General Information and Implementation Proposal Application Guidelines

General Information and Implementation Proposal Application The implementation phase of the A GP for Me program requires submission of a completed application. There are two parts to this document, a General Information section and the Proposal Application. The contents of each part are listed below. The Proposal Application portion includes instructions, please follow them carefully. Contents 1. General Information... 2 Program Description... 2 Funding Available and Term... 3 Funding Principles and Parameters... 3 Application Procedures... 3 Implementation Proposal Application: intake, review, and approval process... 4 Proposal Review and Approval Criteria... 5 Reporting Processes and Funding Release... 6 Submission Inquiries... 6 2. Implementation Proposal Application... 7 Instructions for Completing the Proposal Application... 7 Contact Information and Signatures... 12 Appendix A A GP for Me Divisional Funding Principles... 13 Appendix B A GP for Me Implementation Funding Parameters... 15 May 21, 2014

1. General Information Program Description Research shows that a strong primary care system, centered on continuous doctor-patient relationships, leads to the best health outcomes for patients. The number of patients without a family physician in British Columbia is uncertain, varying between studies and communities. The Canadian Community Health Survey estimated that 13.8% of British Columbians (approximately 615,000) do not have a regular medical doctor 1 and 3.96% of British Columbians (approximately 176,000) are looking for a regular family physician. 2 A GP for Me is a joint initiative of the Government of BC and the Doctors of BC (formerly known as the British Columbia Medical Association) through the General Practice Services Committee (GPSC). The goals of this initiative are: To confirm and strengthen the GP-patient continuous relationship, including better support for the needs of vulnerable patients; To enable patients who want a family doctor to find one; and To increase the capacity of the primary health care system. A GP for Me strategies include a strategic approach to provide supports at both the practice and community levels: 1. At the physician practice level new patient attachment incentives have been introduced that are intended to increase the efficiency of individual practices and further develop their capacity to take on patients who do not have access to primary care. These incentives include telephone consultation codes to encourage non-face-to-face visits, fees for accepting new unattached complex patients, and expanded fees for caring for patients with complex chronic illness. A detailed description of each new incentive introduced in April 2013 is available on the GPSC website. 2. At the community level funding is available to Divisions of Family Practice until March 2016 to: o Evaluate the number of people looking for a family doctor and access to primary care services in their community, the needs of the local family physicians, and the strengths and gaps in local primary care resources. o Develop and implement a community plan (working with their local health authority and other partners) for improving local primary care service delivery capacity, including a mechanism for finding doctors for patients who are looking for one. 1 Statistics Canada. Canadian Community Health Survey Share File, CCHS 2009-2010 Combined Sample. 2 British Columbia, Ministry of Health, Primary Health Care and Specialist Services Branch (PHCSS). (2012). Estimates using CCHS 2009-2010 Combined Sample based on the methodology developed by PHCSS. 2 Page General Information and Implementation Proposal Application

Divisions are being encouraged to work with their partners to promote, optimize, and streamline existing supports that already exist through the GPSC s Practice Support Program (PSP) and other programs. Divisions are looking at other ways to better support their physician member practices in order to help to increase capacity. Other related provincial and regional initiatives that aim to enhance local primary care capacity through team-based care, such as the Integrated Primary and Community Care and NP4BC initiatives, can be leveraged to help ensure success at a community level through local collaboration and partnerships, such as through a Collaborative Services Committee structure. Provincially, strategies are being developed to clearly communicate to patients and the public the benefits of a strong relationship with a GP. The foundation of all of the GPSC s work is the Triple Aim, which will form the basis for evaluation of the success of this initiative. Funding Available and Term The amount of funding available has been determined for each division based on a modified population-based funding formula. Your Physician Engagement Lead will provide this information. The funding will be available for each fiscal year up to March 31, 2016. Funding Principles and Parameters Applications for implementation funding need to align with the: Divisional Funding Principles that guide the use of A GP for Me funds (see Appendix A) Implementation Funding Parameters that identify items considered within or out of scope for funding as well as recommended maximum allocations for specified budget categories (see Appendix B). Application Procedures The implementation phase of the A GP for Me program requires submission of a completed application. There are two parts: General Information and a Proposal Application. The Application portion includes instructions, please follow them carefully. 3 Page General Information and Implementation Proposal Application

Implementation Proposal Application: intake, review, and approval process The GPSC, through the A GP for Me Working Group, will accept proposals as they are submitted and review them monthly. Divisions are encouraged to request a readiness assessment meeting before formally submitting a proposal to the Working Group to review, and they will receive verbal and written feedback from both meetings. Divisions submitting a proposal that appears after formal review by the Working Group to meet the review and approval criteria will be invited, as capacity allows, to present at the next available GPSC meeting. The table below outlines dates for arranging a readiness assessment meeting and Working Group review in advance of the GPSC meeting when a division would like to present. (See the Implementation Proposal Approval Process document on the Divisions website for more information about the readiness, review, and approval stages.) Divisions may have up to five people (two staff members and up to three physicians) attend their division s presentation. Presentations will be scheduled during the afternoon of the second day of the two-day GPSC meeting and will be open to all GPSC and A GP for Me Working Group members. The GPSC estimates there may be sufficient time to schedule three to four presentations each month. Depending on the volume of proposals received, it may be necessary to move some divisions presentations to the following month s meeting. Alternatively, if there is enough demand, the A GP for Me Working Group may arrange an extraordinary meeting to ensure all proposals are dealt with in a timely manner. A total of 40 minutes will be allotted for each division presenting: 20 minutes for the presentation and 20 minutes for follow-up questions and answers. Proposals will be scheduled for presentation on a first come, first served basis. Schedule of Important Dates HOST READINESS ASSESSMENT MEETING BY* SUBMIT PROPOSAL TO WORKING GROUP WORKING GROUP MEETING GPSC MEETING PRESENTATION January 17, 2014 February 3, 2014 February 10, 2014 February 18, 2014 March 19, 2014 April 2, 2014 April 9, 2014 April 29, 2014 April 23, 2014 May 7, 2014 May 14, 2014 May 27, 2014 May 21, 2014 June 4, 2014 June 11 2014 June 24, 2014 June 18, 2014 July 2, 2014 July 9, 2014 July 22, 2014 August 15, 2014 August 29, 2014 September 10, 2014 September 16, 2014 September 17, 2014 October 1, 2014 October 8, 2014 October 21, 2014 October 14, 2014 October 28, 2014 November 5, 2014 November 18, 2014 November 10, 2014 November 25, 2014 December 3 2014 December 16, 2014 Mid-December 2014 Early January 2015 Early January 2015 Mid-January 2015 Mid-January 2015 Early February 2015 Early January 2015 Mid-February 2015 4 Page General Information and Implementation Proposal Application

Proposal Review and Approval Criteria As the proposal applications are reviewed the GPSC will be focusing on the following areas: 1. Community Assessment Results Demonstrated understanding of the local community (strengths and challenges/gaps) and nature of the attachment problem. Demonstrated engagement of key stakeholders in the assessment and development of the plan, including: division members; health authority; community partners; First Nations and Aboriginal populations; patients and the public. 2. Implementation Plan Comprehensiveness and feasibility of strategy(ies) to address all three attachment goals. Taken together, the strategies must demonstrate how primary care capacity will be increased to allow for access to GPs by patients who currently do not have access. The approach should demonstrate: Optimizing, streamlining, and/or integrating existing resources to maximize impact. Alignments with local, regional, and provincial initiatives. Community/division-level strategy must work together with practice-level suite of incentives as an arm of the strategy (i.e., physician participation and commitment indicated through 14070). Coordinated approach for attaching vulnerable or high needs as well as general populations. Plan for sustainability. Identification of risks and mitigation strategies. Demonstrated partnerships with key stakeholders, particularly health authorities, and supported by Letters of Intent where applicable (from health authorities, community agencies, etc. as per specific attachment strategies identified). 3. Organizational Readiness and Capacity 4. Communications and Community Engagement 5. Quality Improvement and Evaluation Divisional capacity and readiness, especially evidence of member engagement in A GP for Me. Communications strategy to support implementation. Demonstrated awareness and use of processes, tools and templates provided for public engagement and communications, information management, privacy, and security. Clear, embedded plans for quality improvement and evaluation. 6. Timeline and Budget Feasibility of implementation plan including budget and ability to move into implementation within proposed timelines. 5 Page General Information and Implementation Proposal Application

Reporting Processes and Funding Release Reporting requirements and phased release of funding are outlined in the Funding Transfer Agreement for divisions to receive A GP for Me funding. Funds will be approved and released based on review of detailed project checkpoint reports submitted by divisions at: Three months: project status report. Six months: detailed report on how the division is progressing in its work plan for all strategies, including key activities, milestones, key outcomes and measurements, communications, partner agreements, risks and mitigation, sustainability plan, and budget review and update). Ongoing: quarterly reports, including work progress, milestones met, lessons learned, and strategy changes. The checkpoints may be adjusted depending on the length of the project. Submission Inquiries If you have any questions regarding this process please contact your Physician Engagement Leader. General inquiries can be sent to agpforme@doctorsofbc.ca. 6 Page General Information and Implementation Proposal Application

2. Implementation Proposal Application Instructions for Completing the Proposal Application To simplify the application and review process and to ensure consistency and fairness across divisions proposals must adhere to the following instructions for submission to the review process: All materials must be a minimum of 11 point size, Verdana (or similar easy-to-read font), single-spaced, on one side of the page with a 2.5 cm margin on all sides. Observe the page limitations per section; only attach additional pages to a section if permitted. Suggested page length for sub-sections is provided as a guide to ensure you stay within the page limits. Additional pages must be letter size and have a header with the name of the division in the top left-hand corner and page number in the top right-hand corner. All print must be black, of letter quality, and easy to read. Appendices are limited. Only 10 pages of appendices to support the proposal are permitted. References, Letters of Support, and Letters of Intent are NOT included in this limit and should be attached following the Appendices. Section A - Proposal Summary (maximum 1 page) The proposal summary should provide a high-level overview of target populations, the attachment strategies to be implemented, and the anticipated outcomes. Section B Full Proposal (maximum 30 pages) 1. Community Assessment Results (4-5 pages) This section is intended to describe the nature of the attachment problem in your community/communities, including information about gaps in primary care capacity and access for the local population and sub-segments of the population (e.g., First Nations). Tell us how you have come to understand your community/ communities and how you engaged your members and partners in this process? Describe and discuss the relevant features (strengths and weaknesses or gaps) of your community as they relate to your proposal. Provide a summary of relevant demographic information and include relevant detailed information where it clearly helps to inform your strategic priorities. NOTE: Other detailed demographic information and reference information sources may be included in an appendix. Reference information source: e.g., websites, physician practice survey, health authority data, Ministry of Health data. The following are examples of information that could be considered in your summary or included in the appendix: 7 Page General Information and Implementation Proposal Application

General Information: Population. Boundaries and any geographic significance/uniqueness. Demographics/socioeconomic factors unique and/or significant to your community. Projected population growth and/or changes in demographics (e.g., growing senior population). Overview of general health and community resources (e.g., is there a hospital or urgent care centre in your community). Specific Population Characteristics: Estimated numbers and needs of patients with chronic and complex diseases. Percentage cultural/minority groups. Challenges unique and/or significant to your community (e.g., homeless populations). First Nations communities (i.e., Indian Reserves) and/or description of urban Aboriginal populations. Physician Population/Practice Characteristics: Demographics and estimated numbers of physicians. Projected retirements. Recruitment, retention, and practice coverage issues. Scope of practice/practice styles (e.g., percentage of solo practices, group practices/gp special interest practices, APP practices, WIC practices, hospital affiliations). EMR implementation in your community. Specific practice challenges (e.g., large number of elderly, complex patients). Patterns of utilization that impact attachment (e.g., usage of WIC especially when have an identified GP, avoidable ER visits). Discuss the estimated numbers of unattached patients and level of complexity/specific characteristics where possible. Describe how the following key stakeholders have been engaged in the assessment and planning process and the development of the plan, for example, communication, consultation, and collaboration. Clearly show what you learned from your engagement activities. Division members. Health authority. First Nations and Aboriginal populations. Patients and public. Other partners (community groups, provincial organizations, foundations, etc.) if applicable. Based on your findings, how were priorities identified and weighted? 2. Implementation Plan (15 pages) Given what was learned through the assessment of local primary care needs and capacity in your community, this section is intended to focus on how you intend to address the attachment problem in your community. Describe the specific strategies 8 Page General Information and Implementation Proposal Application

planned and provide a discussion of how the individual strategies will work together to address each of the goals of A GP for Me. How will your approach be aligned with other relevant provincial and regional initiatives to maximize impact? How will you plan to promote and leverage attachment billing incentives as part of your overall strategy? Explain how you are optimizing, streamlining, and/or integrating existing resources and initiatives to maximize impact. Pay particular attention to describing the impact on, and synergy with, services that are delivered by your health authority s mandate. For each strategy consider the following: Objective(s)/aim statement Target population(s) Gap(s) being addressed Scope of the work Anticipated outcomes/proposed measures Use of existing resources and partnerships; for example, what health and community services already exist that relate to this strategy? These may include: Health authority clinics and services such as diabetes education, cardiac rehab programs, mental health resources, sexual health clinics. Physician-run or partnership clinics such as after-hours clinics, maternity clinics, youth clinics. First Nations Health Services. Other community resources such as community-run counselling clinics, seniors centres, addictions services. Alignments with local/regional and provincial initiatives; for example, what other initiatives and/or programs have similar goals to those you are working towards and how are they going to be leveraged? These may include: Provincial initiatives (e.g., NP4BC, PSP, PSP Technology Group, Shared Care). Division initiatives. Integrated primary and community care (IPCC) acceleration initiatives (e.g., Home First, Breathe Well, integrated health networks, End of Life/Advance care planning, intensive case management, ACT). Other community organizations initiatives (e.g., a municipality s Healthy Community Initiative, United Way s Home is Best ). Sustainability considerations if a strategy is being proposed for which ongoing funding would be required. Risk considerations for what might prevent the success of the strategy. List risks and proposed mitigation strategies for addressing these risks. Please attach any supporting documents, for example, letters of support or letters of intent that clearly demonstrate how partners involvement and commitment. 9 Page General Information and Implementation Proposal Application

3. Organizational Readiness and Capacity (2 pages) Tell us about your division organization and membership. How will the members be involved in this work? What supports do you have in place and intend to have in place to help you achieve success? About your division What are your membership numbers and percentage membership? What working groups do you currently have, and what is your physician participation in these groups? What staff/contractors/consultants do you have in place or will require? Describe the current and anticipated involvement and commitment of your members in the work of A GP for Me. Governance Describe how the governance of the implementation work will be structured. Will there be a working group or subcommittee and what will be the relationship to the board? Who will participate? How will members be involved? How will partners contribute to your implementation work at the governance level? Operations Who will be the lead(s) for this work and what will their role(s) be? Who will do the work will you be hiring staff or contracting? How will the plan be managed? How are partners contributing at the operational level? What resources, tools, and supports are needed to implement your proposed plan? 4. Communications (1 page) Briefly outline your communications strategy to support your implementation work. Describe how you will keep members, partners, and stakeholders informed of your activities and your progress. Some considerations include: How will you coordinate activities with other divisions, communities, and the provincial divisions communications team? For example, show how you will use templates, tools, and processes for public engagement and communications, information management, privacy, and security. (Communications guidelines, templates, and other resources are available in the A GP for Me Communications work area, which can be accessed through the Divisions website.) How will you ensure your branding and messaging about the wider A GP for Me program aligns with provincial program standards? Will any part of your communication strategy be targeted to the public and patients and, if so, how will you ensure that your communications acknowledge the wider program and funding partners? Who is designated to address questions from the media or public about your local work? 10 Page General Information and Implementation Proposal Application

5. Quality Improvement and Evaluation (3 pages) Describe how quality improvement and evaluation will be integrated into the attachment strategies to meet each goal of A GP for Me and the Triple Aim. Quality Improvement Propose clear, concise, and measurable aims as part of the attachment strategies and identify proposed measures. Show that a system to monitor and methods to report data have been considered in your planning. Evaluation Please outline your evaluation objectives, questions, and both process and outcome data. Include a logic model if available. Discuss resources and partnerships required to undertake this work. Describe how you will integrate or benefit from any existing partner or health authority evaluation (e.g., IPCC). Include any additional information about your evaluation plans or framework in an appendix. 6. Timeline and Budget (3 pages) Please use the following sub-sections to describe how the proposed plan will be implemented. Timeline Provide a timeline for strategy implementation, including what will be done and when. Your timeline should demonstrate multiple years (to March 31, 2016), with more detail for the first year. A timeline graphic page may be added as an additional page. Budget Provide a detailed budget showing the costs associated with your implementation work. Please use the timeline to guide the development of your budget and ensure it meets the Divisional Funding Principles (Appendix A) and Implementation Funding Parameters (Appendix B). Attach an additional page to explain major cost categories. What in-kind resources and financial supports will come from other sources (e.g., what are partners contributions, including health authorities)? Please include a Letter of Intent from the health authority and/or other partners that confirms their commitment and contributions (including any in-kind or financial contributions). 7. Wish List (1-2 paragraphs) Is there anything in addition you would ideally like to do if you were less constrained by budget and timelines? 11 Page General Information and Implementation Proposal Application

Contact Information and Signatures Include the below table with contact information and relevant signatures as the last page of your application. Name of Division: Mailing Address for Correspondence: Physician Lead: Contact Information Phone: Signature: Board Chair (if different from Physician Lead): Email: Contact Information Phone: Signature: Senior Staff (ED/Coordinator): Email: Contact Information Phone: Signature: Email: A GP for Me Staff: Physician Engagement Lead: Signature: Signature: 12 Page General Information and Implementation Proposal Application

Appendix A A GP for Me Divisional Funding Principles The parties agree to the following principles to guide the use A GP for Me funds: Updated: April 11, 2014 a. Goals of A GP for Me: The use of these funds should work towards the goals of the A GP for Me initiative: o o o To confirm and strengthen the GP-patient continuous relationship, including better support for the needs of vulnerable patients; To enable patients who want a family doctor to find one; and To increase the capacity of the primary health care system. b. Accountability: There will be clear reporting requirements in association with receiving the funding. c. Quality oriented: The model of improvement methods and theories, including measurement and Plan-Do-Study-Act (PDSA), will be embedded into all phases of the A GP for Me work. The A GP for Me work will aim to optimize the Triple Aim objectives. d. Locally based and community developed: Strategies for A GP for Me are expected to respond to unique community needs, priorities, and resources. Solutions will be guided by the culture and wisdom of each community, and public engagement and patient involvement will be key to the sustainability of the community s primary health care system. Where relevant, examples from other jurisdictions can be used as models. e. Collaborative: Work will take place primarily at the community level through the collaboration and support of all representatives on the Collaborative Services Committee (CSC) and local, regional, and provincial partners as appropriate. f. Alignment: Community-level work will align and with and support relevant regional and provincial strategies and initiatives. Care will be taken to leverage existing systems and to eliminate replication and duplication. g. Integrated: refers to the overall management and delivery of health services across a continuum of health care needs over time and different levels of the health system; services and providers are linking, communicating and coordinating to provide seamless care for patient population, functioning as a team as appropriate depending on level of integration required. Integrated care is seamless for patients, and above all avoids duplication and fragmentation of services, in particular when care is required across multiple providers. h. Patient centered: Patients are anticipated not only to benefit from the initiatives but also to have ongoing involvement in evaluating and assessing the impact of the initiative. i. Comprehensive: Strategies should support the Full Service Family Practice (FSFP) concept promoting generalization and full practice scope of GPs in keeping with the mandate of the GPSC. 13 Page General Information and Implementation Proposal Application

j. Sustainable: Recognizing that funding is guaranteed only until the end of March 2016, strategies implemented should consider models for sustainability beyond this time frame. k. Simplicity: Solutions that are transparent and easily understood are preferred. l. Avoid fragmentation: Strategies should seek to consolidate and streamline service delivery rather than fragment it. This should help with service delivery coordination. 14 Page General Information and Implementation Proposal Application

Updated: May 8, 2014 Appendix B A GP for Me Implementation Funding Parameters (Funds available April 1, 2014 to March 31, 2016) The following items are considered within scope for A GP for Me funding: Administration and Overhead (maximum recommended 20% of total budget) These costs are related to administration of the project, over and above the costs related to baseline divisional administration. These costs are not related to clinical service delivery. Operational/overhead (upfront) costs: o Physical space (rent, utilities) only if existing space cannot accommodate A GP for Me and new space needs to be acquired. o Sustainability and risk mitigation plan needed for continuation if enhanced administration needed after term of funding completed. Telecommunications and equipment (e.g., telephone, computer, Internet), office supplies, postage, printing, etc., specific to A GP for Me use. Staffing support costs specifically allocated to A GP For Me may be cost shared with the division infrastructure funding: o Salaries for staff support (e.g., Executive Director, administrative assistant, bookkeeper). o Costs associated with hiring staff and consultants (e.g., advertising, interviewing, travel). o Travel and communication costs for division staff, to liaise and/or meet with other divisions regarding attachment. Innovative and Enhanced Clinical Services including new models of care and change management These are the costs of implementing and delivering clinical and support services and programs. Start-up or initial co-funding costs for specific clinical/partnership projects (e.g., multidisciplinary clinics for unattached patients, co-located programs, networked services): o Initial leases, equipment, and supplies, IT set-up, leasehold improvements, clinical administrative support. o This does not include cash payouts to physicians for costs incurred in breaking of leases. o Sustainability and risk mitigation plan needed for continuation after term of funding term completed. o Health authority input and discussion needed to ensure that no similar supports are available through the health authority and that opportunities for optimizing partnership involvement have been explored. 15 Page General Information and Implementation Proposal Application

o One-time costs associated with additional privacy impact assessments or legal advice over and above what exists provincially (i.e., related to who holds patient data during and beyond the term of the funding for new practice models, etc.). Support for physician practices: o Enhanced practice coaching (supplemental to what is available through PSP, which would be determined through a conversation between the division and regional PSP program to understand what supports are needed/available). Clinical payments for Allied Health Providers: o Health authority input and discussion needed to ensure: There is no duplication of services with those available through the health authority. Opportunities for enhancement or streamlining of health authority services have been explored. If hiring independently of the health authority, that allied providers will function and communicate with health authority allied health providers as appropriate. o Need to provide a plan for sustainability of service, or risk mitigation plan if service no longer available after term of funding completed. Change management: o Sessional payments to physicians supporting the establishment of a multidisciplinary team or program (Recommended review at one year from initiation of implementation). o Consultants and/or additional staff to lead and/or carry out technical aspects of the work (e.g., project management/project leadership, quality improvement coaching). o Costs related to adaptation and change in programs in relationship to quality improvement and evaluation outcomes. Information management: o Costs associated with putting in place mechanisms to streamline and share information to ensure people have efficient and effective access to information (e.g., patient registries, MOA time). o This does not include costs related to Pathways or IT. Physician recruitment/retention: o Costs associated with advertising and participating in recruitment events o Support for collaborating with other divisions on recruitment activities. Physician/partner/community engagement: o Sessional payments for physician participation in working groups, committees, surveys, engagement and planning events. o Physician travel and expense costs to liaise and/or meet with other divisions relevant to attachment work, in alignment with Doctors of BC sessional or honoraria payments. o Community engagement. o Forums, focus groups, etc. o Stakeholder participation on committees and working groups: Payment for out-of-pocket costs for participants not paid by division or health authority partner (e.g., parking, food, transportation). Payment for honoraria given to First Nations elders. 16 Page General Information and Implementation Proposal Application

o o Meeting costs (e.g., venue, food, audiovisual equipment, travel expenses). Communications. Aligned with provincial approval guidelines for messaging, branding, and partner recognition, and where possible using/adapting available communications templates and materials from the provincial team, such as rack cards, posters, and invitations. Printing costs of materials for public, physician, and stakeholder engagement design to adapt existing provincial branded materials or to create new materials where existing materials cannot be appropriately adapted. Development and writing costs associated with online communications, such as website or social media strategies (in line with existing provincial requirements). Photo shoots and videography for the purposes of A GP for Me communications activities. Advertising, public awareness campaigns, and media relations activities. Evaluation (minimum recommended 10-15% of total budget) Staff and consultant fees directly related to evaluation activities: o Data collection and analysis. o Activities related to alignment with provincial measurement and evaluation framework, and linking with the provincial Evaluation Lead and A GP for Me Working Group. The following items are considered out of scope for A GP for Me funding: Duplication or replication of work/projects/supplies where funding has already been allocated or is available from other partner organizations or initiatives. Cash payouts for breaking current leases. Payment for IT enhancements and IT networking. Replacement funding for initiatives established by PITO. Do not include a contingency line in the budget provide estimates in specific cost categories instead. 17 Page General Information and Implementation Proposal Application