Fall 2005

P r i m a r y   C a r e   R e n e w a l
Mobilizing primary health care renewal


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Provincial framework defines primary health care as a philosophy, or organizing strategy, to provide services across the continuum for the first level of care and/or health and community services.

by Juanita Barrett

Primary health care (PHC) was identified as a priority for Newfoundland and Labrador by the Department of Health and Community Services in 2002, with the subsequent development of an Office of Primary Health Care and a provincial advisory council to support PHC renewal.

The provincial office has a family practice physician representative who provides direction and support for primary health care renewal from a physician perspective. In addition, the advisory council has a representative of the NLMA as a member. A provincial framework, Moving Forward Together: Mobilizing Primary Health was developed, with provincial and advisory council consultation, and was approved in September 2003. This framework defines primary health care as a philosophy, or organizing strategy, to provide services across the continuum for the first level of care and/or health and community services.

Specific goals include enhancing accessibility and sustainability of services; supporting comprehensive, integrated and evidence-based services; promoting self-reliant and healthy citizens and communities; and, enhancing accountability and satisfaction of health professionals.

Primary care projects

Eight projects are currently implementing primary health care renewal changes, based on the framework, in Labrador East, Grenfell, Bonne Bay, Connaigre, Twillingate/New World Island, Bonavista, Placentia and St. John’s (urban), with a ninth project in the proposal stage for the Green Bay area. Project areas identified a population base (minimum 6,000 and maximum 25,000) for planning and implementing primary care services, submitted collaboratively with regional health boards, and identified executive and physician leadership. The St. John’s proposal includes partnerships with physician representatives of the Memorial University Family Practice and Newfoundland Drive Family Practice.

Project areas completed a comprehensive needs and services assessment (including all public and private services). With support of the provincial office, and frontline and other providers in project areas, further analysis sessions assisted with the identification of implementation plans to:

  • support primary health care team development and collaboration;

  • formalize physician networks to ensure medical needs of populations are well served (e.g., 24/7 call, special medical care needs such as mental health);

  • formalize linkages with primary health care networks include public providers who provide service periodically (e.g., speech language pathology) or private providers (e.g., pharmacist);

  • enhance health promotion/wellness activities presently ongoing, in cooperation with provincial and regional wellness activities;

  • build on community strengths and develop community capacity, with the provincial wellness division, rural secretariat, and the local community advisory council;

  • shift scope of practice amongst providers to ensure the right provider, provides the right service, to the right client at the right time;

  • identify potential of enhancing emergency transportation to enhance access to quality 24/7 services; and,

  • build on technology to enhance clinical usage, support the provision of a continuum of care/service, and enhance linkages amongst providers and services.

A provincial plan for chronic disease management, initially for diabetes has also been developed (in cooperation with the Provincial Diabetes Strategy Advisory Committee), and is in the process of implementation.

Supports for primary care renewal

Project level

  • Coordinator, facilitator (wellness, community capacity and chronic disease management), family physician lead and secretarial support one day per week, for an 18-month implementation period.

  • Funding provided to support such activities as team development, scope of practice enhancement, wellness and community project activities.

Provincial/Office of PHC level

  • Proposal development, implementation and sustainability planning.

  • Leadership for team development and scope of practice shifts.

  • Evaluation for the province and projects.

  • Public education campaign being developed.

  • Development and trialing of enhanced sharing of primary health care electronic health information.

  • Implementation of the provincial telehealth plan.

  • Variety of provincial working groups to provide project area representatives. Opportunities to participate in planning and decision making, share successes, support. Opportunities for improvement, and build capacity of providers.

  • Provincial physician working group, which has identified a draft funding/payment model, for piloting in project areas to support family practice physicians working within primary health care teams.

Multi-jurisdictional level

Two Atlantic initiatives include:

  • Building a Better Tomorrow (BBTI) provides increased support for change management, team development and inter-professional development; and,

  • Selfcare-Telecare will provide access to evidence and standard-based 24/7 nurse phone line services for triage and general health information, and a web-based health information service.

The future

Over the next year the provincial office will support project areas in implementing and evaluating their plans, assist them with sustainability plans, and will support the development of four rural and one urban project in proposal development. Opportunities for research regarding chronic disease management, electronic sharing of health information, team development, and inter-professional education are being pursued with partners. Evaluation results inform our progress, and allow us to proceed with renewal that will support sustainable and quality health services to the people in our province.

Juanita Barrett, is team leader with the Office of Primary Health Care. Inquiries may be directed to dryan@gov.nl.ca.

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Nexus is published quarterly for Newfoundland and Labrador's physicians. It is a forum for the exchange of views, ideas and information for members.