levels may be required along with future funding strategies.

PCN Evolution will develop over time, but some opportunity areas have already been identified by the PCN Evolution Steering Committee and Alberta Health. These concepts expand on work already undertaken by some PCNs, which include:

• Building awareness of PCN connections: Some patients know their physician is part of a PCN; others do not. The steering committee wants to make Albertans aware of PCNs and the services they provide.
• Connecting Albertans with a primary care physician: Albertans should have access to a primary care physician when necessary, as well as an ongoing relationship with a physician and health home. PCN Evolution envisions a more formal relationship being established between physicians and patients.
• Increasing same day/next day access for patients within a PCN: After-hours clinics and making another health care provider within a PCN available to patients are just a few ideas already being carried out successfully in some PCNs to improve patient access. These changes will not necessary mean changes for individual physicians, but can possibly be achieved through a PCN solution. Exploring alternative ways to measure patient access to care is also being considered.
• Improving coordination between patients and non-health services support: Coordination of care between PCNs and community and social services is recognized as a key strategy to improve health outcomes. Processes to align work more closely with Strategic Clinical Networks are also being considered.

Yes. Participation in PCN Evolution is voluntary.

However, once a physician decides to participate in PCN Evolution, there may not be a choice of which components to implement. PCN Evolution will evolve through many strategies at many levels over a period of time, similar to the way PCNs developed their programs and services to meet the needs of its population. Decisions on implementation may be determined and implemented provincially, locally or possibly at a zonal level.

Physicians are encouraged to attend upcoming presentations on PCN Evolution offered by their physician leaders or other PCN 2.0 representatives at local town hall, annual general meetings and other venues.

The Primary Care Newsletter — emailed to all primary care physicians province-wide — will provide frequent updates on PCN Evolution. Further details are also available on the AMA website.

Physicians can also submit their questions and comments for consideration by the PCN Evolution Steering Committee to pcnevolution@albertadoctors.org.