A local physician says primary care has come a long way since the first Primary Care Network (PCN) was established over a decade ago, and that to go any further requires better funding and clearer direction from the provincial government.
Alberta Health released an internal review earlier this month that found PCNs are struggling to meet their goal of introducing team-based care and expanding after-hours services.
Improving primary care services is meant to lessen the burden on other areas of the health care system, by curbing unnecessary emergency room visits.
Past president of the St. Albert and Sturgeon PCN Darryl LaBuick says progress is limited by dollars and political will.
PCNs receive funding based on the total number of patients served at a rate of $62 per patient. As a result of the review, where all participating PCNs expressed frustration over lack of stable funding, Alberta Health has committed to developing a new funding model within the upcoming months.
The review also suggested eliminating the closing cost reserve – a sum of money set aside in the event the government decides to disssolve the networks.
The report indicated that for the 13 PCNs evaluated there was a total of $14 million set aside, which cannot be put towards programs.
LaBuick estimates the St. Albert and Sturgeon PCN could hire an additional six staff with the money held back in their contingency fund.
He would also love to develop better programs for seniors in assisted living complexes and improve transition of care for patients leaving the hospital – two areas indentified as lacking progress by the report.
"But these are huge programs that cost a lot of money," he said, "and we need the collaboration with AHS."
Adding to the problem is the lack of political stability said LaBuick.
Alberta has seen five different health ministers and several chief medical officers in the past decade.
“We’ve had incredible turmoil within the health care system. We’ve had to work through that as well as try to improve our game. So I take exception to the fact that they are being critical," said LaBuick.
LaBuick welcomes more stringent financial policies and guidelines. The review found many instances of inappropriate and questionable spending on everything from alcohol for meetings and events to gifts for staff to grants for local charities by some PCNs.
He also believes PCNs could benefit from clearer service level expectations and more standardized approaches to determining and evaluating community needs and health outcomes.
"They have to be careful if they want to implement big sweeping changes," warned LaBuick. "The problem that we've had in our province is continual sweeping changes to our healthcare. I don't think it's really benefitted anybody. We're still way behind in so many areas because we're constantly changing and not offering a level of stability and improvement to programs."
Locally, over 50 per cent of physicians within the St. Albert and Sturgeon PCN are working on medical home concepts and all physicians are required to be on call for their patients.
The PCN tried an after-hours program, but were unable to guarantee funding because it exhausted their surpluses.
“It’s not that we haven’t been working on it, but we’ve been unable to lock down funding that would support that,” said LaBuick. He said the PCN also ran into the issue of private laboratories and diagnostic imaging services not being open past regular business hours.
“We aren’t able to create any supports around after hours, but then they criticize within that paper that we should do things after hours. This is like a car company wanting to design a new car, without changing the assembly line,” said LaBuick.
