MISSION STATEMENT Equality Quality Accessibility Sustainability

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1 MISSION STATEMENT The mission of the Phoenix Medical Practice is to provide everyone with easy access free at the point of need to high quality, sustainable essential health care services regardless of race, colour, creed, sexuality, social class, ability to pay, religious persuasion, language, or the complexity of their need. Equality A civilized society is judged on how it treats its most vulnerable citizens. There must be no barriers to essential health care either financial, individual, institutional, nor perceptual. Patients must both be able and feel they are able to access care equally. No priority or impediment must be placed on the colour of their skin, the place of their birth, the language they speak, the religion they profess, the sexuality they express, the social class they belong to, nor the complexity of the care they require. Essential medical care must be available free at the point of need to all. Quality The care provided to patients must be of the highest possible quality which is only possible by employing a team of the best available professionals and medical assistants, valuing and rewarding that team with the best facilities and best rates of pay and terms of employment possible, using the best available medical computer systems, and working in an environment that is happy, collegiate, welcoming, and conducive to health. We must constantly strive to find better ways to provide care and to monitor our provision of care, both to prove quality care is being provided and to be vigilant for all potential hazards to patient safety. Accessibility We must meet the three levels of the accessibility pyramid. 1. To provide easy access to registration with a family physician for all who need it. 2. To provide easy access to appointments by providing appointments in advance and within 48 hours - making it easy for patients to book an appointment, for example by having enough telephone lines and reception staff to deal with call volumes. 3. To minimise waiting times on the day of the appointment, and to provide patients realtime information about those waiting times online in order that they can plan their visit. Sustainability The provision of health care must be both properly funded, to ensure that we attract and retain the best possible physicians, but also must be provided with maximum efficiency in order that the health care is affordable to society in the long term and is an efficient use of taxpayer money in the short term. Sustainable medical cover for each patient should be achieved by using a group practice model with a number of physicians providing care for a large number of patients, thus ensuring that the loss of a physician will not result in the loss of medical cover for any patient. Development of a Modern Primary Health Care Centre Infrastructure required for a primary care medical practice The infrastructure that is required for a well run, efficient medical practice contain the following elements: Information technology Management structure Nursing team Medical team Professions Allied to Medicine

2 Information Technology Benefits of using an EMR are well known. Within a medical practice it actively supports collaborative practice, ensuring the best possible care for patients. A quality EMR would contain: High Architecture, mission critical features, not found on icore/cerner Disease Registers module Preventions module CPP module (summaries of key medical and social issues) Clinical reminder module Internal referral / communication system eform generator to create auto-population of patient data to common request forms Customizable searches which can be run on an automated schedule SQL database access for data harvesting (trends, targets etc.) Basic features (all EMRs) echarting (free text) Scanning in of paper documents (paperless) Prescribing module Measurements module (BP, pulse etc.) Management Structure In order for an organization to run efficiently so that each person works to their skills and level of knowledge and for the practice to run smoothly on a day-to-day basis some management is required. The Phoenix Medical Practice has the following roles in place in their management team: Practice Manager, Clinical Services Development Manager, Lead Receptionist The following are skills required from the management team: Experience of change management in primary care Trained and worked in a modern primary care team system Experience of clinical governance Experience in managing people Within the organizational structure there needs to be: Clear chain of command Clear policies, procedures, protocols, and processes for all key tasks Clear communication channels internally and externally to the practice Clear communication channels with patients 1. Core Primary Care Clinical Team The Core Primary Care Team is comprised of Physicians, Nurses and a Pharmacist with non medical staff supporting these roles. Nursing Team The nursing team is led by an RN (Lead Practice Nurse) and the team works in collaboration with the medical team. The Lead Practice Nurse requires with experience in Primary Care and managing chronic diseases. The nursing team will work within their own clinical competence and according to the practice Protocols, guidelines, processes for all key clinical elements with supporting Medical directives. The nurses will refer to the medical team when necessary.

3 Medical Team The medical team is led by the Lead Family Physician with experience in leadership in a modern primary care team setting with delegation of appropriate tasks within the medical team to nondoctor health providers. The team consists of: Physician Health Care Technician Pharmacist Pharmacy Technician The medical team will refer to the nursing team when required. Collaborative practice The practice works in a collaborative way that is: A shared focus on delivering quality patient care Improved communication through the EMR, informal and formal meetings Improved decision making More effective use of staff time, knowledge and skills Increased understanding of the contribution that each team member makes in the team. The nurses work to protocols and medical directives but if a patient presents that is outside of that scope then the patient is referred back to the medical team either the physician is asked to see the patient whilst the patient is on the premises or they are asked to make an appointment. Funding Currently the funding is through the Fee for Service model which is not enabling this model to be financially sustainable. Services offered at Phoenix Medical Practice General Nursing Services Phlebotomy ECGs, Wound Care, Ear Syringing, Cryotherapy, INR, Sleep Study, 24 hr Blood Pressure check, Mini-Spirometry, FOB Specimen collection Routine BP checks PAP test Baby and Mom Checks Nurse registration Ante natal health promotion Family Planning/Sexual health services Well person screening Flu shot Clinic Lifestyle advice Weight Chronic Disease Management Diet Advice and Weight Reviews

4 Hypertension Review Diabetic Reviews Hypothyroid Review Asthma review Mental health review Pharmacy Services Travel advice Smoking cessation Medication reviews Medical Services Acute medical care Long term medical care Prostate screening Short term proposal In order to remain viable over the next 6 months the practice will need $204,000 that would be $34,000 per month. This would cover the cost of Dr. Coull reducing his hours down to 37.5 per week. He is currently working 53 hours per week which is not sustainable. It also covers 6 weeks holiday within the 6 month period due to annual leave not previously taken. Scenario One HCT and nurses will be off for the two weeks over the 6 months. One week will be paid and the other one will be unpaid. Dr. Coull has annual leave owing that he will need to take within the next 6 months. The staff will be at work but will be unable to see patients. Scenario Two HCT and nurses will be off for one weeks paid leave as there will be a doctor able to cover their work. The doctors vacation is at 10 weeks to cover the 6 weeks for Dr. Coull and 4 weeks for the second doctor in the 6 months. The practice will still need $204,000 over the six months to cover the GP costs. Proposal for a three year Family Practice Pilot This proposal would be based on the function of the Phoenix Medical Practice as it currently works, but with the added ability to add at least two doctors, one as soon as possible and another in the second year with other nurses and health care technicians as required. The Practice Manager would also be increased to full-time. There would also be the ability to develop relationships with other parts of the health sector to enable the development of services within the practice based on population need. Alternative Funding The level of funding would be decided but the practice would decide how best to use it, with parameters of remaining in budget, increase preventative programs and increase the number of patients on the roster. Funding would comprise of a capitation rate, funding for salaries plus oncosts, services provided and for evidence based practice, through a quality framework. The funding would need to take into account the management structure required. The practice would be able to provide data from the high architecture electronic system in place. Data mining would be provided for meaningful, measurable targets and indicators for ongoing monitoring and

5 evaluation. This would incentivise quality of services rather than quantity of services. A framework for this would need to be discussed and agreed. In essence an agreement for the 3 year pilot to be be in place before that date with details to be worked out during the short term period of 6 months. If the details of the pilot are worked out earlier then the pilot can be in place earlier. One way to achieve this would be to fund the phoenix practice managers to 35 hours per week for 3 months which would increase the monthly amount by $10,000. Overall this would reduce the outlay by $102,000 as long as three months is enough time to allow approval for the financial structure of the pilot. We would be happy to provide additional information on request to support our evidence based practice. If you have any questions please do not hesitate to get in touch with Jane or Liz on or by jane.davies.moire@phoenixmedicalpractice.net or liz.sajdak@phoenixmedicalpractice.net. Within the pilot period it was intended to build positive working relationships with professionals within Health PEI to further strengthen the quality of care and service levels provided for our patients. This is encapsulated in the sections below. The Extended Primary Care Team Professions Allied to Medicine The extended primary care team potentially consists of: Community Pharmacist, Dietician, Counsellor, Physiotherapy, Occupational Therapy, Podiatry etc. Many of the above positions could be attached in the sense that they work with the practice to deliver services for the practice patients. They would work on-site providing clinics and seeing individual patients. The added value of this way of working is that they are part of a collaborative team, with shared resources and patient information. Patient Engagement Patient engagement is important so that the practice is open and transparent in its way of working and is open to continual development. Patients wold be asked if they would like to contribute to the development of the practice as a whole and to specific new services that the practice would like to run.the practice also wants patients to contribute through an annual survey that would inform processes through the patient representative group. A patient representative group to help develop the service as a whole. Different time limited groups to work on specific issues Group chosen fairly with a range of skills and backgrounds Given the data, information, and skills to engage fully Given a clear framework of evidence based practice to work within Use of GPAC survey Not to go ahead with to pilot this model with appropriate funding is a lost opportunity to benefit the people of this island in terms of their health. This type of model when working with at least 3 doctors would have enabled other services to be developed such as minor surgery. This would have benefited the province as the service would include taking dermatological biopsies which would have saved patients from having to go to Halifax for a minor investigation.