In Port Alberni, I acted as Chief of Staff for both the Hospital and Primary Care for the West Coast of Vancouver Island, from Ahousat to Bamfield and Port Alberni. As a Specialist by training, this required me to work closely with my Primary Care colleagues in order that both Community Care and Hospital Care worked.
Tofino and Ucluelet Maternity Care was at risk and the Health Authority didn't understand about the critical mass required to keep any service functional and sustainable. This still seems to be an issue we need to continuously remind the Health Authorities of.
Centralization of services creates uneven access, especially to rural communities. The loss of Maternity services was a problem in Tofino, but it was an order of magnitude more difficult to the residents of Ahousat. Family and community ties don't always follow Health Authority preferred referral patterns and centralized services affect more than just travel time.
In Port Alberni, There was a slow exodus of Family Practitioners from the community. All the practices were solo, making recruitment very difficult. I worked with the Community and the City to create a Community Operated Family Practice Clinic that the community could hire Doctors into. Over the years, it allowed the community to recruit a number of Doctors.
During this period, we worked to protect the healthcare of the community. For my role in this, VIHA removed me as Chief of Staff, while the Community made me "Citizen of the Year". Different priorities, I guess.
As part of my role of Chief of Staff for Primary Care, I worked with the Nuu-chah-nulth Nation to create dental services with their people. During this time, I learned the strength of these people, the need for full services for the population and, in particular, the importance of dental care beyond the obvious issues, including in language, self-esteem and social development. Unfortunately, I also learned the glacial pace of government and the inability to make changes, even when they were obviously needed.
As a Specialist Physician, I speak with, not for my Family Practice Colleagues. I understand many of the issues, but only you know the nuances.
Currently, many Family Practitioners across the province have chosen to join the LFP program. With the governments current focus on cost reduction, there is fear of the program being changed or removed. This is important both from a FP and Specialist point of view.
From the FP point of view, the ability to work, as well as to recruit and retain colleagues has an obvious importance. From a Specialist point of view, we need a strong Family Practice service to allow us to function and to allow our Patients to receive the care they need. Maybe less obviously, the better FP does in their contracts, the better Specialists do. Specialist contracts need to use the FP contracts as leverage to their contractual relationships with government.
We need to be pulling each other up, never pulling anyone down.