Gabriola Health Care Society, September 26, 2008

    A meeting about Primary Health Care on Gabriola was held with senior representatives from the Ministry of Health and Vancouver Island Health Authority, the Gabriola Health Care Society, representatives from community organizations and physicians from the Gabriola community on Sept. 19/08. The following key issues were discussed:

Community Participation

  • The aim is for Gabriola to move forward towards having a robust family practice setting with support, good finances, and connection to community.
  • The community process needed to make this happen will integrate, co-ordinate, identify priorities, and then agree on the steps needed to create solutions.
  • The more people who are engaged, the greater will be the success. There will need to be transparency, clearly understood agendas, reality acknowledgement, honesty, and understood vision.

Robust Primary Health Care

  • Gabriola has a population of 4,500, half of whom choose to receive their medical care off island, leaving a total of approximately 2,300 who choose to seek medical care here on this island. Medical Services Plan billing figures for Gabriola physicians support these figures. Community members indicated that a stable physician population will attract more on-island clients to Gabriola physicians.
  • MoH and VIHA recognize that Gabriola’s population does increase to approximately 7,500 in the summer months and there is a need to respond to the medical requirements of those part time residents in some way although our first priority needs to be stabilizing based on our current winter residential base.
  • Gabriola's population is older than other communities in BC, but somewhat healthier. Our chronic care statistics are consistent with those of other communities in the province.
  • The average volume for a successful family medical practice in the province of British Columbia is 1,200 patients per doctor. Gabriola can therefore support two full time physicians or that equivalent in part time physicians based on the current number of residents using Gabriola physicians. However, if all Gabriola residents had a physician on Gabriola we could support at least 3 -4 full time physicians.
  • There is currently one full time physician (who also provides on call services) and three part time physicians. Of those part time physicians Dr Harding will retire at the end of October, Dr Mackenzie is undecided on his next steps and Dr. Smith is willing to stay on or retire based upon whatever complement of physicians makes sense for Gabriola Island. One Gabriola physician has a waiting list of 200.
  • Without a change in current physician complement or without more Gabriola residents deciding to move to one of the Gabriola physicians or unless there is an increase in population we cannot support another full time physician.

Emergency Care

  • Two full time medical doctors, or the equivalent in part time physicians, cannot provide 24 /7 emergency care or urgent care on Gabriola Island. The toll it would take on them, as individuals, would be unacceptable.
  • A community member stressed the need to look at the business case – the emergency response now on Gabriola is saving taxpayers money through reduced emergency visits to Nanaimo and reduced ambulance trips.

  • Compensation

  • Several community members identified current compensation framework as a barrier to responding to the needs of communities like Gabriola.

  • Supports that Gabriola is receiving

  • VIHA/MOH feel they have gone all-out to help and are willing to work with us to move forward – they also stressed that it is up to the community to make it work. Ministry of Health has designated Gabriola as a site to receive incentive funding in the Family Physicians for B. C. program, $100 K which assists in recruiting doctors to the island.
  • Gabriola has been designated to receive MOCAP funding for after hours on-call emergency response starting October 1, 2008.
  • We must work to ensure the current physicians are supported and make use of VIHA programs that are offered such as IHN. VIHA will support the physicians if they wish to get involved in the Integrated Health Network in Nanaimo
  • The physicians should discuss with their colleagues the possibilities of a Family Practice Division involving either other Nanaimo family physicians or family physicians on the other Gulf Islands.

  • Location of Clinic

  • Future location of a community based clinic on Gabriola must be based on community identified criteria, a transparent community process and if possible should co-locate all physicians. GHCS provided an outline of the process they are undertaking, including input & decision making points by community members (this was further outlined in the next steps email sent out by GHCS).
  • The most cost effective way to support a multi-physician population would be in a single location. The community should do what’s best for the community irrespective of previous arrangements.

  • Nurses and Nurse Practitioners

  • VIHA does not recommend a Nurse Practitioner for Gabriola. Under BC policies a Nurse Practitioner operates on a Fee for services basis so would reduce the income available to the MDs. Nurse practitioners work best in practices of four or more doctors. On the other hand, Integrated Health Care workers can support MD’s and do not reduce the fee-for-service income.
  • The home support nurses at the meeting stressed the need to ensure that those nurses currently working on the island be included in the planning for primary health care on Gabriola. Cuts to home support services and impact on ambulance society's need to provide those services now was raised as an issue.

  • Physician Recruitment

  • No matter what we as a community think or want, no new physician is going to come to Gabriola and set up a medical practice, if they know they will not succeed financially, and be unable to pay their expenses. The existing doctors, and the community, must develop a well thought out business case that demonstrates that the Island can support an additional physician. We need to work on suitable accommodation and low clinic overheads to make it financially attractive for physicians to live on the island. Other communities across the country are offering incentives to make their location attractive for physicians.
  • New medical graduates have a huge range of options. It is up to the community to make itself an attractive place to practice for the potential physician, and an attractive place to live for all family members. The last locum on Gabriola indicated she felt very welcomed into the community.
  • There are at least thirty similar communities in the province who are having difficulties attracting physicians. We must continue to recognize and appreciate the current services on Gabriola Island and recognize that the difficulties we face are similar to other communities throughout BC and Canada.

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