British Columbia Members’ Final Report in English

British Columbia Priorities Panelon PrimaryCare:

Newperspectives andpossibilitiesfor primarycareinCanada

Areportwrittenby membersofthepublic

September2023

Chair’sNote

Thisreportistheoutcomeofa dedicatedandcollaborativeprocess involving31BritishColumbianswho collectivelyinvestedalmost1000hours oftheirtimeandenergyoverthree monthstowardsaddressingthecritical challengesfacingourprovince’s primarycaresystem.Theresultsof theirhardworkinclude25clear, actionablerecommendationsthatwill transformthewaywethinkaboutand deliverprimarycareinBCandbeyond.

TheOurCareBritishColumbiaPriorities PanelonPrimaryCarebroughttogether peopleandperspectivesthatrepresent ourgreatprovinceatlarge,fromrural regionstobigcities,fromallagesand backgrounds,andfromawiderangeof experienceswithrespecttoprimarycare.

APrioritiesPanelfostersanenvironment wheremeaningfuldialoguecantake placeamongcitizens.Workingtogether, theycanmakesenseofcomplexissues andfindcommongroundonissuesof publicconcern.Thisinclusivemethodof learninganddeliberationnotonly enrichesthequalityofthepanel’s

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recommendationsbutalsofostersa senseofsharedresponsibilityforchange andempowerscitizenstobecomemore involvedinshapingthepoliciesthat affecttheirlives.

Policymakers,healthcareleaders,and thepublicwillfindinthisreporta blueprintformakingprimarycaremore accessible,equitable,andsustainable; forleveraginginnovationslike team-basedcare,virtualcare,andnew technologies;andforovercomingthe inefficiencies,biases,andentrenched practicesthatarestandinginthewayof achievingatrulyworld-classpublic healthcaresystem.

Iappreciateandapplaudthe31British Columbianswholenttheirtimeandtheir passiontothiswork;theentireteamof facilitators,guestspeakersandother partnerswhosupportedthepanelists alongtheway;andourfundersand stakeholdersfortheircritical contributionstothesuccessofthe OurCareinitiative.

Sincerely,

RichardJohnson OurCareBCPanelChair

RichardJohnson

OurCareBCPanelChair

WhatPolicyMakers ShouldKnow

ColumbiaLead

FamilyPhysician Executive,BCFamilyDoctors

ClinicalAssistantProfessor,Department ofFamilyMedicine,UniversityofBritish Columbia

Primarycareisthebedrockofour healthcaresystem:thesolid foundationthateverythingelseneeds toholditup.Yetthatbedrockhasbeen erodedovermanyyears,culminatingin thehealthcarecrisisweallknowtobe truetoday:6.5millionCanadianslack accesstoafamilyphysicianornurse practitioner,theclinicianswhoprovide comprehensiveandcoordinatedcare topatientsoverthecourseoftheirlives. Theerosionoffamilymedicinehasbeen fuelledbyalackofthoughtful investmentinboththefamilyphysician workforceandtheirworkplaces, includingcrucialinfrastructureandthe teamsneededtosupporthighquality care.

Withoutaccesstoaprimarycare practitioner,patientsstruggletoaddress theirnewhealthproblems,manage chronicconditions,andaccessother doctorsandhealthservices.Theyalso don’tgetthebenefitsofpreventative carethatcouldkeepthemhealthy long-term.

FamilyPhysician,St.Michael’sHospital

AcademicFamilyHealthTeam

Scientist,MAPCentreforUrbanHealth Solutions,St.Michael’sHospital, UnityHealthToronto

FidaniChairinImprovementand Innovation,UniversityofToronto

Weneedtochangehowwestructureand supportourprimarycaresystem.But how?

Inthecourseofourworkasphysicians andresearchersinprimarycare transformationandreform,weoftenwork closelywithotherphysicians,policy makers,administrators,andresearchers tomakechangestothesystemsowe canbettercareforpatients.Butit’srare thatwegettheopportunitytohear directlyfrompatientsabouthowto designthesechanges.

Overthelast12months,OurCarehas soughtoutthevoicesofthepublicto betterunderstandtheirneedsand perspectivesaroundhealthcare.This reportsummarizestherecommendations from31membersofthepublicwholivein BritishColumbia—peoplefromacross theprovince,withdiversedemographics, lifeexperiences,andinteractionswithour existinghealthcaresystem.These panelistsspentnearly30hourstogether learningabout

Dr.TaraKiran,OurCare PrincipalInvestigator

Dr.GoldisMitra,OurCare British

primarycarefromsomeofthetop expertsinthefieldanddeliberatingwith eachothertocometoconsensus aroundrecommendationsforabetter system.Theyhaveidentifiedasetof valuesthattheyfeelshouldbeour“North Star”inprimarycare,andtheir recommendationschartapaththat,if followed,willserveBritishColumbians wellintothefuture.

WhatdoBCcitizensvaluemost?

Inaprovincewherenearly30percentof patientsdon’thaveaccesstoafamily physicianornursepractitioner,the citizenpanelistsfeelthataccessibilityis themostimportantissuetoaddress. EveryBritishColumbianneedsafamily physicianorcareteam,andthisshould beakeypriority.

Thepanelistsidentifiedthatthecarea personreceivesinBCshouldnotdiffer dependingonwheretheylive,their income,whatlanguagetheyspeak,and otherfactors.Theyfeelthatstepsto addressequityincaregohand-in-hand withaccess.

Thereisalsoafocusonpreventative health.Thisincludestargeted investmentsinsocialdeterminantsof health,mentalhealthcare,social services,andhousing,sincetheseare importantfoundationsofahealthy population.Italsomeansprioritizing wellnesscare—notjustsicknesscare— topreventproblemsbeforetheyoccur.

Finally,thecitizenpanelistsfeelthatclear andtransparentaccountability structuresarerequiredtoensurethat healthcareinvestmentshavetheir intendedeffects.

Howshouldthesystemadapt?

Oneofthemostimportantwaysinwhich BCcitizensbelievethatprimarycarecan beimprovedisthroughthe reorganizationofhowcareisprovided. Citizensfeelthatatransitiontoward healthcareteamswillbethekeyto improvingaccesstoprimarycareacross urbanandruralcommunities.Theyfeel thatprimarycareshouldbeorganized similarlytothepublicschoolsystem,with catchmentareasthatguaranteeaccess tocare.

Theyspecificallyrecommendinvestingin CommunityHealthCentres(CHCs), whicharecommunity-governed, multidisciplinaryteamsofpractitioners thatincludefamilydoctors,nurses,social workers,andotherhealthprofessionals whoworktogetherinacoordinated fashiontoprovidecaretopatientsina modelconsistentwiththe“Patient MedicalHome.”

Topromoteequity,theyfeelthatCHC developmentshouldbeprioritizedin remote,Indigenous,andlow-income communities.Otherrecommendations toimproveequityincludeexpanding medicarecoveragetoinclude,for example,pharmaceuticals,dentistry, 6

andphysiotherapy,aswellas introducingpatientadvocateswhocan assistvulnerablepatientsinnavigating thehealthcaresystemandensurethat noone“fallsthroughthecracks.”

Tofurthersupportthepatientjourney, citizenpanelistsadvocateforimproved accesstoelectronicmedicalrecords (EMRs)tofacilitateimprovedcontinuity andefficiencyofpatientcare. Theyfeel thiscouldbedonemostlogically throughtheestablishmentofacentral medicaldataplatformforcliniciansand patientsthatwouldprovide province-wideaccesstorecords regardlessofthedatabasesoftware usedinanygivenlocation.

Thecitizenpanelistsstronglybelievethat patientswanttobetterunderstand healthcareissuesandprovideongoing feedback.Theyfeelthattargeted educationforthepublicaroundhealth careissueswillsupportthedevelopment ofaninformedcitizenry,andthatthere willbevalueintheestablishmentofa provincialpatientadvisorygroupthat canprovidefeedbacktopolicymakersin astructuredandconsistentway.

Finally,therearetwostrongoverarching policyrecommendations.Thefirstisthe recommendationthatnationalandlocal governmentsadopttheWorldHealth Organization’s“HealthinallPolicies'' approachtoshapepublicpolicy initiativesacrossallsectors.Thereisalso acallforgreatertransparencyinhow healthcaredollarsarespent,coupled ourcare.ca

withcarefulevaluationofprimarycare initiativestomeasuretheirimpactand outcomes.Theyfeelthatevaluation shouldbeindependent,andthatefforts shouldbemadetoquicklyspreadand scaleeffectiveprogramsand community-levelinterventions.

OnJune25,2023,theOurCareBritish Columbiapanelistspresentedtheir recommendationsforabettersystem toTedPatterson,AssistantDeputy MinisterofPrimaryCarefortheMinistry ofHealth,BonitaZarrillo,MPforPort Moody-Coquitlam,andotherkey systemleaders.Thevaluesand recommendationstheyarticulated wereinspiringforallofthoseinthe room.

Asphysicians,healthsystem administrators,andpolicymakers,itis raretohavetheopportunitytohear frompeoplewhocomefromallwalks oflifeandallcornersofourprovince aboutsomeofthemostimportant questionsinhealthcare.Whenwedo havethatopportunity,itbehoovesus tolistenandworktothoughtfully implementtheirinsights.

Dr.GoldisMitra

OurCareBritishColumbiaLead

Dr.TaraKiran OurCarePrincipalInvestigator

BritishColumbiaPrioritiesPanel

At-a-Glance

TheOurCareBritishColumbiaPrioritiesPanelbroughttogether31BCresidents,randomlyselectedto roughlymatchtheprovince’sdemographicswithemphasisonunderservedcommunities.They spentapproximately30hourslearningfromexpertsanddeliberatingtogetherbeforemaking recommendationsonwhatabetterprimarycaresystemshouldlooklike.OurCareisalso conductingPrioritiesPanelsinOntario,Quebec,NovaScotia,andManitoba.Reportsarewrittenby membersofthepublic.Formoreinformation,visitOurCare.ca/PrioritiesPanels.

RecommendationHighlights:

AccessibleprimarycareforallBritishColumbians

31members

19speakers

29programhours

25recommendations

Members’Values

Accessible• Equitable• Prevention-focused• Accountable• Sustainable• Person-centred• Universal•

• Foster,set-up,andfundCommunityHealthCentres(CHCs)in everycommunitytosupporttimelyaccesstoprimarycare, includingphysiciansandteam-basedcare

• EnsuremoreCHCsinrural,remote,Indigenousand low-incomecommunities

• Legislatezeroout-of-pocketcostsonexpensessuchas transportandmealswhenaccessingprimarycare

• Fundandimplementinfrastructureinruralcommunitiesto supportaccesstovirtualcare

Primarycaresysteminfrastructure

• Assigneachresidenttoacatchmentareafromwherethey canselecttheirprimarycarepractitionerorcareteamsimilar tohowthepublicschoolsystemworks

• Refocusthehealthsystemtoprioritizerelationalcontinuity throughallstagesoflife

• Expandprimarycarecoverage,subsidization,andteamsto includeholisticcare,includingbutnotlimitedto pharmaceuticals,dentistry,physicaltherapyandmental healthservices

Technologyandinformationsysteminfrastructure

• Establishacentralmedicaldataplatformforcliniciansand patientstoaccesselectronicmedicalrecords

• Trainandsupportpatientsinthetechnologicalaspectsof accessingprimarycare,includingvirtualcare

• Offerflexiblemodesofcareincluding,atminimum,in-clinic, video,phone,andsecuremessaging.Virtualcareshould complement,notreplace,in-personcare

RecommendationHighlights(cont’d):

Fundingandresourceallocation

• AdopttheWorldHealthOrganization’s“HealthinallPolicies”to shapepolicyanddisbursementofresources

• Ensuremoreresourcesgotocommunitiesinhigherneed

Theproblemswewant solved

Humanresource strain•Archaicand fragmented informationsystems• Lackofequitable access

•Continuityof caredeprioritized• Absenceofsystemic patientpower• Politicsand bureaucracyprevent transformation

• Increasethenumberofprimarycareclinicians,forexample,by reducinglicensingbarriersforclinicianstrained out-of-provinceandexpandingtheuseofprofessionalsunder physiciansupervision

• Commissionindependent,third-partymonitoringand evaluationofresourcesexpendedonprimarycareinitiatives tomeasureimpactsandoutcomes

Politicalwillandpatientadvocacy

• EstablishaPatientAdvocacyOrganization(PAO)thatsupports consultationonprovinciallegislation,championstransparency, andensuresaccountability

• ImplementacomprehensivePrimaryHealthCareCharterto defineandclarifytherightsandexpectationsofpatients

• ImplementandfullyfundthePatientMedicalHome(2019)and establishGoalsandStandardsforPrimaryCare

Publiceducationandmobilization

• Createanindependent,publiclyfundededucationcampaign aboutprimarycare

Understanding thePanelProcess

APrioritiesPanelisalong-form deliberativeprocessthattypically involves30to48randomlyselected residents.Theseresidentsarechosen usingaprocesscalledaciviclottery, arandomselectionmethodthat prioritizesfairnessandwide representation.Theindividuals selectedforaprioritiespanelcome togethertolearnabout,andthen advisepublicauthoritieson,divisive andcomplexissuesthattypically involvetrade-offsorcompromises. Thepanelmembers’objectiveisto reachaconsensusonaseriesof recommendationsthatcanbe directedtogovernment,professional associations,andsocietyatlarge.

WhatisaCivicLottery?

Aciviclotteryisabalancedwayof selectingthemembersofapriorities panel.Itisbasedonaformof sortitionthatusesarandomized selectionprocesstorecruitpanelists fromapoolofvolunteersthathave indicatedtheirinterestinservingon thepanel.Theresultisagroupof volunteersthatbroadlymatchesthe demographicsofthejurisdictionit represents.

Morethanahundredpeople volunteeredfortheBritishColumbia PrioritiesPanel.Manyofthese volunteershadcompletedthe OurCareNationalSurveyand indicatedtheirinterestinthepanel byansweringdemographic questionsinaseparate questionnaire.Thestratifiedcivic lotteryprocessensuredthat membersofthepanelwerefairly selectedandbroadlyrepresentative ofthedemographicmakeupofBritish Columbia.

OurCaredeliberatelysoughtto overrepresentresidentsknowntobe underservedbytheprimaryhealth caresystem:racialized,lowerincome, newcomer,andgender non-conformingresidents,andthose wholiveinrural,remote,ornorthern regionsoftheprovince.Inshort,the panelwascomposedinsuchaway astodeliverdemographicdiversity andtoensureweheardfrom residentswhoaremost disadvantagedbythecurrent system.

PanelSnapshot

31members

Gender*:

18-Women

12-Men

1- Non-binaryperson

Age:

3 -18-29yearsold

12-45-64yearsold

9 -30-44yearsold

7 -65+yearsold

Memberswhoidentifyas Indigenous:1

Health:

24-Good,VeryGood,orExcellent

7-FairorPoor

Memberswhohavebeenin Canadalessthan10years:3

Geography:

11-Southwest

8-Island

6-Interior

5-Vancouver

1-North

Memberswhoidentifyas partofaracializedgroup:12

*-“Women”referstocisgenderandtransgenderwomen.“Men”referstocisgenderandtransgendermen.

TheMembers’ Reportofthe OurCareBritish Columbia PrioritiesPanel onPrimaryCare

Whoweareandwhywe volunteered

Weare31residentsofBritish Columbiawhorepresenta cross-sectionofourdiverse, culturallyrichprovince.Werepresent abroadspectrumofages,abilities, experiences,andhealththroughout theprovince.Together,we respectfullyacknowledgethatallof uslive,work,andplayonthe traditional,ancestral,andunceded territoriesoftheIndigenouspeoples ofBritishColumbia.

Wearegravelyconcernedwiththe stateofourprimarycaresystem.We aretroubledbytheinequities, deficiencies,andvariousformsof discriminationwithinit.

Wearefrustratedbythesystemic lackofprogressfromthosein governmentateverylevel,bethey federalorprovincial;medical agenciesandhealthauthorities;and cliniciansthemselves.Thisinaction hasresultedinanever-increasing deficitinprovidingsuitableand sustainablehealthcareforall.There isadrasticshortfallinprimarycare servicesaswellasinadequate supportsystemsforphysiciansand theirpatients.Thereisalso inadequatefocusonpreventative

care,whichevidencesuggests improvesoverallpatienthealthand reducestheriskoflong-termillness.

Weseektopartnerwiththosein governanceandourhealthcare professionalstoachievemore equitable,accessible,cost-efficient, andreliablehealthcarenotonlyfor ourselves,butforallBritish Columbiansbothpresentandfuture.

Wevolunteeredbecausewebelieve allresidentsofBritishColumbiahave arighttoaccessprimarycare regardlessofwheretheylive,work, andplay.

Whatweseeandwhatwe learned

WeseethatBritishColumbiansare strugglingeverydaytoaccess adequatehealthcare.Weseethe incrediblestrainonourhealthcare workersastheystruggledbefore, during,andsincetheCOVID-19 pandemic.Weseeaprimarycare systemthatisarchaicand fragmented,andthatdoesnotserve thehealthcareneedsofourgrowing, aging,andculturallydiverse population.

Wehavelearnedthedrastic importanceofprimaryand

preventativecareservicesforhealth outcomes.Wehavelearnedthat therearededicatedhealthcare workers,researchers,policyexperts, advocacygroups,communities,and individualswhohavesolutions,yet welargelyfailtoimplementthose solutions.

Wehavelearnedthattherearemajor barrierswiththeinteroperabilityof informationsystemsaswellas redundanciesandbureaucratic burdensthatcontributeto inequalitiesofprimarycareservice anddelivery.Wehavelearnedthat thereareamultitudeofcitizenswho areengaged,optimistic,and committedtorevolutionarychange inprimarycareinBritishColumbia. Wehavealsolearnedthatwemust drivethischange.

Webelievethatbyprovidinga patientperspective,whilealso recognizingtheneedsofourmedical professionals,wecancreateabetter systemforeveryone’sbenefit.

Forthesereasons,wehavejoined togethertochampionthis much-neededtransformation.

TheChallengesWeWant Solved

OurprimarycaresysteminBritish Columbiaisincrisis.Wehave identifiedthefollowingmajor challengesthatmustbeaddressed:

Thereareenormousstrainson humanresourcesinprimarycare.

MorethanaquarterofBritish Columbianslackaccesstoaprimary carephysicianorteam,and countlessmoresufferfromalackof qualitycare.Physiciansandother healthcareprofessionalsare overworked,experiencingburnout, andstrugglingtomanagework/life balance–andtheproblemisgreater inruralandremoteareas.Thereare significantbarrierstoenteringthe fieldincludinghigheducationcosts, slowandexpensivelicensing processesforhealthcare professionalsbothnationaland international,andsystemicbiases. Outdatedpaymentmodels, administrativeburdensinfamily practices,andthelimitednumberof communityhealthcentresarealso obstaclestosystemictransformation andsolvingthe“attachmentcrisis.”

Alloftheseissuesfostercompassion fatigueinprimarycareallaround. Everyone’shealthsufferswhen patientscannotbeheardand acknowledgedbecausedoctorsand healthcareprofessionalsare overloadedwithadministrativetasks whichrelyonarchaicsystemsand regulations.Primarycareproviders arealsochronicallyshortstaffedand takingonmoreworkthanisfeasible orsafe.Suchworkcontinuallystrains anddemoralizeshealthcare professionalstothepointthatmany leavethefieldaltogether,leavingthe systemwithevenlesssupport.We mustprioritizetheirmentalhealthto lowerthecurrentlevelsofburnout andfrustrationandcreatea supportivesystemthatenableshigh qualitycare.

Anotherissuerelatedtohuman resourcesintheprimaryhealthcare systemistheonerousprocess requiredtohirenewhealthcare professionals,whetherthesenew professionalsarerecentgraduatesor newarrivalstotheprovinceorto Canada.Thecurrenton-boarding processhinderstheachievementof desirablegoalssuchasproviding newdoctorstimely,real-world experienceinteractingandtreating patients;alleviatingthestrainand burnoutofcurrentclinicians;offering moreoptionsforpatientswhen selectingtheirprimaryhealthcare

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clinician;decreasingwaittimes;and creatinganetworkofclinicians availabletoapatientatanygiven time.

OurprimarycareInformation systemsarearchaicand fragmented.

BritishColumbia’sprimarycare systemisburdenedwithinformation systemsandpracticesthatcannotor donotspeakwitheachother,are frequentlysiloed,andareoften foundedonoutdatedtechnologies (notleastofwhichisthefax machine).Usersofthesesystems, bothhealthcareprofessionalsand patients,arefrustratedbythelackof coordinationandaccountability amongdigitalsystems.Referralsand electronicmedicalrecordsareoften stuckorlost,forexample.The downstreameffectsoffragmented informationsystemsincludelimiting thedevelopmentanddeploymentof moreeffectivetechnological solutionsandembedded mechanismstosafeguardthe accuracyandprivacyofpatient information,especiallyforvirtualcare inruralandremoteregions.

Theproverb“toomanycooksinthe kitchenspoilthestew”reflectsthe frustrationsfeltbybothhealthcare professionalsandpatients,inthat therearetoomanysystemsandno

setstandardsinplace,preventing effectiveaccesstourgentlyneeded information.Thischallengeis preventingusfromhavinga world-class,high-techprimarycare systemhereinBritishColumbia.

Thereisaclearlackofequitable accesstoprimarycareamong differentcommunities.

NotallBritishColumbianshaveequal accesstoprimarycare.Residentsof ruralandremoteregionsofthe province,thosestrugglingwith mentalhealthissuesoraddictions, newcomerswithculturaland languagebarriers,vulnerable low-incomepopulationswhoface highcostsofaccess,thosewith physicaldisabilities,andIndigenous peopleallfacevariousbarriersand biaseswhenaccessingprimarycare. Thosewithoutreliableinternetaccess orwhoareunfamiliarwithtechnology areincreasinglyleftbehind.Family doctorsarenotcompelledtochange practicesthatwouldhelpovercome issuesofaccess,suchasadopting paymentmodelsthatencourage doctorstotakeonmorepatientsor practicingdifferentmodelsofcare thatfacilitateaccess,including team-basedcare.

Toomanyfamilydoctorshave refusedtotakeonpatientswhohave

complexhealthissues,whichfurther hindersindividuals’abilitytoaccess healthcare.Aprimarycaresystem thatcannotovercomethislackof equitydoesnotworkforthemajority ofBritishColumbians.

Continuityofcarehasbeen deprioritized

PrimarycareinBritishColumbiahas becomemoreepisodic,lessholistic, andoverlyfocusedontreating patientsswiftlyratherthan comprehensively.Firstpointsof contactintheprimarycaresystem areoverwhelmed,whilethedemand onlygrowsformoreaccessto primarycarephysiciansandteams. Healthcareprofessionalsand primarycareservicesare increasinglyfragmentedratherthan housedunderone(actualorvirtual) roof,andthereisanabsenceofa holistic,preventative,and team-basedapproachtoprimary careatasystemlevel.Relyingon emergencyroomsandurgentcare clinicsfortreatmentafterapatient becomesillorinjuredisnota proactivesolutionforlong-term patientcare.Wemusthavea primarycaresystemthatenables patientsandclinicianstheabilityto stop,reverseormitigateillnessand injurybeforetheyhappeninorderto reducetheadverseeffectsonour ownhealthandonthesystemasa ourcare.ca

whole.Patientsexpect comprehensive,longitudinalcare, regardlessofwheretheyliveormove –carethatemphasizesrelational continuitybetweenpatientsandthe doctorsandteamswhocarefor them–andtheseexpectationsare notbeingmet.

Thereisanabsenceofpatientpower inthesystem.

Thecrisisinprimarycarecannotbe overcomewithoutacknowledging thatpatientslackmechanismsto advocatefortheirowncareand systemicchange.Patientscurrently donothavethemeanstosecurely accessandverifytheaccuracyof theirelectronicmedicalrecords.

Thereiscurrentlynocomprehensive systemencompassingapatient’s medicalinformationandnomethod ofresponsibledata-sharingto ensurethoserecordsareaccessible andportable.Patientsdonothave enoughknowledgeandeducationon howtheprimarycaresystemworks andhowtoadvocateforthemselves withinit.Patientsfrequentlyfeelmore likeclientsthanpeople.Thereisa lackoftrustinthesystemandits clinicians.Patientsexpectmore accountabilityandqualityassurance thantheycurrentlyhave.Theyexpect morechoiceinthecaretheyreceive, includingoptionsintheirown communities.Theyexpectclinicians

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totakeintoaccountthepatient’s desirestomaintainoverallgood health,especiallyifthejourneyto attainthatgoodhealthwilltaketime, varioustypesoftreatments,and inputfromotherhealthcare professionals.Yetthereisnocentral patientadvocacyorganizationor institutionthatcanaddressthis challengeonasystemlevel,suchas anombudsperson.

Politicsandbureaucracyare standinginthewayof transformation

Likeotherareasofpublicpolicy, primarycarepolicyisatthemercyof electioncycles,partisanship,andthe directionthepoliticalwindsare blowing.Thefundingandresource allocationofprimarycaresystems andservicesisoftenpolitically motivatedorbasedonoutdated priorities,andneedsmore transparencyandlessredundancy. Thereispoliticalapathyforreal, transformationalchangeinsteadofa “band-aid”approach,whichapplies onlyshort-termsolutions. Bureaucratically,therearetoomany playerswithvaryingpriorities, practices,anddirectives–health authorities,collegesand associations,regulatorybodies, advocacygroups,government departments–andnotenough coordinationandcollaboration.

Innovativepilotprojectsarecommon andoftensuccessfulinBritish Columbia,butsufferfromasystemic lackofwillorabilitytoimplement thematgreaterscales.Though successhasbeenproveninthese pilotprograms,determined adherencetoabrokensystemby variousplayershasmeantthatthe systemhasstayedbrokenfortoo long,witheachleaderpassingthe bucktothenextpersontofixthings, an approachthathasonlyfrustrated patientsandcliniciansalike.

Issuessuchastheopioidcrisisand mentalhealthcarearenot hot-buttonfodderforpoliticiansto tossaroundlikeagameofhot potato.Thesearesubstantialissues thatprimarycaregiversdonothave enoughresourcestoaddress. Politiciansmustnotmakepolitical hayoutofprimarycareissuesbut insteadmustproperlyfundprograms thathavebeenproveneffective.The bureaucracyofpoliticshasleftour healthcaresysteminperilofbeing totallyineffectual,whilerealchange andimplementationofprograms thatwillworkcollaborativelyand sustainablyareleftsittingindrawers nevertobeusedwholesale.

UndertheUNCharterofHuman Rights,recognizedagainunderthe

1966InternationalCovenanton Economic,SocialandCulturalRights, allhumanbeingshavetherightto accessmedicalcare,including primarycare.Yetthegovernmentsof CanadaandBritishColumbiaare fallingwoefullyshortinproviding sustainable,equitable,andreliable medicalcaretoallCanadians.We wanttoseethischanged.

We,asCanadians,havecome togethertoseesuchrealchangebe implementedandaretenderingthis reporttoreflectaseriousdesirefor thefuturecollectivegoodofthis nationandallthosewhocallithome.

OurValues

Whenitcomestoenvisioningan idealprimarycaresystemthat acknowledgesandservestheneeds ofallresidentsofBritishColumbia,we affirmthatsystemmustbe:

Accessible

Accessibilityinprimarycaremeans therightofaccesstoaspacewhere primarycareisprovided.Itmeans thatthereisaphysicianorcareteam foreveryperson,whenandwhere theyneedthem,andthatthereare alternativestomeetinginperson, includingvirtualcare,phone,mobile clinics,safeandprivatespacesto accesscarevirtually.Accessibilityin primarycarefurtherentailsproviding assistancetoaccessingcare.

Accessiblecarealsomeansinclusive care:aprimarycaresystemthatis availableandwelcomingtoeveryone regardlessoftheirlocation,ability, language,oridentity.Italsomeans overcomingbarrierstolearningand usingtechnologyinhealthcarefor patientsandprofessionals,aswellas ensuringinterconnectivityand reliabilityofinformationamong patientsandproviders.

Equitable

Equitableprimarycaremeetsthe differingneedsofeveryonewho accessesit.Itmeansensuringthat

thattheprimarycaresystem addressesthemanybarriersto accessingcare,suchasfinancialor geographicbarriers,andthat everyone—regardlessofage, gender,identity,background,or language— receivesthesame qualityofcare.Equitablecarealso meansaddressingsocial determinantsofhealth,suchasby expandingmentalhealthsupport andinvestinginsocialservicesand housing.Itallowsprimarycareto meetpeoplewheretheyarerather thanapplyingasetstandard.

Equitableprimarycareisalso destigmatized,anti-oppressive,and culturallyresponsive.

Sustainable Sustainableprimarycaremeans takingalong-termoutlooktowards providingservicesanddevotingthe necessaryresourcestoensurecare systemscangrowalongsideus. Sustainabilityencapsulatesfunding andimplementinghigh-quality primarycareacrossallservicelevels, aswellastrainingcurrentandfuture medicalprofessionals.Withouta sustainableapproachtoplanning andimplementation,ourprimary caresystemwillcontinuetofailusas wecontinuetoapplya"band-aid" approach.

Accountable

Accountabilitywithinthehealthcare systemisbuiltthroughboth transparencyandtrustworthiness. Transparencyallowsforbetter understandingofhowthehealthcare systemfunctionsandisfunded.The healthcaresystemmustembody honestyandintegritytobuildtruston abroadscale.Individualtrustisbuilt throughrelationshipswhereinhealth careprofessionalscommunicatewith andareaccountabletopatients, includingthroughlisteningand takingconcernsseriously,ensuring thatpatientsfeelheardand informed,andfollowingupwith patientsregardingtestresultsand referrals.Recognizingthathealth recordsbelongtothepatientis essentialinensuringaccountability. Accountabilitywithinthehealthcare systemmustfurtherensurethat standardsofcarearemetand shortcomingsaddressed.Together, accountability,transparencyand trustworthinessallowforbettercare andempowermentofpatients.

Person-Centred

Person-centredcareaimsto empowerpatientsbyequalizingthe powerdynamicbetweenpatients andhealthcareprofessionals, focusingonamutuallyrespectful andcollaborativerelationship.This beginsbyaddressingsystemic

socio-economicstatussothat patientscanfeelsafe,comfortable, andempoweredwithinthehealth caresystem.Person-centredcare empowersallpatientstoknowtheir rights,theircareoptions,andhowto accessservices.Person-centredcare focusesonallofapatient’sconcerns andgivesampletimeforhealthcare professionalstounderstandand addressmultipleandoverlapping issues,especiallylife-longdisabilities ordiseases,inordertofacilitatea goodqualityoflifeforthepatient.

Universal

Universalprimarycareencompasses equityintheextent,quality,and accessibilityof medicalservicesand coverage.Universalprimarycare keepsthepatientatitscentre.This doesnotequatetoahomogenousor singularapproachtoprimarycare; ratheritallowsforadiversityof approachesconsideringindividual, cultural,regional,and socio-economicfactors.Assuch,a universalhealthcaresystemis inclusive,impartial,and conscientious.Thisvalueisacrucial cornerstoneofasocialcontractthat upholdscitizens’rightstowell-being, equality,andagency.

Prevention-Focused

Prevention-focusedprimarycareis proactiveinnature,aimingtoprevent healthproblemsbeforetheyoccur ratherthanwaitingtoaddressthem whentheyhappen.Itmeans educatingchildrenandyouthtoseta strongfoundationintheirlivesforthe basisofhealthyliving,andcontinuing tosupportlifelonglearningashealth needscontinuetoevolve.Itmeans takingacomprehensiveviewof patientwell-beingandinvestingin therightinfrastructuretosupporta strongandsupportivelevelofcare fromdayone.Prevention-focused careaimstomitigatetheburdenon theentirehealthcaresystemand enhancequalityoflifeforallBritish Columbians.Withoutafundamental governmentcommitmentto preventativecare,therewillbeno realimprovementtoourdailyhealth ortothehealthcaresystem.

OurRecommendations

A. AccessiblePrimaryCareforallBritishColumbians

Inordertoensureuniversalandequitableaccesstoprimarycareforall residents,werecommend:

1. TheProvincialMinistryofHealthestablishandfundcommunityhealth centresineverycommunitywiththegoalthateveryonehastimelyand reasonableaccesstoprimaryhealthcare,includingphysiciansand team-basedcare.Thefollowingmandatesoftheplanwouldfallunderthe purviewoftheMinistryofHealth.

a. Takeanactiveroleinsupportingthedevelopmentofcommunity healthcareservicesinanycommunitywithunmetneeds;

b. Takeresponsibilityforfundingandreducingimplementationtimeto oneyearorlessfortheinstallationofcommunityhealthcentres;

c. Developaframework,withinputfromappropriatestakeholders,by whichtoevaluatetheperformanceof,andensureadherenceto, defined,measurabletargetstoimproveprimaryhealthcare services;

d. Createapanel–whichshouldincludehealthcareprofessionals, patients,communityhealthcarecentreoperators,emergencyroom staffanddirectors,technicians,andparamedics–togiveregular updatesastothestatusofimplementationofthesenewpractices, aswellasreportingonthoseareasthatarenotperformingto standardandthatrequiremoreinput,attentionorfinancingtomeet thetargetsrequired.

2. TheProvincialGovernmentpasslegislationforzeroout-of-pocketcosts (forexample,transportationormeals)sothatpeoplecanaccessprimary careatnopersonalcost.

3. TheProvincialandFederalgovernmentsreviewandprovideaplanwithin1 year,andfullyfundandimplementwithin5years,foraninternet/ satellite-basedinfrastructuresuchthatruralcommunitiescanaccess virtualcare.

4. TheFederalGovernmentperformasystematicreviewofpoliciestoensure thattheydonotmarginalizevulnerablegroupsinsuchawaythatcauses barrierstoaccessingprimarycare.Policyareasforreviewinclude,butare notlimitedto,education,infrastructure,andhealthcareaccessibility.

5. TheProvincialandFederalgovernmentsdevotefunding,spaces,and initiativestotrainpeoplewithintheirowncommunitiestoaccessquality healthcareservicesinthosecommunities.Ideally,thismeansthatlocal residentsaregiventheopportunitytostudy,live,andworkwithinthose communities.

B. PrimaryCareSystemInfrastructure

Inordertoguaranteeprimarycareattachment,quality,and comprehensivecoveragethroughoutthehealthcaresystem,we recommend:

6. TheProvincialGovernmentassigneachresidenttoacatchmentarea withinwhichtheyareguaranteedaccesstoaprimarycareprovideror team,ideallyoftheirchoice.

a. CreatecatchmentareasthroughoutBritishColumbiainthesame manneraspublicschooldistricts,forexample,ensuringprimary careattachment,especiallyforchildren;

b. Createaneasy-to-usedirectoryofpractitionersacceptingpatients withinareasonableradiusofeachresident;

c. Buildinflexibilitywhenaccommodatingnewpatients,accordingto availabilitywithinandacrosscatchments;

d. Accommodatethosepatientswhohavemovedtoanother catchmentbutwishtocontinuewiththeirclinicianorteamof cliniciansbecausetheyhavedevelopedastrongconnectionor attachment.Thepatientshouldnotbeautomaticallycycledoutof theirclinician’sofficeiftheydonotwish.

7. TheProvincialGovernmentprioritizerelationalcontinuityofcareinall aspectsofprimarycaretransformation,inordertoenableaprimary healthcaremodelthatbestservesthechangingneedsandpreferences ofpatients,carepractitionersandcommunities.

a. Theexpansionofteam-basedprimarycarethroughouttheprovince willgreatlyenhanceattachment,continuityandoverallpatientcare. Thereisampleevidencethatteam-basedcarereducesburdenson bothfamilydoctorsandpatientswhilefosteringmore comprehensivecare.

8. TheProvincialGovernmentre-evaluatetheefficacyofserviceswithinthe multiplehealthjurisdictionstostreamlineadministrativeprocesseswithin healthauthorities.

9. Regionsacrosstheprovinceworkcollaborativelytopilot,evaluate,and scaleupprojectsandnewresearchwithacleartimelinetodrive innovationinprimarycareservicedelivery.

10. Primarycareservicecoverageandteamsbeexpandedtoincludeholistic care,includingbutnotlimitedtopharmaceuticals,dentistry,physical therapy,andmentalhealthservices,toensurecomprehensiveand preventativecareforallresidentsoftheprovince.

a. Theseservicesshouldbecoveredatthepointofserviceorhighly subsidizedforthosewhocannotaffordtopay.

C. TechnologyandInformationSystemsInfrastructure

Inordertoadvanceinformationsysteminteroperabilitythatfacilitatesthe exchangeofpatientandprimarycareinformation,accesstomedical records,andotherelementsofin-personandvirtualcare,werecommend:

11. Provincialhealthcareauthoritiesestablishacentralmedicaldata platformforcliniciansandpatientsthatprovidesprovince-wideaccessto electronicmedicalrecords(EMRs)regardlessofthedatabasesoftware usedinanygivenlocation.Thegoalistofacilitatecontinuity,portability, comprehensiveness,andefficiencyofpatientcare.

a. Thisplatformshouldincludeallpatientnotes,testresults, prescriptions,andreferrals.Thisplatformshouldprovideclinicians andpatientswithcomprehensive,easy,andfreeaccesstotheir medicalrecords.Thegoalistoensureportability,continuity, accessibility,andagencyforpatients;

b. Inaddition,theplatformmustincludeadequateaccessibility features.Thisincludes,atminimum,supportforscreenreaders, automatedtranslation,enlargedandsimplifiedtext, closed-captioning,responsivedesignandmobilecompatibility,and color-contrast;

c. Theplatformshouldallowforpatientstoinputinformationtomake surerecordsareup-to-dateforboththeclinicianandpatient’s benefit;

d. Theplatformshouldhaveasingular,easypointofaccess,suchas yourBCServices/CareCard,whichworkslikealibrarycard;inputting yourindividualcardnumberallowsyouaccesstoyourinformation.

12. Governmentfundsbeallocatedtosupportcommunity-basedinitiatives thatraiseawarenessofandprovidetrainingandsupportforpatientsin thetechnologicalaspectsofaccessingprimarycare,includingvirtual care.Thisshouldbeimplementedbasedoncommunityresourcesand needsandmayinclude,forexample,classesatcommunityandsenior centres,mobileoutreachtoruralandhome-boundpatients,andtraining forhealthcareandsupportworkers.

13. Cliniciansandagenciescommittoadoptingastandardforelectronic medicalrecords(EMRs)thatismutuallyagreeduponbypublicofficials, patientrepresentatives,andindustryexperts.TheseEMRsmustbe inter-operablewiththeaforementionedpatientandpractitionermedical dataplatforms.Theymustalsohaverobustsecurityanddataencryption inplacetoprotectpatients’privacy.Cliniciansshouldreceivesufficient, high-quality,professionaltrainingandsupporttoensuretimelyand seamlessadoptionofthesesystems.

14. Primarycarepractitionersofferflexiblemodesofcareincluding,at minimum,in-clinic,video,phone,andsecuremessagingtoensure accessible,inclusivehealthcareforallpatients.

a. Patientsshouldhaveagencyinchoosingtheirmodeofcare,thus honouringthevaluesofaccessibilityandsafety;

b. Virtualcareshouldcomplement,notreplace,in-personcareifitis requestedandfeasible;

c. Provincialauthoritiesshouldfundvirtualservicestosuchacomplete extentthattheyfullycomplementin-personcare.Theyshouldalso fundandsupportcommunitiestodeveloppublicandmobile infrastructurethatallowspatientstoaccesstelehealth appointments.Forexample,fundingcouldbeallocatedtoexpand callboothsinpubliclibrariesorpurchasemobilecallbooths. Implementationshouldagainbebasedoncommunityresources, needs,andpreferences;

d. Patientsshouldhavetheabilitytoauthorizeafamilymemberor friendtoaccesstheirmedicalfileincaseofemergency.

D. FundingandResourceAllocation

Inordertomaximizeinnovation,primarycarequality,andhealthcare managementcosts,werecommend:

15. FederalandProvincialgovernmentscommittoadoptingtheWorldHealth Organization’s“HealthinallPolicies”approachtoshapepublicpolicy initiativesacrossallsectors/ministriesandthedisbursementoffunding andresources.Thisisinrecognitionthathealthisastateofcomplete physical,mental,andsocialwell-being,andnotmerelytheabsenceof diseaseandinfirmity.

16. TheProvincialGovernmentengagewithpartnersintheprivatesectorto findinnovationsandtechnologicalsolutionsthatcanstreamline administrativeprocessesandprocedures,reduceduplication,enhance primarycareinitiatives,andmaximizeclinicians’timewithpatients.

17. TheProvincialGovernmentreallocateandincreasefundingtoexpand patientandpopulationhealthinitiativesthataddresssocialdeterminants ofhealth(e.g.housing,foodsecurity,etc.)withanequitylensand attentiontoruralandremotecommunities.

18. TheProvincialGovernmentcommittotheexpansionofCommunityHealth Centres(CHC)toensurethatallBritishColumbianshaveaccessto primarycareviaCHCs.Ataminimum,thereshouldbeatleastoneCHCin eachcommunity,andideallymoreinrural,remote,Indigenousand low-incomecommunities.TheseCHCsmustalsobefundedtoprovide

expandedresourcestothesepatients,whoaremorelikelytofacegreater barrierstocarethanthoseinmoreaffluentcommunities.

19. TheProvincialGovernment,theFederalGovernment,andregulatory bodiesworkcollaborativelytoexpandthenumberofhealthcareclinicians via:

a. Expandingaccessandreducingsystemicbarrierstohealthcare educationforpotentialprimarycareclinicians;

b. Reducingbarriersforinternationallytrainedandout-of-province professionals(i.e.,pan-Canadianlicensing).Thisincludes streamliningtheprocessofcertifyingimmigrantprimarycare clinicians;

c. Integratingandexpandingtheuseofphysicianassistantsandother healthcareprofessionalstoprovidecareunderphysician supervision;

d. Medicalschoolsandregulatorybodiesexpandingfamilymedicine residents’trainingtoemphasizevaluessuchascontinuityofcare, long-termillnesssupport,andchronicpainmanagement.This trainingshouldalsofocusonthestabilityrequiredofa clinician/patientrelationship,whichfostersabeneficialpartnership inlong-termcare.

20. FederalandProvincialgovernmentscommittoindependent,third-party monitoring,evaluation,andresearchofresourcesexpendedonprimary careinitiativestomeasureimpactsandoutcomes,financialorotherwise (i.e.,toscaleupeffectivepilotprojectsinanexpeditedmanner).

E. PoliticalWill&PatientAdvocacy

Inordertoguaranteetherightsofpatientsinthehealthcaresystem,we recommend:

21. TheProvincialGovernmentlegislatethecreationofaPatientAdvocacy Organization(PAO)—whichshallbepubliclyfunded,independent,and non-partisan—inordertoprovideequitablerepresentationofthediverse needsandperspectivesofBritishColumbians.ThisPAOshouldconsistof publiclyelectedboardmembersanditsmandateshouldinclude,butis notlimitedto:

a. TrainingandsupportingIndividualPatientAdvocateswhowilllearn aboutandimplementtherequiredknowledgetoassistvulnerable patientsinnavigatingtheprimaryhealthcaresystem.Thiswould includeassistanceinfillingoutforms,makingandfollowingupon appointments,explainingmedicaljargon,andaskingappropriate questionsonbehalfofthepatient;

b. Supportinglocal,community-basedprimarycarechampionsand chaptersthatengagewiththePAOincommunityinitiatives;

c. Consultingonprovinciallegislationrelatedtoprimaryhealthcare beforeitisvotedonandwiththeoptionofcarryingoutreferendums;

d. Championingtransparencythroughouttheprimaryhealthcare system,includingbutnotlimitedto:

i. Publicizinginformationon:

1. Provincialhealthcarelegislationandpolicies;

2. Theinternalprocessesofthe variousprofessional collegesthatoverseehealthcareworkers;

ii. Providingpatients’accesstotheirpersonalmedicalrecords;

iii. ActingasanindependentbodyseparatefromtheCollegeof PhysiciansandSurgeons,thatcanreviewmedical professionalsethicsandconduct,andensurethat,whena complainthasbeenlodged,thepatients’concernsarebeing addressedadequately.

e. DefendingandupholdingthePrimaryHealthCareCharter(see Recommendation22)onbehalfandinthebestinterestofthe patientsinBritishColumbia.

22. TheProvincialGovernmentandthePAOdraftandimplementby2025a comprehensivePrimaryHealthCareChartertodefineandclarifytherights andexpectationsofpatientsthatincludesbutisnotlimitedto:

a. Adiscussionofsocio-economicdeterminantsofhealth;

b. Recommendationsforensuringtransparency,accountability,and equitableandtimelyaccesstomedicalservicesforallBritish Columbians;

c. Provisionsforpubliclyfunded(freeorsubsidized)educationforall medicalprofessionalsinexchangeforaperiodofpublicservicein BC;

a. Aframeworktoenhancework-lifebalanceformedical professionals;

b. Guidelinesoncontinuityofcare.

23. TheFederalGovernment,inconsultationwithotherregionalandprovincial healthorganizations,implementandfullyfundthePatientMedicalHome (2019)1aswellasestablishGoalsandStandardsforPrimaryCareby2025 inordertoprovidetimely,consistent,qualityprimarycaretoeveryBritish Columbian,regardlessof:

a. geographicallocation;

b. socio-economiclevel;

c. race;

d. colour;

e. nationalorethnicorigin;

f. Indigeneity;

g. age;

h. genderidentityandexpression;

i. sex;

j. sexualorientation;

k. size;

l. diversephysicalandmentalabilities;

m. pre-existingconditions;

n. substanceuse.

24. TheProvincialGovernmentcreateregionalprimarycarehealthboards, consistingofpubliclyelectedmembers,workinginatransparentand accountablemanner,toprovideoversightonmedicalservices.

a. Eachprimarycareboardshouldhavenomorethanonepolitician whilealsoincludingatleast:amedicalclinician,anoutreach/social worker,acommunityhealthcenteradministrator,andapatientwith multiplehealthbarriersorissues,aswellasvariousadditional stakeholderstoreflectthediversebackgroundsofallBritish Columbians.

F. PublicEducation&Mobilization

Inordertoincreasepublicawarenessofprimarycareissuesandempower BritishColumbianstoshapehealthcarepublicpolicy,werecommend:

25. PatientAdvocates(seeRecommendation21a)createanindependent, publiclyfundededucationcampaignthatincludesthefollowingactions:

a. Supportinggrassrootsstorytellersthroughbroadmediareachto highlight“cracks”inthecurrentsystem;

b. Educatingthepublicontheirrightsinprimaryhealthcareincluding accesstotheirowninformationthrougha“HealthCareBasicsinBC” campaign;

c. Highlightingsuccessstoriesofchangeonacommunitylevelto motivateandeducatethepubliconthebenefitsofparticipatingin effortstotransformtheprimarycaresystem;

d. Invitingthepublictolargevenueareastohaveameet-and-greet withclinicians,offeringincentiveslikefreefood,sothepubliccanbe askedquestionslike,”Doyouknowwhathappenswhenyoudon’t haveprimarycare?”orhavecliniciansacknowledgetheshort-falls ofthesystemandletthepublicinformcliniciansoftheirneedsand fears;

e. Invitingindependentfilmmakerswhoreflectthediversebackground ofBritishColumbianstomakeshortfilmsandotherinteractive mediafromtheirperspectiveonhowbesttointeractwithclinicians andpatients.Thewiderthespectrumofpublicengagementand informationcommunications,thegreaterknowledgebaseyouare providingtothepublic.

OurCarePrioritiesPanel Program

TheBritishColumbiaPrioritiesPanel, consistingof31*membersfromacross theprovince,metonlinetwice(inApril andMay2023)andthenin-person overthreedaysinVancouver(inJune 2023).Duringtheirnearly30hours together,panelmemberslearned aboutprimarycareinBritishColumbia andotherjurisdictions;theyheard fromandengagedwith19subject matterexpertsinpresentationsor moderateddiscussions.Themembers alsospentasignificantamountof timeinconversationwitheachother astheyengagedinaseriesof facilitateddiscussionsand deliberationsthatculminatedinthe consensusrecommendationsput forwardinthisreport.Videosofsession presentationsandrelatedmaterials areavailabletothepublicat ourcare.ca/prioritiespanels.

Session1: Saturday,April29,2023

Virtual

TheopeningsessionofOurCareBC beganwithaformalwelcomefrom thePanelChair,RichardJohnson,as wellasOurCare’sPrincipal Investigator,Dr.TaraKiran.Richard talkedaboutthepanel'smandate andtasks,andensuredmembers understoodhowadeliberative processlikeaprioritiespanelis uniqueinhowitasksitsmembersto thinkaboutthebroaderpublicandto considertheinterestsofthosethey represent.Membersthenhadthe opportunitytomeetoneanotherin smallbreakoutgroups.

Afterabriefpresentationfrom Richardonthehistoryandevolution ofCanada’shealthcaresystem, includingtheCanadaHealthAct,the panelwelcomedDr.ChristieNewton, PresidentoftheCollegeofFamily PhysiciansofCanadaandAssociate Head,EducationandEngagement,at theUniversityofBritishColumbia’s DepartmentofFamilyPractice,who deliveredapresentationgivingan extensiveoverviewofprimarycarein BC.Memberslearnedaboutvarious facetsofpopulationhealthandthe rolesthatprimarycaresystemsplay

*Owing to personal and health-related circumstances, two memberswereunabletotraveltoVancouverforthefinalsessions, thoughtheirperspectiveswerestillapartoftheprocess.

inensuringindividualandcommunity health.Thepresentationalsocovered theprinciplesandvaluesofprimary healthcare,theevolutionofprimary caredeliveryinBC,thevariousways primarycareisorganizedandfunded intheprovince,andhowastronger primarycaresystemmayhelp overcomebroadercrisesand challengesfacinghealthcareinthe province.

Membershadtheopportunitytoask questionsofDr.Newtonbefore headingintosmallgroupdiscussion aboutthevaluesthatshouldguidea renewedprimarycaresystem.

Laterintheopeningsession, membersheardfromDr.Goldis Mitra,afamilyphysicianinNorth VancouverandtheBCProjectLead forOurCare.Dr.Mitrapresentedthe findingsfromtheOurCareNational Survey,which,betweenSeptember andOctober2022,gatheredinsights frommorethan9,000Canadians abouttheirexperienceswithprimary careandtheirpreferencesand prioritiesforthefuture.Thefullresults ofthesurveyareavailabletothe publicatdata.ourcare.ca.Dr.Mitra tookquestionsfrommembersabout thesurveydataandhowitmay guidetheirworkasapanel.

Session2:

Saturday,May27,2023

Virtual

ThesecondsessionoftheOurCare BCPrioritiesPanelbeganwitha welcomeandrecapfromPanelChair RichardJohnson,followedbya presentationfromDr.TaraKiranon modelsandfeaturesofprimarycare systemsinOECDcomparator countries(includingFinland,the UnitedKingdom,Norway,andthe Netherlands)andotherCanadian provinces,highlightinghowthese differfromthecurrentstructureand deliveryofprimarycareinBCand offerpotentialideasforthisprovince toconsider.Shediscussedvarious featuresofprimarycaresystems suchaspracticeandrostering models,fundingandpayment models,useofinformationsystems anddatasharing,afterhoursand urgentcare,andaccountability measures.AfteralivelyQ&Aperiod, membersbrokeintosmallgroupsto discusstheprosandconsofthe differentfeatures,andtoidentify whichfeaturesshouldbeavailableto allBritishColumbians.

Laterinthesession,members listenedtoamoderateddiscussion aboutaccesstoprimarycarefor equity-deservingcommunitiesin

whichPanelChairRichardJohnson engagedwiththreeguestspeakers: Dr.EvanTleslaAdams,DeputyChief MedicalOfficeroftheFirstNations HealthAuthority;Dr.LindsayMackay, UBCclinicianandMedical CoordinatorofDowntownEastside Connections,asubstancecareclinic inVancouver;andDr.Alan Ruddiman,afamilyphysicianinrural BCandformerPresidentofDoctorsof BC.Thespeakersdiscussedthe importanceofconsideringequityin deliveringqualityprimarycaretoall BritishColumbians,focusingonsocial determinantsofhealthand underscoringthesocialand economicdisadvantagesmany peoplefaceaccessingthehealth careservicestheyneed.The speakersdescribedsomeofthe challengesofdeliveringprimarycare inruralandremoteregionsofthe province,amongIndigenous populations,andinthecontextof mentalhealthandsubstance-use care.Eachspeakeralsogave examplesofinterventionsthatcould helpimproveaccessandleadto betterhealthoutcomesforthese equity-deservingpopulations.The moderateddiscussionwasthen followedbyarobustQ&Awith members.

Session3:

Friday,June23,2023 Vancouver

Aftertwomonthsofvirtualwork,the membersoftheOurCareBCPriorities Panelgatheredtogetheratthe brightlylitMorrisJ.WoskCentrefor DialogueatSimonFraserUniversityin theheartofdowntownVancouver, locatedwithintheshared,unceded, ancestralterritoriesofthe xʷməθkʷəy̓əm(Musqueam), Sḵwx̱wú7mesh(Squamish),and səlilwətaɬ (Tsleil-Waututh)Nations.

Followingaroundofintroductionsas membersmeteachotherinperson forthefirsttimeandsharedwhythey volunteeredandwhattheylearned sofar,theybrokeintosixsmall workinggroupstodefinethevalues previouslyidentifiedinSession1, whichtheybelieveshouldguideany andalleffortstoimproveBritish Columbia’sprimarycaresystems. Membersmovedbetweentablesto assistoneanotherandsharedtheir resultsinplenary.

Laterthatevening,themembers welcomedfourspeakersina moderateddiscussionwithPanel ChairRichardJohnsonaboutvirtual careanditsroleindelivering high-quality,accessiblecarewithin primarycaresystems.Addressing

ourcare.ca

thepanelwere:Dr.LindsayHedden, AssistantProfessorofHealthServices ResearchatSimonFraserUniversity andco-PrincipalInvestigatorofthe HealthSystemsResearchLab;Dr. BirinderNarang,ClinicalAssistant ProfessorintheDepartmentofFamily PracticeatUBCandafamily physicianfortheREACHCommunity HealthCentre;Dr.KeirPeterson,Chief MedicalOfficerofTelusHealth;and GladysSelkin,amemberofthe Saik’uzFirstNationresidingwiththe Stellat’enFirstNation,whopresented apatientperspectiveonhowvirtual careisworkingwiththe Carrier-SekaniFamilyServices.

Membershadtheopportunityto engagewiththesespeakerson issuesofvirtualcareanddigital informationsysteminfrastructure beforeretiringfortheevening.

Session4:

Saturday,June24,2023

Vancouver

OnSaturdaymorning,members gatheredonceagainattheWosk Centreforbreakfastandarecapof thepreviousday’swork,ledbypanel chairRichardJohnson.Themembers thenheardandinteractedwithtwo panelsofguestspeakers.Thefirst wasaninteractivepresentationon

ourcare.ca

team-basedcare,ledbyDr. Thuy-Nga(Tia)Pham,family physicianandCo-MedicalDirectorof theSouthIslandUrgentandPrimary CareCentresinVictoria,andher team,including:Estephanie Acebedo,anurselead;Hayley Diakiw,anursepractitioner;and DavanaHarlow,aregisteredsocial worker.Joiningthemvirtuallyvia ZoomwasValerieSt.John,Executive DirectoroftheBritishColumbia AssociationofCommunityHealth Centres(BCACHC).Membershadthe opportunitytolearnabouttheroles andopportunitiesofteam-based careandthepotentialofmodelslike CHCstobescaledacrossthe province,andtoengageinalively Q&Awiththeguests.

Intheday’ssecondpresentation, membersparticipatedina moderateddiscussionontradeoffs betweentimeliness,continuity,and community-basedcare,welcoming threeguestspeakers:Dr.Rita McCracken,afamilydoctorand AssistantProfessorintheDepartment ofFamilyPracticeatUBC;Dr.Tracy Monk,afamilydoctorandtheFaculty LeadfortheUBCCentrefor RelationshipBasedCare;andAndre Picard,anaward-winningGlobeand Mailhealthreporterandcolumnist. Membershadtheopportunityto learnandaskquestionsaboutthe

tradeoffsinprimarycaredelivery withtheaimofunderstandinghow besttoprioritizeandbalance elementsofprimarycarethatwork forallBritishColumbians.

Followingeachofthemorning presentations,membersbrokeinto smallworkinggroupstoidentifythe issuesandchallengesfacingour primarycaresystemandbeginto prioritizethemandidentifypotential solutions.Afterlunch,members workedcollaborativelytogrouptheir listsofissuesintosixthemes,which becametheworkinggroupsinwhich theyspentthebulkoftheafternoon developingtheirconsensus recommendations.

Afteranhour’sbreak,members reconvenedinthelovelyMount Pleasantconferenceroomnextdoor attheDeltaVancouverHotelfora sumptuousdinner,followedbya moderateddiscussionwithDr. KathleenRoss,President-Electofthe CanadianMedicalAssociationanda familyphysicianinCoquitlamand NewWestminster,whosharedher perspectiveonprimarycaresystem transformationandengaged membersinan“AskMeAnything” session,inwhichtheyraisedany lingeringconcernsandquestions regardingtheirrecommendationsin progress.

Session5:

Sunday,June25,2023 Vancouver

Onthemorningoftheirfinalday, followingaplenaryreflectionledby PanelChairRichardJohnsononthe workachievedtothispoint,members oftheOurCareBCPrioritiesPanel spenttimeinsmallfacilitated workinggroupsfinalizingtheir recommendations,draftingother partsoftheirfinalreport,and reportingbacktoeachotherin plenaryastheyworkedtowards consensus.Afterlunch,invitedguests –includingleadersinBritish Columbia’shealthcaresectors–joinedtolistenasmembers presentedtheirdraftfinalreport, including25recommendationsfor strengtheningprimarycareinthe province.

PanelChairRichardJohnson welcomedguestsjoininginperson andonline,andgaveanoverviewof theOurCareprocess,acknowledging thefinancialsupportoftheMaxBell Foundation,theStaplesEventhe OddsCampaign,andHealthCanada. Next,individualmembersofthe PrioritiesPanelcametothepodiumin turntodeliverthevarioussectionsof thedraftreport.Followingthe presentation,members

welcomedtothepodiumtwovery specialguestswhodeliveredtheir reflectionsonthereportand committedtotakingupthefinal reportwhenitispublishedin September:TedPatterson,Assistant DeputyMinisterforPrimaryCareat theBritishColumbiaMinistryof Health;andtheHonourableBonita Zarrillo,MemberofParliament representingPortMoody-Coquitlam, NDPCriticforInfrastructure, Communities,andDisabilityInclusion, andDeputyHealthCritic.

PanelChairRichardJohnsonthen invitedpanelmembersandinvited gueststosharetheirreflectionson thepanelprocessanditsoutcomes. Finally,Dr.GoldisMitra,theBCProject LeadforOurCare,andDr.TaraKiran, theOurCarePrincipalInvestigator, gavewordsofthanksanddistributed CertificatesofPublicServicetoeach panelmember,acknowledgingand documentingtheircontributiontothe conversationaboutthefutureof primarycareinthisprovince.They thankedeachpanelmemberfortheir timeandworkonbehalfofallBritish Columbianstowardsstrengthening primarycareasoutlinedintheir recommendations.

MeettheMembers

REBECCAAUSTIN

ExceptforthefirstyearinAlberta,Ihavelived mywholelifeinBC,growingupinbeautiful NorthBurnaby.ImovedfromtheLower MainlandtoPrinceGeorgewhereIstarteda familyandraisedmytwoboys.Nowretired sixyearsfromacareerwiththeprovincial publicserviceinwhichIassistedresidents withaccessingmultiplegovernment programs,Iamtakingcollegeclasses, learningtoplaytheflute,andmakingsoaps andfermentedfoods.MyhusbandandI enjoyourruralacreageandourdogs, chickens,andbees.Itisaprivilegetobeona panelcontributingtoadiscussiononcrucial healthcaredecisions.

CORRIEBELTRAME

Hi,I'mCorrie,originallyfromDidsbury,AB,but I'vehadtheopportunitytoliveinseveral countries,whichincludeScotland,England, Australia,SouthAfrica,andnowbackin Canada.IcurrentlyresideinOsoyoos,BC, andhavebeenheresinceOctober2020.My experiencehasbeenprimarilyin administrationroles,includinggeneral adminandofficemanagementpositions. Havingakeeneyefordetailanda proceduralmindsethaveproventobe valuableassetsinmycareer.Forthefirst timeinmylife,Ihavenothadaccessto healthcarefor2.5years,andthisisoneof thereasonswhyIwantedtoparticipateon thepanel,formyselfandcountlessothers whohavesufferedduetoourlackofhealth care.Ienjoysolvingproblemsandfinding creativesolutionstochallengingsituations, andIamexcitedtoworkwithyoualltohelp makeapositivechangeinourhealthcare system.

JANEBOCKMAN

IamoriginallyfromtheUSA,NewYorkin particular.The1960’swasafantastictimeto belivinginNYC;atimeofexploration, expression,activismandmusic.Inthe1970’sI traveledtheworld,settlingintheMiddleEast whereIfoundedakibbutz.AfteryearsI returnedtoNorthAmerica,settlingatfirstin Montreal,thenToronto,Calgaryand Vancouver.FiveyearsagoImovedto VancouverIsland.IstudiedDental TechnologyinTorontoandVancouver,and hadalong,successfulcareer.Iwaselected tositonmyregulatoryboardandeventually becameacollegeinstructorinmy profession.Ihavepracticedyogamyentire life.Ibecamearegisteredyogainstructoras wellasacertifiedPilatesinstructorandhave taughtclassesinmanystudiosand recreationcentres.CurrentlyIteachyoga andPilatesfortheParksBoardinNanaimo.I hopeIhelppeoplefindsomebalanceinour challengingworld.Iloveanimalsandam currentlyaslavetotwodemandingrescue cats.Communityandworldinvolvementare responsibilitiesthatItakeseriously.

DANABOSCHMAN

Nobiographyavailable.

SABRINABROSNAN

IwasbornandraisedinNorthDelta,BC, identifyasShe/Herandamanactive memberinmycommunities.Ihavehada chronicillnessformorethan30years,am theprimarycaregiverformydisabled,senior mother,and Ihadbeenformygrandmother atonetimeaswell.Ihaveagreatmany friendsthataremembersoftheBIPOC, LGBTQ2+,single/married/committed communitiesaswellasthosewhoareablein differentways;theirperspectivesandneeds areoftheutmostimportancetome.Ihave workedinalargevarietyoffields,from administrationtoconstruction, manufacturingtolandscaping,charity fundraisingandpublicengagement.Ihave volunteeredformanypanels,surveys,and groupstotryandhelpbringawarenessto issuesthatareimportanttopeople,manyof whomfeeltheydonothaveavoice,except withme.Assomeonewhohasseenthevery worstinthepublicmedicalservicesof Canada,aswellastoomanygooddoctors burningoutorthrowinginthetowelbecause thesystemitselfwasagainsttheneedsof thedoctorsandpatients,I'dliketoseethese issuescomeforwardandhavethem discussedseriously.Ihaveagreatloveof reading,writing,gardening,sports,dancing, andotherphysicalactivities,whennot working.

DEBBIECHOW

IwasbornandraisedinVancouver.Iwas pleasedandexcitedtobechosenforthis panel.Ihavealongcomplexhistorythat beganover30yearsago.Moreimportantly,I haveheardmanystoriesmainlyfromstroke survivors.Webegan“BuildingLifeAfterStroke Together”withanEasterweekendBLAST.This ledtoamonthlydinner.Thatrunsitselfevery 15thatTrocaderos.Whenlocalstroke recoverybrancheswereshutdown,we createdSOCIALS“SurvivorsOffer CamaraderieInActiveLifeStyle.”Itis peer-ledbystrokesurvivors.Wechooseto beautonomousandnotapplyforgrants.We havenoleadpersonandonlyask$5per sessionwhichincludeslunch.

ELLYGRABNER

MynameisEllyandIama41-year-old motherof3.Iwasbornandraisedin Kamloops,whereIcurrentlylive,work,create, learn,andraisemyfamily,onthetraditional territoryoftheTk’emlúpsteSecwépemc nation.Myfamilyisdiverse,andincludes women,2SLGBTQIA+,Metisandindigenous backgrounds.Ihaveworkedinpublicservice foralmost2decadesandampassionate aboutwomen'srightsandsocialequity.I joinedthispaneltohelpforma recommendationforourprimaryhealthcare systemthatisrootedinreal,attainable goals,basedontheexperiencesofthe averageBritishColumbian.

MICHAHOGG

IhavelivedonVancouverIslandforover threedecades,havingmovedherewithmy momwhenmyparentsdivorced.Iobtained aDiplomaofArtsandSciencethrough VancouverIslandUniversityandamcurrently enrolledinaBachelorofArts,majoringin psychology.Myworklifehasbeenvaried, runningthegamutfromcleaninghomesand offices,workinginmanufacturing,working withinthehospitalsysteminMedical Imaging,tomycurrentemploymentwiththe BCprovincialgovernmentworkingwith marginalizedindividualsandseniors.Ihave twoamazingsonsandamcurrentlyliving withmypartnerinMillBayontheislandtobe closertofamily.Enjoyingtheoutdoors, whetherhiking,camping,boating,gardening, walkingthedog,ortakingphotos,ismy passion.Thereisnothingbetterinlifethan beingastewardoftheland,atraitIinherited frommygrandfather.Ivolunteeredforthe OurCarePrioritiesPanelbecausehealthcare isimportanttocommunitiesandindividuals throughoutlife.Isupporttheprovisionof well-roundedpreventative,accessible primarycarewhichincludesdental, optometry,andmentalhealthcoverage,and remainsprovinciallycoveredunder increasinglydiverseneeds,avoiding two-tieredmodelssupportingaccess accordingtowealth.

BENSONIZUNWANNE

IwasborninPortHarcourt,Nigeria.I immigratedwithmyfamilytoWinnipegin 2011.Iamanaccountantandworkinthe publicsector.Iammarriedwithfourchildren, butonlytheyoungestliveswithusnow.We movedtoKelowna,BCin2014andVictoriain 2017.Ienjoysoccerandamafanofthe ArsenalFootballClubofLondon.Ilovehiking andenjoyingthebeautifulnatural environmentofVancouverIsland.Ivolunteer asTreasurerforsomeCharities,TaxClinics, andmyprofessionalorganization.I volunteeredforthepanelasawayofgiving backtothecommunitythathasbeengood tomeandmyfamilyandcontributingto buildingabetterCanada.

RUBYJAGGERNATH

ImovedtoBC’sLowerMainlandwithmy familywhenIwas13andhavelivedhereever since.Ifirmlybelieveinthevalueoftalkingto frontline“workers”or“clients”soIfeltthis panelisimportanttomaintainingahealthy community,andagreatwaytocontributeto ourcommunity.I’vevolunteeredforthepast fewyearsbypickingupgarbagealongour streets.I’malsopresidentoftheFraserValley RockandGemClubandpastsecretaryof theBradnerCommunityAssociation,aswell asamemberandformeractivememberof theAbbotsfordPhotoArtsClubanda memberofCAPA.I’vebeenateacher,day careworker,newsreporteronasmalllocal paper,independenttechnicalwriter,and donesomefreelancewriting,aswellas raisingthreeboyswhoarenowraisingtheir ownfamilies.

JASMINEJAVILLO

IwasborninSurrey,BritishColumbia,andhave livedinvariousareasinMetroVancouver.Iam nowlivinginEastVancouverwithmypartner andmylittleCorginamedMonai.Istudied DentalHygieneatVancouverCommunity Collegeandwentontocompletemy bachelor'sdegreeattheUniversityofBritish Columbia.Inmysparetime,Ienjoyreading andvolunteeringforvariouseventsthroughout thecity.AsaDentalHygienist,Icanseehow limitedaccesstocareaffectsmyclients,and theneedforimprovementwithinourhealth caresystems.Ivolunteeredforthispanelto providemyindividualperspectiveonour primarycaresystem,aswellaslearnaboutthe experiencesofothers.

DAMANKANDOLA

Iamasettlerandsecond-generation CanadianofSikhPunjabiheritage.Icurrently workasanEvaluationSpecialistwithNorthern HealthandasanAdjunctProfessorwiththe FacultyofMedicineattheUniversityofBritish Columbia.Atrainedresearchscientist,my interestsincludehealthservicesandpolicy, ruralhealth,knowledgetranslation, patient-orientedresearch,andcardiovascular health.Outsideofwork,Iamactiveinmy communityandenjoyexploringtheoutdoors. I’manavidreaderandcurioustravellerwhois alwayslookingforwardtomynextbig adventure.Ivolunteeredtoparticipateinthe OurCarePrioritiesPanelbecauseIam passionateaboutensuringhealthyand sustainableprimarycarewithequitableaccess forall.

COLEKEITAMO

Iwasbornandraisedinasmalltownin NorthernFinlandandimmigratedtoBurnaby, BritishColumbia,27yearsago.Mycareerasa salesmanagerinthetravelindustrygivesme opportunitiestoexploretheworldandmarine lifewhichIampassionateabout.Ialsoenjoy thecommunityIlivein,thestunningviews,the closenesstonature,andthehiking opportunities.Acoupleofyearsago,Isawthe effectsofclimatechange:theextremeheat wavethatcausedmanypeopletolosetheir lives;thisisoneofthereasonsIvolunteeredfor thePanel.Iwanttocontributemyideasand thoughtsandbepartofpositivechangesin Canada.

JEANETTELIM

IhavelivedinMetroVancouversincemyfamily emigratedfromSingapore30+yearsago. WhenIamnotworkingasanaccountingtemp, Iamacaregivertomyagingparentsand grandaunt.JohnF.Kennedy’swords,“Asknot whatyourcountrycandoforyou,askwhatyou candoforyourcountry”havealways challengedmetocontributeinsomewayto thepublicgood.Iexcitedlyvolunteeredforthis Panelasitgivesmetheopportunitytoshape ourprimarycaresystem.Inmysparetime,I lovetododifferentkindsofwalking–power walking,Nordicwalkingandracewalking.Ialso lovetoreadnon-fiction,watchdocumentaries, andvolunteerwithcharities.

MALIKALIM

IwasborninVancouverandhavelivedinmost areasofGreaterVancouver.Iworkfull-time withinthetechindustryandhaveforthelast near-decadenow.In2019Igotmarriedand wasalsodiagnosedwithMultipleSclerosis.It tookover9monthstobediagnosed.Myfirst noticeableonsetsymptomsincludedhalfmy bodygoingnumb.Ilivewithconstantlevelsof chronicpainandfatigueasaresult.Oneofthe mainreasonsIvolunteeredfortheOurCare PanelisbecauseIamhopingtoseereal positiveactionsandimpactscomeoutofthis.I havenothadaccesstoafamilydoctorinover tenyearsandtheshortageofhealthcare resourcesisonlyrising.Assomeonewith severehealthissues,Idon'twantanyoneelse togothroughwhatIexperiencedinmy diagnosisprocess.

JESSEMacGREGOR

BornandraisedinVancouver,Inowresidein Missionfollowingseveralrelocationsaround theprovinceovermyworkingyears.Muchof thatworkhasbeenconcentratedinseeking socialchange,whetherinworkingfor neuro-diversepopulations,lowincomegroups, orpersonswithHIV/AIDS.MorerecentlyIspent 8yearsvolunteeringinmylocalhospice facility,where,amongthemanylifelessonsI gleaned,Ihadtherareprivilegeofspending manyhourswithindividualsontheirfinal transition.Finally,asatransmanandanow elder,Ihaveakeeninterestinhowhealth care/policiesareorarenotmeetingtheneeds ofthisdemographic.ForfunIamahome renovationjunkieandwatchfartoomany homerenovationTVshows,muchtothe consternationofmypartner. ourcare.ca

DONALDWESLEYMARCH

IwasborninNanaimoBCandraisedin Ladysmith.Icurrentlyworkin telecommunications.Inadditiontomyinterest inallthingstechnological,Ialsoenjoyreading, writing,andwalking.IhaveADHD,andIama passionateadvocatefortheneurodiverse community.Iamhonoredtohavebeen selectedtoparticipateintheOurCarepanel. Everyonewillinteractwithourhealthcare systeminmanywaysoverthecourseofa lifetime,andwhileIbelievewehaveagood system,Ialsobelievewecanmakeitbettervia activeparticipation.

AMYMASON

IwasborninVancouver,wenttoschoolin Montreal,livedinthesouthernUSasayoung adult,andreturnedtotheVancouverarea whenIcould.Unabletoaffordlivingdowntown, forthelastseveralyearsI'vebeeninaremote suburbanarea.Onlinerole-playinggamesare themainwayIspendmytime.I'dworkinthe creativesectorasawriterifIcouldaffordto livewheresuchjobsareavailable.Asa transgenderwomanlivingbelowtheBC povertylineforthepastdecade,Ivolunteered forthepaneltoprovidemyperspectiveon healthcareinBC.

RAYMcDONALD

IhavelivedinSouthBurnabysinceretiringas afoodplantmanagerfollowingastrokein 2011.I’mactiveinlocalstewardshipgroups andanavidwalkerandtransitrider.I’ve participatedinmanyfiveand10Kwalks.I volunteeredforthePaneltohelpshapeour healthsystemformychildrenand grandchildren.Iamactiveinthestroke recoverycommunity.Iamconcernedabout healthcareformydaughtersufferingfrom longCOVID.Ilookforwardtoexchangingour variedlivedexperiencesandviewpoints.

MARKNEATH

OriginallyfromtheMaritimes,Ihavelivedin NorthernAlbertaandCentralOntarioinmy journeyacrossCanada. Ihave,though, spentthelastfortyyearsinBCworkingin telecom(projectmanagement)andraising mytwoboys.IwasattractedtoVancouver primarilyfortheworkbutalsothe communityasIenjoyboththemountains andsea.Whennotworking,Iusuallyfindtime forphotographyandhiking. ThoughIam trainedasaglassartisanIhaven’tinvested toomuchtimeinitlately, somethingIhope toremedyatretirementinthe not-too-distantfuture.Iputmyhandupthis panelfortworeasons:Ithinkitisimportantto domoretomakeourvoicesheardandhear thevoicesofothersontopicsimportantto Canadiansinastructuredmanner;andI wouldliketoreturnabittothecommunity whichhasgivenmeandmyfamilysomuch.

HENDRIKDEPAGTER

IwasbornintheNetherlands,grewupin Montreal,andhavespentmostofthelast fourdecadesontheWestCoast.Igraduated fromConcordiaUniversityinMontrealand UBC,whereIstudiedsocialwork,followedby adecadeinchildprotectionandsixteen yearsinmostlypsychiatrichospitalsocial work,withaneight-yearstintasaCanada ImmigrationOfficer,postedinPretoriaand Paris,inbetween.Nowretired,I’mkeento distillmyexperiencesasahospitalsocial worker,asacaregiverforfifteenyearstoa parent,andasanengagedcitizen,tohelp Canadarealizethefullintentof comprehensiveandequalhealthcareforall.

JENNIFERRAMESCH

IamanIndian,Panamanian,andNorth Americanfemalegeologicalengineer.Ihave livedexperiencewithprimarycarein Panama(PanamaCity,ColonCity),the UnitedStates(EugeneOR,NewHavenCT [bothinandoutsideofuniversity],and BostonMA),andinCanada(Vancouver [bothinsideandoutsideofuniversity], Burnaby,andnowNanaimo.)Myinterestsare ineverything,excepthockey(pleasedon’t holditagainstme)andspreadsheets.My interestsinvolvinghealthcareinclude:

● Differentculturalnormsaround healthandwellness;

● Whatweknowaboutpreventative medicine,includingoralandgut health;

● Privatevspublichealthcare,hybrids, andgainingknowledgefromhealth carepoliciesinEuropeand Scandinavia;

● Alternativemedicine,suchas acupuncture,naturopathic,TCMand othermodalities;

● Pharmaceuticalmedicineversus nutrition,stress-management,and otherwhole-bodyapproachesin primarycare;

● Similarly,theconnectionbetween mindandbodyandhowmany diseasesandconditionsmaybe relatedtopsychological“dis-ease”;

● Mentalhealthandthebestapproach totreatandsupportindividuals strugglingwithmentalhealthissues.

Inessence,Iwanttolookathowprimary carepractitionerscanexpandtheir“toolbox” tomakeourhealthcaresystemmore efficientandequitableforCanadians.

KENRAYNOR

MywifeandIcurrentlyliveintheShuswap, whichwepickedtobeourretirementhome. WewerebothborninVancouverbuthave livedmostofourlivesinsmallertownsall overBC.Mylastfouryearsofworkhadus livingintheUS,whichgaveusdirect exposuretoprivateinsuranceandfor-profit medicine.Ihopetobeabletoexpressthe viewsofsmalltownresidents,whereyour careisoftenprovidedbyrecentgraduates tryingtogetestablishedandnotintendingto stay,andwhereanythingbeyondbasiccare requiresthetimeandexpenseoftravelingto aregionalcentre.

CHRISTINESORENSEN

IamaregisterednursefromKamloopsBC.I haveworkedincommunitypublichealthas wellasseniorhealthcareleadershipforthe past33years.Ispentthelast15yearsofmy careeradvocatingforchangestohealth policythatwouldprovideforsafepatient care.In2022,IcompletedaMasterofHealth LeadershipandPolicyfromUBC,andIam currentlyteachinghealthpolicytonursing students.Iamthemotheroftwoamazing youngmen,daughterofaretirednurse,andI identifyasMetis.IlovetotravelandIaman avidwalkerandreader.Iamkeenly interestedinhealthcarereformasIseethe gapsincarerelatedtoseniors,mentalhealth andaddictions,accessibility,racism,and healthpreventionandpromotion.

BOBBITATOOSH

IwasbornandraisedinPortAlberniand havelivedeverywherebetweenCampbell RiverandVictoriainaspanof20years(with ashortstintinCalgarysomewherealongmy gypsytravels).IcurrentlyresideinFannyBay withmyhusband(marriedlastyear)andmy 13-year-olddaughterandcommuteto NanaimodailyforworkastheTrainingand DevelopmentLeadforascaffoldcompany.I haveaBachelorofBusinessAdministration withmajorsinAccountingandHuman ResourceManagement.Iusedtovolunteer withNanaimoSearchandRescue,andnow volunteermytimetothePortAlberniShelter Society.Mycurrenthobbiesarelifting weightsandbeadingearrings.Ihave volunteeredbecauseofmyownissueswith ourfailinghealthcaresystem.

JOELTHERRIEN

IwasborninKelownaBCbutmovedtothe Vancouverareainmyearly20s.Istudiedmy master’sinstatisticsatSFUandcurrently workasaDataScientist,whereIuse machinelearningtoautomaticallyappraise homes.Iliketostayuptodatewiththenews andtheeconomyandhavefollowedsomeof Canada’shealthcarechallenges.Afew yearsagoIneededafamilydoctorforcare andwasaffectedbyBC’sfamilydoctor shortage.Iwasveryluckyinthatanewclinic openedupnearmyhome,butitbothersme thatothersaren’tsolucky.Ivolunteeredso thatIcanlendmyperspectiveandadvocate forabettersystem.

HANNAHWILSON

Iamadedicatedandexperiencedsocial serviceworkerandcommunityactivist basedinBurnaby,BritishColumbia.Withover 7yearsofexperienceinsocialworkand non-profits,andadiplomainSocialWork fromHumberCollege,Ihavedevelopeda widerangeofskillsandexpertiseinvarious advocacy-basedsettings.Currently,Iworkat alargeanimalwelfarenon-profit organizationandasaprivatedisability advocateforcommunitymembers.Iaman avidreader,knitter,andartist,andenjoy spendingtimeinnatureasawayto rechargeandstayconnectedtotheEarth. Drivenbymypersonalexperiencesasa chronicallyillanddisabledwoman,Iam deeplycommittedtoaddressingmedical misogynyandsystemicmedicaloppression. IrecentlyvolunteeredfortheOurCare PrioritiesPaneltocontributemyexpertise, experience,andpassionforsocialchange. ThroughthisPanel,Ilookforwardto engagingwithotherindividuals,learning fromtheirinsightsandexperiences,and exploringopportunitiesforcollaborationand impact.

SANDIWILSON

Hello,mynameisSandraWilson,butplease callmeSandi.ImovedtoVancouverIsland 30yearsago.IwasborninVancouverbut movedtoMedicineHatAlbertaintheearly 1980’s.Iamselfemployedasahousekeeper, workingtohelpseniorstostayintheirhomes forlonger.Ialsoworkforafewyoung families.Myhusbandisdisabled,butthe governmentwillnotpayhimanything, makingusalow-incomehousehold.I volunteeredforthispanelbecauseIfeelIcan reflecttheneedsofseniorsandfamilieswho arebothstrugglingwithourhealthcare system.

ERICWINTER

IhavelivedintheDuncanareaforthelast threeyears.IlivedinVictoriafortheprior yearandahalf.Icurrentlyworkinaquick servicerestaurant.Iamdivorcedand have onechild.Iamahomebody,andImainly spendmyfreetimereading,watchingTV, andplayingvideogames.Ivolunteeredfor thepanelasIbelieveingivingbacktothe community.

MATTHEWZHISS

IwasbornandraisedintheChicagoarea beforeimmigratingtoVancouverinrecent years.Atmycore,I’maclinicalsocialworker withamajorinterestinhealthcareequityand accessibility.Everyday,asbothahealthcare clinicianandapatientmyselfwithulcerative colitis,IseefirsthandhowCanadacanimprove insupportingthehealthofall.Volunteeringfor thispanelwasthusanobviousopportunity whichalignedwithmygoalsand,inmytimeso farinBC,I’vebuiltastrongfaithinthis province’spotentialtore-envisionanamazing healthcaresystem.Whennotadvocatingfor thischange,I’motherwiseanavidswimmer, cyclist,andamateurphotographer.

GuestSpeakers

NineteenexpertsgenerouslygavetheirtimeandsharedtheirknowledgewiththeBritish ColumbiaPrioritiesPanelonPrimaryCare.ThePanelextendsitssincerestthankstoeachof them.

EstephanieAcebedoisaClinicalNurseLeaderforthe UrgentandPrimaryCareCentreforIslandHealthin Victoria,responsibleforthreeofthesixurgentand primarycarecentresintheSouthIsland—Gorge,North Quadra,andDowntownVictoria.ShehasaB.Sc.in Nursingandhasworkedinspecializedcareareas includingOperatingRoom(OR),PediatricIntensiveCare Unit(PICU),andOrthopedicsandRehabilitationUnit. Overatwenty-yearcareerinpatientcare,shehasheld otherleadershiprolesincludingClinicalNurseLeader andClinicalNurseEducator.

Dr.EvanTleslaAdamsisaCoastSalishphysicianfrom Tla’aminFirstNationnearPowellRiver,BC.Dr.Adams completedhisMedicalDoctorateattheUniversityof Calgary,aresidencyintheAboriginalFamilyPractice programatUBCinVancouver,andhasaMasterof PublicHealthfromJohnsHopkinsUniversityinBaltimore, Maryland.HewastheDeputyProvincialHealthOfficerfor BC(2012to2014),theChiefMedicalOfficeroftheFirst NationsHealthAuthority(2014-2020),andthenthe DeputyChiefMedicalOfficerofFirstNations&Inuit HealthBranch,IndigenousServicesCanada (2020-2023).HehasrecentlyreturnedtotheFirst NationsHealthAuthorityastheirDeputyChiefMedical Officer.

HayleyDiakiwisaNursePractitionerattheGorge UrgentandPrimaryCareCentreinVictoria,whereshe providesprimarycareforpatientsofallages.She completedherMasterinNursingin2020attheUniversity ofVictoriaandcurrentlyhasalocumforherpatient panelandworksparttimeinurgentcare.Sheandher spouserecentlywelcomedababygirlinFebruary.When notworking,shelovesbeingactiveoutsideand spendingtimewithherfriendsandfamily.

DavanaHarlowisaRegisteredSocialWorkerwiththe DowntownVictoriaUrgentandPrimaryCareCentre,with aspecialinterestinsupportingindividualswith concurrentdisorders,complexhealthcareneeds,and thosefacingbarriersinaccessingcare.Asystemic thinker,shelooksforwaysthatwecancatalyze improvementinourservicedeliverytobestmeetthe needsofourpatients.Sheloveslearningandis supportedbyherteamandleadershiptocontinueto improveonherownpracticeandtoidentifywaysto improveaccessandcontinuityofcarewithinour broadersystem.

Dr.LindsayHeddenisanAssistantProfessorofHealth ServicesResearchworkingintheFacultyofHealth SciencesatSimonFraserUniversity,aMichaelSmith FoundationforHealthResearchScholar,andthe co-PrincipalInvestigatoroftheHealthSystems

ResearchLab.Dr.Hedden’scurrentprojectsaddressthe rapidshifttotheuseofvirtualcare;measuringcurrent andpredictingfuturehealthsystemcapacityand demand;andexaminingtheeffectsoftheincreasing corporatizationandprivatizationofprimarycareon equity,accessibility,andqualityofcare.

Dr.TaraKiranistheFidaniChairinImprovementand InnovationattheUniversityofTorontoandVice-Chairof QualityandInnovationattheDepartmentofFamilyand CommunityMedicine.Shepracticesfamilymedicineat theSt.Michael'sHospitalAcademicFamilyHealthTeam (SMHAFHT).Dr.Kirancompletedherfamilymedicine residencyatMcMasterUniversityin2004andspenther firstcoupleofyearsinpracticeasalocuminIndigenous communitiesinnorthernOntarioandinCommunity HealthCentresinurbanToronto.Shepracticedatthe RegentParkCommunityHealthCentrefrom2006to2010 beforejoiningSt.Michael'sin2011.

Dr.LindsayMackayisafamilyphysicianand clinician-scientistintheDepartmentofFamilyMedicine atUBC.Sheprovidesprimarycareandaddiction medicineatPHSCommunityServicesSocietyand VancouverCoastalHealthinVancouver’sDowntown Eastside.Dr.MackayistheMedicalCoordinatorfor DowntownEastsideConnections,aVancouverCoastal Healthlow-barrier,rapid-accesssubstance-usecare clinic.SheisalsoChairoftheVancouverDivisionof FamilyPracticeMentalHealthandAddictions CommitteeandamemberoftheVancouver CommunityActionTeamonoverdoseresponseinthe DowntownEastside.

Dr.RitaMcCrackenisafull-servicefamilydoctorandan AssistantProfessorintheDepartmentofFamilyPractice atUBC,whereshestudiesprimaryhealthcareworkforce issuesandreliablewaystomeasurechangesinprimary careaccess.Herotherresearchworkincludesassessing theeffectsofmedicationsprescribedbyfamilydoctors andhowtoalterthoseprescribingpatterns.Shechose medicineasasecondcareerafteralmost10years workinginHumanResourcesforhightechcompanies. ShelivesinEastVancouverwithherfamily.

GladysMitchellisfromtheSaik’uzFirstNationlocated nearVanderhoof,BC,buthasresidedontheStellat’en FirstNationfor33years.Sheisthegranddaughterofthe lateDr.MaryJohnSr,alsoknownas“StoneyCreek Woman.”Sheandherhusbandownedandoperateda loggingcompanyfor30years,duringwhichtimehe earnedalawdegree.TogethertheywontheBC AboriginalAwardandaCanadaWideAwardfor outstandingbusiness.Theyemployed95percent

Indigenouspeoplefrom10differentFirstNation communities.Aftersellingthebusiness,Gladysnow worksfromhomewithaverysuccessfulsewing business,creatingcustomhandbagsandworkingwith Indigenousartiststocreateone-of-a-kindpieces. “Ido whatIloveeveryday.”

Dr.GoldisMitraisafamilyphysicianbasedoutofNorth Vancouver,BritishColumbia,andpracticesasa HospitalistatSurreyMemorialHospital.Herinterests includebothpractice-andsystem-levelinnovationin primarycare.SheworkswithBCFamilyDoctorsand DoctorsofBCnegotiatingprovincialprimarycare compensationandprimarycarereform.SheisaClinical AssistantProfessorintheDepartmentofFamilyPractice attheUniversityofBritishColumbia,andteachesboth medicalstudentsandresidents.

Dr.TracyMonkisafamilydoctorinBurnaby/ Coquitlam.ShegraduatedfromMcGillmedicalschoolin 1987.SheistheFacultyLeadfortheUBCCentrefor RelationshipBasedCareandClinicalAssistantProfessor intheUBCDepartmentofFamilyPractice.Sheisthe PhysicianLeadfortheProvincialPathwayswebsiteand sitsontheFamilyPracticeServicesCommittee(FPSC).

Dr.BirinderNarangisaClinicalAssistantProfessorwith theDepartmentofFamilyPracticeattheUniversityof BritishColumbia,aMedicalContributorforGlobalBC andCKNW980,andaFamilyPhysicianfortheREACH CommunityHealthCentre.Heiscurrentlyintheroleof ChairfortheBoardofDirectorsatBurnabyDivisionsof FamilyPractice,aswellastheBoardofGovernorsforthe SouthAsianCommunityHealthTaskForce,wherehe alsoco-foundedthe‘ThisIsOurShot’Vaccine ConfidenceCampaignacrossCanada.

Dr.ChristieNewtonisAssociateHead,Educationand Engagement,atUBC’sDepartmentofFamilyPractice andMedicalDirectorofUBCHealthClinic,whereher timeisdedicatedtobuildingcapacityfor community-basedclinicaleducationwithin team-basedcaremodelstoenhanceprimarycarein BC.SheisaformerPresidentoftheBritishColumbia CollegeofFamilyPhysicians(2015-2017),hasbeena memberofnumerousCFPCcommittees,andnowis PresidentoftheCollegeofFamilyPhysiciansofCanada.

Dr.KeirPetersonistheChiefMedicalOfficeratTELUS Health,aglobalhealthcareleaderdeliveringdigital innovationandclinicalservicestoimprovetotal physical,mental,andfinancialhealthandwellbeing.He supportsateamofmorethan1,000clinicians,covering over50millionpeoplewithin-personandvirtualpatient caresolutions.Keircombinesabackgroundinhealth technologywithtwodecadesofclinicalexperience.He hasbeenanemergencyphysicianinBCandAlberta, andisaformerAssociateClinicalProfessorand ProgramDirectorattheUniversityofAlberta.

Dr.Thuy-Nga(Tia)Phamisafamilyphysicianwho trained,workedandtaughtwithinaUniversityofToronto affiliatedFamilyHealthTeamforcloseto20yearswhen primarycareteamswerefirstintroducedinOntario. She haslecturedandpublishedinternationallyonprimary careteamsinherroleasanAssociateProfessoratthe UniversityofToronto,andbringsthispassiontoVictoria whereshecurrentlyistheco-MedicalDirectorofthesix SouthIslandUrgentandPrimaryCareCentres,seeing patientsandfamiliesdailywhostrugglebecausethey donothaveafamilydoctor.

AndrePicardisahealthreporterandcolumnistatthe GlobeandMail,wherehehasbeenworkingasa journalistsince1987.He’stheauthorofsixbestselling books,mostrecentlyNeglectedNoMore:TheUrgent NeedtoImprovetheLivesofCanada’sEldersinthe WakeofthePandemic.HewasnamedCanada’sfirst “PublicHealthHero”bytheCanadianPublicHealth Association,asa“ChampionofMentalHealth”bythe CanadianAllianceonMentalIllnessandMentalHealth, andreceivedtheQueenElizabethIIDiamondJubilee Medal,forhisdedicationtoimprovinghealthcare.

Dr.KathleenRossisafamilyphysicianinCoquitlamand NewWestminster,BCandPresident-Electofthe CanadianMedicalAssociation.Shedoesclinicalworkin communityprimarycareandobstetricsandsurgical assistwork,includingcardiovascularsurgery,atRoyal ColumbianHospital(RCH).Dr.Rossispastpresidentof DoctorsofBC;foundingmemberandchairoftheFraser NorthwestDivisionofFamilyPractice(FNDFP),RCH’s CollaborativeServicesCouncilandFNWDFP’sShared CareCommittee;andpresidentoftheRCHmedical staff.Shehasservedasthephysicianleadandchairof thePathwaysPatientReferralAssociation.

Dr.AlanRuddimanisaninternationallytrainedrural generalistphysicianlivingandworkinginOliver,British Columbia,forthepasttwenty-sevenyears.Heservedas presidentofDoctorsofBCfrom2016-2017,andfrom 2014-2023heco-chairedBC’sJointStandingCommittee onRuralIssues.Alanholdsanappointmenttotheboard ofBC’sInstituteforHealthSystemTransformationand Sustainability(IHSTS),andcurrentlyservesasoneof ninecommissionersonBritishColumbia’sMedical ServicesCommission(MSC).Heremainsconnectedto UBCFacultyofMedicineholdingalongstandingClinical Teacherappointment.

ValerieSt.JohnhasservedastheExecutiveDirectorof theBCAssociationofCommunityHealthCentres (BCACHC)sinceJuly2020. Shehasworkedinanumber ofcapacitiesinBC’shealthsectorfor15yearspriorto joiningBCACHCholdingrolessuchasAssistantDeputy Minister,HealthHRPlanning;ManagingConsultant, EnVisionBusinessSolutions;andChiefExecutiveOfficer, NursesandNursePractitionersAssociationofBC.Val’s passionisafocusonsystemlevelchangeinsupportof healthserviceexcellenceandthrivingcommunities.She livesinVictoriaandenjoysislandlifetothefullest,hiking andboatingwithfamilyandfriends.

MinorityReports

Memberswereencouragedtoshareallpointsofviewthroughoutthepanelprocess.Discussionremained livelyandrespectfulthroughouttheproceedingsand,whilesomeminordifferencesinopinionremained, everymemberofthepanelendorsedtherecommendationsinthisfinalreport.However,membersalso weregiventheopportunitytowriteaminorityreportiftheywishedtohighlightanypointsofagreementor disagreement,ortoincludetheirowncommentary.

MatthewZhiss

Wehaveknownfordecadesthathealthismorethan ourphysical,anatomical,andpathologicalwellness. Healthissocial,spiritual,psychological,financial, nutritional,legal,cultural,educational,and,most importantlyofall,tiedcloselytohousing.Yetwe rarelysomuchaswhisperthesewordsduringhealth carediscussions.Weshoutabouthospitals,more physicians,morenurses,moreMRImachines,and nevertrulybroadenourviewtothesocial determinantsofhealth.Asaclinicalsocialworker,I seeeverydaytheimportanceofsecuringbasic shelter,food,cleanliness,andbelongingtowardsthe healthofthosewhomIserve.

Whiletheworkthatmyselfandmyfellowpanelists recommendedinthisreportareavitalbeginningfor re-imaginingtheprimarycaresystem,Iimploreusto thinkmacroscopicallyandingrainhealthintothe veryfabricofsociety.Givemeasystemwhich genuinelyaddressesthesocialdeterminantsof health.AsystemwhereIcanofferincrediblesocial servicessuchascomprehensivehousingsupports, mentalhealthservices,andsufficientincome supplements.AsystemwhereIneveragainneedto tellaperson,“I’msorry,butthesystemdoesnothave anyresourceswhichIcanofferyou.”

Thisisthedeadlyfailingofoursystem.Itremains centredaroundhospitalsandclinics,setlocationsfor advancedclinicalmedicine,andfailstoaddressthe broaderaspectsthattrulyencompassourhealth.

RubyJaggernath

Doctorscan’tdoitalone.Thepatientneedstobe partoftheprimarycareteam.Person-centredcare supportspeopletodeveloptheknowledge,skills,and confidencetheyneedtomoreeffectivelymanage andmakeinformeddecisionsabouttheirownhealth andhealthcare.Doctorstrytoencouragepatientsto dobetterself-care,butaltogethertoomanypeople areapatheticabouthealthcareuntiltheyareinan emergencysituationthemselves.Thentheywantthe doctortofixit.Thereneedstobealotmoreworkon publicawareness,especiallyofpersonal responsibility

Ontheotherhand:Whydoesn’teveryoneaccess theirmedicaldata?

IgotmysixthCOVIDvaccinationrecently.Ithen receivedanemailsuggestingIcoulddownload informationaboutwhattoexpectoverthenextfew days,dependingonwhichvaccineyoureceived.If youhaveaBCServicescard,theytoldme,youcan viewyourimmunizationrecordonlineafter24hours athealthgateway.gov.bc.ca.OK,greatidea!Iwould liketotrackmyhealthreports.Iclickedontheirlink. OOPS!havetosetupaBCServicesCardaccount.I clickedonthenewlink.Thereare2options:mobile deviceorpassword.Okay,Idon’thaveamobile device.NowIneedtogotoaServiceBClocation. Anotherlink,anotherclick.Inordertofindtheservice BClocation,Ihavetoenterakeyword?What keyword,eh?“ServiceBC,Abbotsford”givesmealist of66locations,ingroupsof5.Whatawasteofmy time!Ittookawhile,butIfinallyfoundthenearest ServiceBClocation,inChilliwack.Icanevenbookan appointment,butIhavetohavemyBCServicescard ormyBCeIDreadywhenIbook.TheideaisthatIam tryingtogetaBCservicescard!AndwhatisaBCeID? Iamthunderstruck.Again!

Peoplewithalowincomeareevenlesscomfortable usingtechnology.Alotneedstobedonetohelp peopleachievepersonalresponsibilityfortheircare, somethingthatwillreachthepublic.Videogames abouthealthorthehealthsystem?Supportfrom popularsingers?Movies?Cartoonsforschoolkids? Let’sthinkoutsidetheboxmore.

JoelTherrien

There’sonerecommendationthatIfeelthat,evenon itsown,couldmakeasubstantialimprovementto primaryhealthcareifimplementedproperly: Recommendation19.c:Integratingandexpanding theuseofphysicianassistantsandotherhealthcare professionalstoprovidecareunderphysician supervision.

Thebasicideahereistoreusethesamemodel alreadyusedinotherhighlyregulatedprofessions.

Considerdentists:Dentistsemploydentalhygienists totakecareofsimplertaskssuchascleaningteeth whilethedentistscanfocusonthetasksthatreally requiretheirexpertise.Thiskeepsthecostsofthe systemmanageablewithoutsacrificingsafetyasthe dentistisstillhandlingcomplicationsand determiningtreatmentplans.Therewouldbe waitlistsifwerequireddentiststoperformallaspects ofdentalcare.Thelackofthesewaitlistsisa meaningfulclueastowhatasuccessfulmodel mightlooklike.

Howcanthisworkinprimarycare?Allowfamily physicianstohirenursestobethefirstpointof contactwithpatients.Nursesaremorethanqualified tobandageupasprainedankle,lookatapatient’s tonsils,andtalkthroughthepatient’ssymptomsand history.Thenursecanreporttheirfindingstotheir supervisingphysicianandthephysiciancan determinethebestcourseofaction.Withthismodel onedoctorcansuperviseateamofnursesall simultaneouslytreatingpatients.Thisone recommendationalonecoulddoubleortriplethe capacityofBC’sprimaryhealthcaresystem.

Willthisworsenthenursestaffingshortage?No. Manynursesareleavingtheprofessionbecauseof burnoutduetophysicallyexhaustingwork,long shifts,inconsistentschedules,andanimpossible patientload.Thisopportunitycouldprovideawayfor nursesonthevergeofburnouttostillserveinthe medicalsysteminarelaxedmannerwithconsistent hours.Nurseswho’dretiremayinsteadopttowork part-timealongsideaclosephysiciancolleague. Finally,thesenurseswillabsorbsomepatientload beforeitreacheshospitals—helpingtheircolleagues there.Theendresultisthatlessnurseswillleavethe

SabrinaBrosnan

AnissueIraisedduringoursessionswhichdidnot makeitintotheconsensusrecommendationshas todowithaccesstoservicesinaprivateareaof yourlocallibrary.Formanypeople,accessingany kindofmedicalcarecanbeadauntingtask,dueto barriersinapatient’slife.Thesebarrierscanbedue tohomelessness;mentalhealthissues;dangersdue tophysical,sexualordomesticviolence;andthose thatareelderlyandnotfamiliarwithvirtualcare technologiesamongotherscenarios.Furthermore, individualswhoareinacohabitedliving arrangement,suchasroommates,donotwantto talktotheirclinicianvirtuallywiththestigmaofa roommatehearingprivatemedicalinformation.

Havingaprivateroomatthelocallibrarytovirtually connectwithaclinicianisavitalwaytoreachsome ofthemostmarginalizedmembersofthepublic.I recommendthattheFederalandProvincial governmentsfundtheadditionoftheseprivate roomsatlibraries,aswellasaddfurtherfundingfor stafftobetrainedtoassistthoseindividuals,totrain andretainindividualswhoaresocialoroutreach workerswhocanbetterassistthoseindividualsto workinalibrary,aswellascreateanawareness campaigntoeducateindividualsastothe availabilityoftheseservicesatlibraries.

AnotherissueIfeltneededtobeincludedinthis reportwastoaddresstheopioid crisisthathascausedsuchastrainonthemedical system,forcliniciansandpatientsalike.Froma patientviewpoint,thecrisisbeganwhenclinicians stoppedprescribingopioidmedicationsforserious illnessesandinjuriesduetofearofretaliationfrom medicalauthorities.Thisinturncausedpatientsin extremepaintolooktostreetdealerswith dangerousanddeadlyvariationsofopioids.

Inordertocombatthis,Irecommendthefollowing:

a. Allcliniciansbeabletoprescribeopioid medications,whileunderastrictreview processbyanindependentpanelmadeup offellowclinicians,collegeadministrators, medicalauthoritiesandsocial/outreach workerswhointeractwithopioidusers.

b. Patientsreceivingopioidmedicationmust beplacedonapaintreatment managementprogramwherethepatient andclinicianworktogetthepatienttoa goodqualityoflifestatus,whereanendto opioiduseisthetargetgoal.Thosewith life-longillnessesorinjurieswhomuststay onopioidmedicationlong-termmustalso beonatreatmentplanwithaclinicianfora minimummonthlyreviewofamountsof opioidmedicationconsumption,witha goalofreducingtheneedforopioids,as

wellasensuringthepatientisnotorisnot getting addictedtoopioids.Aplanmustbe putintoplaceforpatientstoreceivemedical treatmentssuchasphysicaltherapy,which mustbecoveredunderFairPharmacareor BlueCrossforthoseinlowerincome brackets.

c. Clinicianswhoprescribeopioidswithout properreviewofpatients'progresstoensure thepatientisn’tbecomingaddictedto opioidsmustbefinedandhavetoworkwith patientsinareasofhighdruguseforatleast oneyeartomitigateandreducethenumber ofdrugoverdosesduetoopioids.

Inconjunctionwiththeissueoftheopioidcrisis,there isalsotheissueofaseverelackofmentalhealth carebeingprovidedtothoseinneed.Aspecific recommendationthatIfeelisnecessaryisa dedicatedhospitalforthosewithmentalhealth issues.Thisshouldbeaddressedinthereopeningof RiverviewHospital,whichwouldrequireboththe FederalandProvincialgovernmentsfundingforthe existingbuildingtobetorndownandanewmodern hospitaltobecreated,withinputfromthosewho dealdirectlywiththosewithmentalhealthissues,as wellasfromthepatientsthemselves,astowhat wouldmakethemfeelsafeinsuchabuilding.In otherareasoftheprovinceoracrossthecountry, othersuchhospitalsmustbeopenedtoaddressthe needforadedicatedfacilitythathastheabilityto providein-patientcareandthatworkswith organizationssuchasBCHousingtofindpermanent, safehousingforindividuals.Thiswouldassistin gettingmanyhomelessindividualswithmental healthissuesoffthestreetsaswell.Furthermore,all emergencydepartmentsshouldhaveadesignated areaforthosesufferingeitheramentalhealthcrisis oranoverdose,inwhichthepatientcanbequickly assessedandtransferredtoamoreappropriate in-patientcarefacility,suchasarehaborthemental healthhospitalfordedicatedcare,reducingthe numberofpatientsinER’s.

AnissuethatIalsofeltneededaddressinghastodo withthecontinuingclimatechangesweareall experiencingwithgreaterfrequency.Therehave beenreports,fromFraserHealthamongothers,that duetotheextremechangesinweather,bothin summerandwinter,emergencydepartmentsare oftenoverburdenedwithpatientssufferingfrom heat/sunstroke,heatexhaustion,orfrostbiteand hypothermia.Duetothelargenumberofindividuals whohavebeenintheemergencydepartmentsat thesametime,theaircontrolsystemshavefailed, oftenmakingtheindoortemperaturefeelthesame astheoutdoortemperature.

InordertocombatthisIrecommendthefollowing:

a. FederalandProvincialgovernmentsfundthe immediateupgradeofairheatingand coolingsystemstoamoreefficientsystem, suchaswithheatpumps.Inconjunction

withBCHydro,thesesystemscouldbe implementedandBCHydrocouldusethe additionofthesesystemsaspartoftheir advertising,inapartnershiptoraise awarenessoftheuseofsystemssuchas heatpumps.

b. Installsolarandreflectivepanelstousefor energygenerationandtoreflectheatand sunlightoffhospitalsandothermedical facilitiesinordertoreduceheatinthe summer.

c. Consultblueprintsfromoldbuildings(e.g., 100yearsandolder)andinstallvents systematicallythroughoutmedicalbuildings toventheatinsummer.

d. Createmobileoutreachunitsthatcan providepop-upcoolingorheatingareasin publicspaces.Theseunitswouldfunction likeafood-truck-typeservicewhere individualscangetwaterorcoffee,thermal blanketsinwinter,orminibatteryfansin summer,aswellasmedicalcarefor those inneedofaidduringtheseseasonswith extremetemperaturefluctuations.

Finally,asperconversationsduringthepanel meetings,Irecommendedthatforeachmedical clinicorcommunityhealthcentre,eachdoctorhave one schedulerwhoinputsspecificdoctors’ appointmentsintoasystemthatcandeterminein realtimewhetherthedoctorwillhaveenoughtimein theirscheduletocovereachaspectofthe appointment.Ialsosoughttodiscusstheneedfor clinicianstomaintainappointmentsatnolessthan 20-minuteintervals,aslessthanthisamountoftime doesnotallowforcliniciansandpatientstoproperly covermedicalissues.However,theallottedtimefor anappointmentmustbeforonepatientonly.

Patientsbringinganumberoffamilymemberstoan appointmentandthendemandingthecliniciantake theallottedtimefromanotherpatienttodealwith thefamilymember'shealthissuesisunfairtothe clinicianandotherpatients,anditdeviatesfromthe setschedule,takingtimeoutofaclinician’spersonal lifeaswell.Thosepatientswhobringfamilymembers foranyreasonotherthanfortranslationorsupport purposesandthendemandthecliniciantreatthe familymembersaswellwillbegivenonewarningnot todosoagain.Shouldthepatienttrytodosoa secondtime,theywillberemovedfromthat clinician'spatientrosterforabusingtheregulations ofthatclinic,centre,oroffice.Aclinician'stimeand attentionaretoovaluabletowasteonpatientsthat donotrespecttherulesoftheofficeorrespectthe personaltimeandlifeoftheclinicianthatgetstaken awaywhentheymustspendextratimetreating patientsthatarenotscheduledforthatday.

Ialsosuggestthatinordertocutdownonthe amountofpaperworkthatclinicianshavetofillin daily/weekly,atranscriptionistbeemployedtotake doctors'notesduringorafteranappointment;fillin medicalformsasperclinician'sinstructions,soa cliniciancanjustreviewandsigntheforms;and provideneatlytypednoteswithallrelevant informationbeforeanappointmentwithapatientto remindtheclinicianofanypertinentinformation, priortothestartoftheappointment.

Asindicatedattheoutsetofthisreport,Ihad discussedtheseissueswithvariousmembers. However,othermemberswerefocusedonthecore issuessetoutinthedraftreportanddidn’trecognize theimportanceofadding theseissuesIhave addressedinthisminorityreport,giventheir correlationtothecoreissuesinthedraftreport. WhilemanyoftheissuesIhaveaddressedherein canbeconnectedtoothersectionsofthedraft report,suchastheneedforresourcesatlocal librariestoaidthemostmarginalizedmembersof thepopulation,otherPanelmembersfeltthatthese issuesshouldn’tbeincludedinthedraftreportfor fearthatitwouldbetoovoluminousordistractingto thosewhowillbereviewingthefinalreport.In addressingtheurgentneedfortheseissuestobe includedinthefinalreport,Ifeelthatthosewhowill bereviewingthefinalreportwillnothaveany difficultyinrecognizingtheimportanceofincluding theseissueslong-term,astheyareissuesbeing dealtwithnotjustinBC,butnationally.

AboutOurCare

OurCareisapan-Canadianconversationwitheverydaypeopleaboutthefuture ofprimarycare.Itseekstounderstandwhatresidentswantinahighquality, equitableprimarycaresystemandtocapturetheirrecommendationsfor change.

TheprojectisledbyDr.TaraKiran,afamilydoctorandrenownedprimarycare researcherbasedinToronto.SheandtheprojectteamareworkingwithAdvisory Groupsacrossthecountrytoalignwithdifferentprovincialcontexts.

OurCarehasthreestages:

NationalResearchSurvey

ThesurveywasonlinefromSeptember20toOctober25,2022.Morethan9,200 Canadianscompletedthesurvey,sharingtheirperspectivesandexperiences. VoxPopLabsco-designedandexecutedthesurvey.

PrioritiesPanels

PrioritiesPanelswillbeheldinfiveregions:NovaScotia,Quebec,Ontario,British ColumbiaandManitoba.MASSLBPisco-designingandexecutingthepanels withOurCareadvisorsandlocaldeliverypartners.

CommunityRoundtables

Twocommunityroundtableswillbehostedineachofthefiveregions,focusing onequity-deservinggroupsthatwedidnothearenoughfromduringstages1 and2.MASSLBPisco-designingandexecutingthecommunityroundtableswith OurCareadvisorsandlocalcommunityorganizations.

OurCareProjectPartners

OurCareisfundedby:

HealthCanada

HealthCanadaistheFederaldepartmentresponsibleforhelpingCanadiansmaintain andimprovetheirhealth,whilerespectingindividualchoicesandcircumstances. Productionofthisdocumenthasbeenmadepossiblethroughafinancialcontribution fromHealthCanada.Theviewsexpressedhereindonotnecessarilyrepresenttheviews ofHealthCanada.

Staples

Canada-EventheOddsCampaign

StaplesandMAPhavecometogethertocreateEventheOdds:aninitiativetoraise awarenessofinequityinCanadaandtohelpbuildvibrant,healthycommunities.The partnershipisbasedonthesharedbeliefthateveryoneshouldhavetheopportunityto thrive.EventheOddsfundsresearchandsolutionstohelpmakethefuturefairfor everyone.Learnmoreatstaples.ca/eventheodds

MaxBellFoundation

MaxBellFoundationbeganmakinggrantstoCanadiancharitiesin1972.Today,the Foundationsupportsinnovativeprojectsthataredesignedtoinformpublicpolicy changeinfourprogramareas:Education,Environment,Health&Wellness,andCivic Engagement&DemocraticInstitutions.TheFoundationalsodeliversthePublicPolicy TrainingInstitute,aprofessionaldevelopmentprogramdesignedtohelpparticipants moreeffectivelyengageinthepublicpolicyprocess,andPolicyForward,a future-orientedspeakerseriesthatbringsthoughtleaderstogethertodiscussthe intersectionsofpolicy,technology,andinnovation.

OurCareisbasedat:

MAPCentreforUrbanHealthSolutions

MAPCentreforUrbanSolutionsisaresearchcentrededicatedtocreatingahealthier futureforall.Thecentrehasafocusonscientificexcellence,rapidscale-upandlong termcommunitypartnershipstoimprovehealthandlivesinCanada.MAPisbasedat St.Michael’sHospitalinToronto.

St.

Michael’sHospital,UnityHealthToronto

St.Michael’sHospitalisaCatholicresearchandteachinghospitalindowntownToronto. ThehospitalispartoftheUnityHealthTorontonetworkofhospitalsthat includesProvidenceHealthcareandSt.Joseph’sHealthCentre.

OurCareSupporters

OurCareisalsosupportedby:

DepartmentofFamily&CommunityMedicine,UniversityofToronto

TheUniversityofToronto’sDepartmentofFamily&CommunityMedicineisthelargest academicdepartmentintheworldandhometotheWorldHealthOrganization CollaboratingCentreonFamilyMedicineandPrimaryCare.

St.Michael’sFoundation

Establishedin1992,St.Michael'sFoundationmobilizespeople,businessesand foundationstosupportSt.Michael’sHospital’sworld-leadinghealthteamsindesigning thebestcare–when,whereandhowpatientsneedit.Fundssupportstate-of-the-art facilities,equipmentneeds,andresearchandeducationinitiatives.BecauseSt. Michael'sFoundationstopsatnothingtodeliverthecareexperiencepatientsdeserve.

OurCareisworkingwith:

BritishColumbiaAdvisoryGroup

TobyAchtman,BCCollegeofFamilyPhysicians

TerriAldred,FirstNationsHealthAuthority

RayChaboyer,NorthShoreDivisionofFamilyPractice

SariCooper,GeneralPracticeServicesCommittee(GPSC),FamilyPracticeServices Committee(FPSC)

WilliamCunningham,IslandHealth

DanetteDawkin,BCFamilyDoctors

JanetEvans,GeneralPracticeServicesCommittee(GPSC),FamilyPracticeServices Committee(FPSC)

ReneeFernandez,BCFamilyDoctors

LindsayHedden,SimonFraserUniversity

ElizaHenshaw,NursesandNursePractitionersofBritishColumbia(NNPBC)

KarinKausky,DoctorsofBC

ChristinaKrause,BCPatientSafety&QualityCouncil

RayMarkham,RuralCoordinationCentreofBC

RitaMcCracken,UniversityofBritishColumbia

KimMcGrail,CentreforHealthServicesandPolicyResearch

AnthonMeyer,RuralCoordinationCentreofBC

GoldisMitra,DepartmentofFamilyMedicine,UniversityofBritishColumbia

BirinderNarang,BurnabyDivisionsofFamilyPractice

ChristieNewton,CollegeofFamilyPhysiciansofCanada&DepartmentofFamily Medicine,UniversityofBritishColumbia

TedPatterson,BCMinistryofHealth

Thuy-Nga(Tia)Pham,IslandHealth

MorganPrice,DepartmentofFamilyPractice,UniversityofBritishColumbia

KathleenRoss,CanadianMedicalAssociation

AlanRuddiman,BCJointStandingCommitteeonRuralIssues&RuralCoordination CentreofBritishColumbia

JustineSpencer,BCCollegeofFamilyPhysicians

NardiaStrydom,VancouverCoastalHealth

ValerieSt.John,BCAssociationofCommunityHealthCentres

NationalCollaboratingOrganizations

AkoAnyaduba,BlackPhysiciansofCanada

RickGlazier,CanadianInstituteforHealthResearch

JohnFeeley&MoiraTeed,CanadianMedicalAssociation

ChristieNewton,CollegeofFamilyPhysiciansofCanada

BenjaminDiepeveen,KajanRatneswaran,SusannahTaylor,ElizabethToller&Jocelyne Voisin,HealthCanada

BillCallery&JenniferMajor,HealthcareExcellenceCanada

MelanieOsmack,IndigenousPhysiciansAssociationofCanada

AdditionalCollaborators

AishaLofters,DepartmentofFamilyandCommunityMedicine,UniversityofToronto

AlanKatz,ManitobaCentreforHealthPolicy

AmandaCondon,UniversityofManitoba

AndrewMacLean,DalhousieUniversity

AndrewPinto,St.Michael’sHospital,UpstreamLab&DepartmentofFamilyand CommunityMedicine,UniversityofToronto

BrynHamilton,AssociationforFamilyHealthTeamsofOntario

DanaCooper,NursePractitioners’AssociationofOntario

DanielleBrown-Shreves,RestoreMedicalClinics

DerelieMangin,DepartmentofFamilyMedicine,McMasterUniversity

DominikNowak,JimWright&RoseZacharias,OntarioMedicalAssociation

EmilyGardMarshall,DalhousieUniversity

IsabelleLeblanc,McGillUniversity

JenniferRayner,AllianceforHealthierCommunities

KamilaPremji,DepartmentofFamilyMedicine,UniversityofOttawa

KimMcGrail,CentreforHealthServicesandPolicyResearch

LeslieGreenberg,MekalaiKumanan&KimberlyMoran,OntarioCollegeofFamily Physicians

MaggieKeresteci,CanadianAssociationforHealthServices&PolicyResearch

MikeGreen,DepartmentofFamilyMedicine,Queen'sUniversity

MonicaAggarwal,DallaLanaSchoolofPublicHealth,UniversityofToronto

MylaineBreton,UniversityofSherbrooke

NebKovacina,McGillUniversity

NicoleBlackman,IndigenousPrimaryHealthCareCouncil

NoahIvers,DepartmentofFamilyandCommunityMedicine,UniversityofToronto

RuthLavergne,DalhousieUniversity

SabrinaWong,UniversityofBritishColumbia

SarahCook,DalhousieUniversity

SarahNewbery,NorthernOntarioSchoolofMedicine

ScottGarrison,UniversityofAlberta

SophiaIkura,HealthCommonsSolutionsLab,SinaiHealthSystem

VanessaWright,Women’sCollegeHospital

VivianRRamsden,UniversityofSaskatchewan

PatientAdvisoryGroups

CanadianMedicalAssociation’sPatientVoiceAdvisoryGroup

MAPCentreforUrbanHealthSolutions’ImprovingPrimaryCarePublicAdvisorsCouncil

OurCareisengagingwithdistinctAdvisoryGroupsineachprovincewhereitisworking. VisitOurCare.caformoreinformationaboutoursupporters.

PanelDevelopmentandFacilitation

TheBritishColumbiaPrioritiesPanelonPrimaryCarewasdesignedand facilitatedbyMASSLBP.

FoundedbyPeterMacLeodin2008,MASSisCanada'srecognizedleaderinthe designofdeliberativeprocessesthatbridgethedistancebetweencitizens, stakeholders,andgovernment.Formorethanadecade,MASShasbeen designingandexecutinginnovativedeliberativeprocessesthathelp governmentsdevelopmoreeffectivepoliciesbyworkingtogetherwiththeir partnersandcommunities.

TolearnmoreaboutMASSLBP’swork,pleasevisitmasslbp.com

PrioritiesPanelTeam:

JasminKay,ProjectDirector

RichardJohnson,BCPanelChair

Facilitators:

RickFoster

JenGamble

CorieKielbiski

JacobMorel

AddyeSusnick

TylerTootle

CivicConcierge:

AbhimanyuSinghChaudhary

AdditionalsupportfromChimwemweAlao,MahaArshadandKayteMcKnight

Imagecredits:OliviaNeale,DepartmentofFamilyandCommunityMedicine, UniversityofToronto

Tofollowdevelopmentsonthisproject,pleasevisitourcare.ca