July 5, 2012, President's Letter

July 5, 2012

From Dr. Linda M. Slocombe

July 5, 2012

Dear Member:

In this letter:

  • Auditor general’s report shows understanding of the value of primary care.
  • PCNs limited by lack of appropriate support.
  • Report has implications for developing 140 family care clinics.

Yesterday’s report from Alberta’s auditor general shows a good understanding of primary care networks (PCNs) – their successes and their challenges – and the value of investing in primary care.

It also speaks to the need for greater accountability. The report, therefore, can serve as a reference and guide as Alberta’s primary health care continues to evolve with additional investments by government.

Guidance for FCCs

Furthermore, the auditor general provides valuable guidance for the government with its plans to set up 140 family care clinics (FCCs). 

“As with the PCN program, all major initiatives in primary health care need clearly defined expectations and systems to measure and report performance. As the FCC initiative goes forward, the department needs to consider the issues discussed above to determine the systems it will require to ensure FCCs are duly accountable and have adequate support to ensure their success.”

Positive outcomes, good practices

The auditor general” found weaknesses in the systems of accountability and centralized support for the PCN program,” but is complimentary to those involved with the primary care networks:

“… we observed many examples of positive outcomes and good practices by individual service providers, management and staff at PCNs and AHS, as well as the department.”

In one success cited, “a recent independent study compared 75,000 diabetics receiving treatment in a PCN with 75,000 diabetics not receiving their treatment in a PCN and found care within a PCN was associated with a 20% reduction in the rate of admissions to hospitals and visits to emergency departments for diabetes-specific conditions.”

More support

The auditor general’s report makes it clear that PCNs could have been more successful with the appropriate support from Alberta Health.

  • “The department assigns patients to PCN patient panels but does not proactively inform the physicians, the PCNs or AHS which patients have been assigned to the PCN physician panels.”
  • Alberta Health should “proactively inform Albertans which primary care network they have been assigned to, and what services are available through their PCN.”
  • Alberta Health “has a wealth of health data that would be very useful to PCNs in planning and evaluating their services, but does not have systems to share this data with PCNs or help them analyze it.” For example, PCNs need information about which Albertans have chronic diseases, and about ”immunizations and patients who require and have received screening services.”

A primer on primary health care

In one sense, the 37-page section on PCNs reads like a primer on the importance of primary care and a history of the primary care networks.

Primary health care is “the key to effective and efficient management of chronic diseases.” Globally, the case for primary health care is well established: stronger primary health care leads to better health outcomes” and “increased availability of primary health care results in higher patient satisfaction and reduced total health care spending.”

And, from a taxpayer’s point of view:

“Chronic diseases are a significant burden for the health care system. Alberta’s health utilization data shows the Ministry of Health spends about $400 a year for a healthy person.

This compares to $650 for someone with an acute condition, $1,400 for a person with a single major chronic condition, and $10,000 for someone with multiple chronic conditions.  “Although cancer is generally presumed to be a major cost to the system, the average yearly expenditure for someone with cancer is $4,700.”

From the perspective of the Alberta Medical Association, primary care networks are perhaps the outstanding innovation in Alberta’s health care system over the past few years – especially with their development of multidisciplinary health care teams. But both PCNs and Alberta’s primary health care system must, and will, continue to evolve.

Physicians and the AMA support additional investments in primary care in order to put Patients First® and provide Value for Patients®. But we also recognize that, as this occurs, there is a need for accountability to the taxpayer – which is at the crux of the auditor general’s report.

As such, the findings by the auditor general speak to the importance of the task force on primary care networks that was contained within the now-expired Agreement in Principle between the AMA and the government. The sooner we have an agreement with government, the better.

I welcome your feedback on the auditor general’s report, and your views on any topic or issue important to you. Email me at president@albertadoctors.org

Yours truly,
Linda M. Slocombe, MDCM, CCFP

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.