About the PCN review report

July 5, 2016

Dear Member:

As you may have seen in media reports, yesterday government released a review of primary care networks (PCNs). The report is available at www.health.alberta.ca/documents/PCN-Review-2016.pdf. The report is a review of some elements of PCN operations in a sample of PCNs. As might be expected, the review identified some things that need to be addressed. As always, we are open to ways to improve what we do as physicians and we will work with government to deal with these issues.

At the same time, I would like to see this event as an opportunity to move forward and build the primary care system that patients want and deserve. I will say more about this at the conclusion of my letter.

A balanced approach

First though, I want to comment on what the report said and – even more importantly – what it did not say. Looking back over 10 years of PCNs, we can see that their impact has included better access to family physicians for more Albertans, fewer emergency department visits and shorter hospital stays. The report identifies some immediate term problems, but does not acknowledge what has been accomplished or address what is needed to continue to improve patient care. Specifically, how can we build on the strong foundation that PCNs have created?

Again, we are more than willing to work with government to address issues arising from the report. Government deserves commendation for their commitment to primary care as the key to system integration and cost reduction. With respect to the problems identified, though, context needs to be considered.

• There has been comment on use of PCN funds outside of policy guidelines. The policy manual setting expectations for appropriate use of PCN funds had not been updated by Alberta Health since 2008. It is now being updated and some issues have already been addressed.
• There will be focus on variation in compensation for some executive directors of PCNs. This is another important topic and also one that the PCNs flagged to government. As a result, a salary grid was established that covers the great majority of cases.
• There will be references to the desired ratio of four other providers to one physician. It must be recognized that a payment of $62 per year per patient will not support that objective. The current lower ratios reflect the costs of hiring, providing space for and supporting those team members.

Getting on with the job

The report will help us solve identified problems, but more importantly will help us move forward on delivering better care for Albertans. What will be required?:

1. The report notes that Alberta Health is responsible for some of the challenges identified. The ministry can continue their efforts in primary care. This means policy development, evaluation of PCNs and their initiatives and efficiency in processing business plans, etc.
2. We need a structure to make decisions together in a way that is timely, balanced and transparent.
3. There are other improvements to be made:
   • Fully enabling e-visits and other technological ways to improve access.
   • Allowing patients access to their own health information so they can actively participate in their care.
   • Improving information available to physicians so we can adjust what we do toward best practice.
   • Reform in the payment model – how physicians are paid for care in teams.

Our job as physicians is to work as partners on the challenges – and then keep pushing for the big goals that matter for patients. The needs I have identified today are things that have been addressed in my term and also by my predecessors. There is well-informed advice available from groups like the AMA-AHS-PCN Physician Leads Joint Venture Council. In that light, I hope the report will create momentum to build on ongoing improvements that are needed in the system.

Please let me know what you think. Email president@albertadoctors.org or leave a comment below.

Kind regards,

Carl W. Nohr, MDCM, PhD, FRCSC, FACS
President