 Thank you. It's good to see everybody today. It's a really a really good day It's a little overcast outside, but it's a really good day for us. I think and we're Very pleased to be here today. I want to respectfully Acknowledge the history customs and culture of the Musqueam of the Squamish to the Slewa tooth first nation on whose Traditional lands and home we meet today Joining me today is Dr. Ramnik Dasanj the president of the doctors of BC who will hear from in a few moments We're obviously this is a very significant day For people who care about primary care in BC. It's a transform Formational announcement we're making today in May as All of you will know Premier Horgan and I met with the doctors of BC We committed to working closely together to support doctors in our province through a collaborative multi-phased approach in August together Dr. Dasanj and I announced stabilization funding of 118 million to support family doctors with overhead costs this stabilization funding Made a significant difference and it has been as close to fully subscribed as such a program can be 107 million dollars of that 118 million dollars is has gone out or is going out the door in the Few days to come we've had a very high rate of Participation in the program and we're very pleased about there's still 11 million dollars We sent out and we'll expect that to happen in the next few weeks as the remaining Doctors take part in that program and clinics take part in this program It's working that program and I think it provided in interim support as we work together On a longer-term solution and it's because of this work together this collaboration that we're here today Together with doctors of BC and BC family doctors We've developed a new patient model and have a new tentative physician master agreement This payment model for family doctors will help perfect and strengthen BC's health care system by helping to attract new family doctors and Retain existing doctors by supporting our health care workers including doctors We are helping patients get better access to the health care that they need and that's what matters most Making sure patients get access to that care this new payment model Which will be available to family doctors beginning February 1st 2023 Provides another option for family doctors that makes a departure from the fee-for-service model under which doctors are paid Primarily on the number of patients they see in a day This brand-new model takes into account five factors Including the time doctors a doctor spends with a patient the number of patients a doctor sees in a day The number of patients a doctor supports through their office the complexity of the issues a patient is facing an Administrative cost currently paid directly by family doctors It would give family doctors a more equitable payment option one that better recognizes their value in providing primary care Full-service care to patients Importantly it will help maintain their business Autonomy giving them more flexibility to create the kind of practice that works for them And most importantly for their patients It was respect to the tentative physician master agreement I'm happy to announce that the province and the doctors of BC have reached a tentative physician master agreement This agreement includes several commitments that will better support doctors as they care for patients It also reflects the desire and commitment of the doctors of BC the government of BC and BC health authorities Working together in the interests of patients The tentative agreement fosters stronger collaboration and reduces the barrier to barriers to doctors in the delivery of care to their patients The tentative agreement supports our continued collaboration on key priorities to improve health care including gender equity reconciliation with indigenous people and workplace safety The tentative agreement we've reached addresses work doctors complete after regular operating hours by addressing improvements to existing Alternative physician payment contracts and increasing Improving and increasing access to health services for patients will continue to be the focus of doctors of BC and the Ministry of Health Working groups over the coming months This includes how to best attach patients with complex needs a provincial rostering System to ensure patient care continuity a provincial patient survey and how best to incorporate into the new model other Services that family doctors provide outside of clinics This is all part of refocusing and our continuing efforts to to develop and improve our primary care strategy In January as our BC pandemic entered a new phase We said it was time to renew rebuild and strengthen our health care system and the actions We're taking including achieving this critical agreement this work together come from hard work And from working so closely with doctors of BC and BC family doctors to find solutions that strengthen our health care system That renew its essential function and that build on our support for doctors and for the patients who count on them So far our efforts have produced significant results in June We started working with resident doctors and new to practice doctors and for incentives to bring them in to ensure that that group of doctors who was entering in to To family practice in BC would choose full-service family practice I'm happy to report so far 62 dot new physicians have signed contracts and 68 are in discussions about suitable clinic placements in the terms of the contracts 151 in total have expressed interest in these incentives put that in context that number had typically been for those contracts 25 in a year a health human resources strategy that will train Recruit and retain health care workers while redesigning the health care system in BC So it works best for patients and health professionals alike creating new residency positions 128 at the 40 new undergraduate medical seats They should say an 88 new residency positions at the University of British Columbia And of course the work we're doing to create a new medical school at Simon Fraser University in Surrey All of these initiatives are part of and build upon our transformational and refocus primary care strategy It's my honor now to to introduce dr. Desans to say a few words about this Exciting day for patients in BC for family doctors in BC for all members of the doctors of BC Thank You kindly minister I am excited to be here today as we announced two major developments that we believe that will move us forward In a significant way to meeting some of our health care challenges I want to thank the provincial government in particular minister Dix the premier and deputy health minister Stephen Brown for what has been a true collaboration The announcements today have been shaped by the voices of physicians in this province Physicians who care passionately about caring for their patients They told us clearly what they need so that they can provide quality care and be Responsive to all of their patients needs This will not happen overnight. There is still much work to be done, but I believe today. We are at a milestone The new physician master agreement That will be going to our members for a vote in the next few weeks It is by far the best agreement negotiated for physicians in Canada this year And I believe it is one of the best that has ever been negotiated here in BC It allows us to target funding to areas that need it most so that we can ensure physicians Both family doctors and specialists are recruited and can stay in their communities and also have the tools and resources To provide the level of care to their patients on a personal note I'm particularly proud of the commitment within the agreement to address gender equity Across the profession and to integrate cultural safety and humility into all of our work our new family physician model Co-developed by doctors of BC BC family doctors and the provincial government represents a set seismic shift in the way we practice in BC It is a model unique in Canada bringing together the best of a range of payment models It addresses rising business costs. It recognized the value Physicians provide when delivering Longitudinal care and it will compensate us for the time spent on evening and weekend administrative burdens Our hope is that this new payment model will not only stabilize longitudinal family practice But help make it both sustainable and rewarding Everyone deserves a family doctor and this new option is a significant step to help make that goal a reality As I said, there's still much work to be done Not just to improve the issues that are facing the doctors but to meet the challenges of the entire healthcare system BC's doctors are leaders and champions for our patients With our partners will continue to work hard on behalf of all of our patients at the end We needed hope and light for our patients and for the physicians that are responsible for providing the care I am very excited and thank you very much for having us here today Thank you, Dr. DeSange. It's been a pleasure working with you Pleasure for our teams. It's been exceptionally Hard work, but I think people will agree that hard work together Building out all of our goals together of team-based care of providing better care for patients of of Fully integrating the role of doctors in that and also and principally for our patients What this means is that we're making family practice the priority it should be We're responding to what dr. DeSange and others have called a broken system by Restoring the value to family practice that is required by building out a system of Locums to ensure that people have care when and where they need it of ensuring that episodic care Is more closely connected to the overall health care system that patients are better linked to community care This will mean better care for patients together That was the principal goal of the ministry of health and the government of bc That was the principal goal in all of this work together of the doctors at bc And I think that we have achieved some of those goals. There is a lot of work to go come This is one element This is a key element, but one element of our overall health human resources plan that you've seen in recent months But it shows what we can do As we continue to work together with all of the people in the system and with patients as well commitment action Collaboration they have they make possible what we can achieve together in our health care system Over the last two and a half years We've been dealing with two public health emergencies and it has had profound effects on everyone On every single person in bc I think our system has shown An ability to respond to that that has been remarkable We face challenges together and we have to take the same approach Commitment to public health care commitment to our patients. That's what today's agreement is all about We're happy to take your questions Thank you minister as a reminder for media on the phone. Please press star one to enter the queue That's star one to ask a question for any reporters in the room Please line up at the microphone provided and wait to be called Please make sure to provide your full name and outlet media will be limited to one question and one follow-up We'll start on the phone today with bender sojin ctv. Please go ahead Hi there. Um, so you mentioned that this is good news for people who are waiting for a family doctor. Can you Uh, maybe provide that link to people with regards to uh, you know in february when this comes into A fact how many more family doctors you expect to see and then how patients will actually get access to them so this um, this uh strongly supports Uh our family practice system so it Stabilizes and supports existing practices allows them in their terms to build out team-based care So that's important because our obviously all those who have Care and ensuring that that system is there for the future and replaces a previous system of Payment to doctors that's important for them It provides incentives and supports for people to choose full-service family practice to choose taking on patient panels of 1250 and serving their patients in the community ensuring that that option Is equal to other options that new family doctors can provide and as we build out more options As we add to our primary care networks as we add to our system And systems of episodic care It ensures that people will choose these these into the future The core of a successful healthcare system is excellent primary care Is people in the community doctors and nurse practitioners and nurses and allied health workers providing excellent care in the communities That's how you respond In and improve as well all of the other services you provide in acute care and ambulance care and all the other services you provide So what you're going to see is um is I think And we've already seen this in the response to the initiatives we took together in an interim way The new to practice contracts and the Stabilization package we put forward in august the willingness and the commitment of family doctors in bc to respond to the needs of their patients And finally a rostering system I think we've had Because of the model we've had in place over a long time And I think both the government and the doctors recognize it A system that is was highly Diffused and difficult to understand for patients So what we're going to put in place together over the next six months is a rostering system That allows people who want a family doctor to have a place that they can connect and then get access to one A lot of our information about who has and who doesn't have a family doctor is based on federal government surveys And they those surveys lose the patient in the process We've put the patient at the heart of this agreement And that's why I think it'll be a better deal for patients and for people choosing full service family practice Binder did you have a follow-up? I do yes, thank you And just with regards to the rostering system with about a million people estimated to not have a family doctor How will people be given priority? In terms of getting access into a family doctor. Well, there's two sets. I think of of patients in that as you know In 2003 There are about 300 000 people without a family doctor in bc By the time I became minister of health as well over 900 000, right? So it tripled and you recall efforts to address that I want to be to I won't be partisan here So I won't mention the various announcements that guaranteed everyone to have in election campaigns by that government That guaranteed everyone to have a family doctor the number of people without one tripled in that time It went it stabilized in the first couple years of ministerial health has been affected by the pandemic so That's what this what you're seeing here Is a focus on patients A focus on the care given to patients a stabilization of our existing network of family doctors Family practice doctors are their ability to build out their practices effectively incentives to ensure that Becoming a full service family doctor is there for people So what we're going to see is a system that better cares for people that focuses on the care And that was a priority for doctors of bc and for ourselves And so you're going to see a system that responds better to people That builds out the number of family doctors and allows people to To access them by a provincial system We sometimes in certain divisions of family practices have excellent ways of linking people to doctors now But we don't have a provincial system. We're going to have that now Build out for the six first six months So we build out a new system of payment that I think is going to be very positive for family doctors And then we're going to Ensure that there's a rostering system in place so that you know, you don't have to search around You don't have to phone doctor by doctor that you'll be able to connect with our system of family doctors better So it's it's a it's good news for patients in that sense We haven't had this before and it's obviously good for doctors as well I don't know if you want to add anything I'd just like to add that this new payment model is a new way of doing things We're listening to the concerns of many of our family doctors that have left practice or have been contemplating actually leaving Many physicians across the province had actually given me a deadline of wanting to leave practice because the conditions were so hard This new payment model enforces the support it bolsters support for physicians Providing the longitudinal family practice care that they have been to their patients So really stabilizing the efforts on the ground and our hope is that we're going to be able to Retain the physicians we have but also recruit more doctors a lot of our new graduating family doctors or have them Incentivized to go into residency to choose family medicine because there's a different way of doing things And we know that we've heard that the burdens and the one patient and one visit and one problem And we're hoping that this support in this payment model will allow physicians to get back to doing doctoring And also be compensated for their administrative burdens and tasks Many colleagues are charting long into the night and on the weekends and taking away from their own time with their families But this puts patients first it allows patients to actually Attach with their family doctors and will build capacity with the existing family physicians on the ground If we make their working conditions easier and the ability for them to be able to teach within their Clinical settings and to actually bring in more supportive staff and work towards team-based care Then we're actually doing the best we can for our patients and minister Dix is right. This is the first time We've ever implemented such a change Thank you Our next question is for Richard Vestman global news. Please go ahead Minister we obviously have cautioned around politicians making promises about you know how many People may be without a family doctor But are there going to be any benchmarks built into rostering here in terms of how quickly you'd like to see Those million people place with a family doctor Well, I think one of the issues I think And this is a technical question But when we say that there are people without a family doctor And the numbers that's in response to something called the Canadian community health survey Which is a survey conducted by at a national level and as you know That was in the in the low 300,000 range in 2003 and it tripled in the years between 2003 and 2017 This in spite of the fact That a commitment was made in multiple election campaigns by that government that everyone would have a family doctor So what this is what this change is about is a fundamental change And it's foundation Foundational to all the other things we're going to do one rostering systems treat people as individuals So it's not your response to a survey that might come to somebody from the federal government and allows us to estimate It allows you to engage with the system it treats people as individuals And so it then sets benchmarks for practices and allows people to access primary care in the same way As one accesses other health care services when you need emergency care you go to the hospital You know what to do and whatever the challenges might be in the hospital You know what your role is and what you're to do This allows I think and empowers patients So we're going to be setting new benchmarks finally having benchmarks in bc and a system that's linked together We've agreed to work together to have a system that responds adequately to the interests of patients We've had over time a fairly diffuse system This is a deal. This is an agreement agreement with doctors that that I think promotes Primary care promotes it as a career for doctors again, and we'll bring more Doctors into the system but richard. It's only one part of it. We need to take action and we have To increase residencies and this agreement supports that by allowing family doctors to support new doctors Community and to be adequately paid for this people sometimes say well, why don't you just have more residencies? Well, they require is a serious and important educational process that needs to be supported by existing doctors This agreement supports that we need to address barriers to internationally educated doctors and to build out team-based care And allow doctors to work more easily with other professions to provide more care and to increase attachment in their clinics This is these are exciting and foundational changes that are going to allow us to succeed in many of the other things It's not 50 strategies But it's it's in fact in this case 70 strategies linked together and this is important and foundational to that Richard did you have a follow-up? I do one of the big challenges obviously is about regionality You know in some areas like here in victoria age is a fact of the populations older They have more reliance on family doctors in metro vancouver. You have in many areas a growing Population in the north you have areas where you know if one family doctor retires it may mean an entire community is not Served so how does this model address the challenges around? regionality in british columbia and aside from that There's a change as well around Nurse practitioners. Can you speak to that and how does that factor in and and if dr. DeSanche can weigh in whether they're all worries because I know there have been in the past From seeing a greater role for for nurse practitioners in the primary care system I think on the latter I would say That there is extraordinary support in collaboration our system With between doctors and nurse practitioners Compared to any time in the past I I think that's just true That you know when I became minister of health we were last in canada in number of nurse practitioners per capita One of my predecessors george abbott had really created and as minister of health had led The establishment of nurse practitioners in bc But we were last in canada and we've dramatically increased the number of nurse practitioners such that I think it was It will by the end of this political mandate have tripled And so that role will continue in all parts of our health care system What this system does it it has been historically very difficult In the 2000 family practices less so in the UPCC's or the health 30 clinics But where generally speaking people have been paid in the same way But it's difficult when you have a system of independent contractors And other people coming to the system who are paid differently and and and it's been hard to bring those together This breaks down some of those barriers allows Family practices to build out their support from nurse practitioners and nurses in such a way That we're going to be able to offer that team-based collaborative care in more ways On that we've had right now in bc 58 primary care networks and there'll be a There will be an ability through them to do that So I think this is building out team-based care in practice And I think the work that doctors and nurse practitioners do in particular and and registered nurses And allied health workers together is going to be enhanced by this agreement and it builds confidence in that And and I think the the new payment model only strengthens that idea So you're going to see nurse practitioners and doctors working together more because We're going to be facilitating that and we can do that and build that out with confidence and I'm I'm very proud of that and we've got to continue to build that out. It's been a challenge, of course In the last number of years which remind people our primary care networks have added 1,200 people to the primary care system to support better care for people who have a family doctor now And those who want one we've added The urgent and primary care centers so those are important with respect to the the Regional elements of this it's true people have different demands and different needs But you know Some things are common We're seeing an increased complexity of patients everywhere as we have an aging population For a long time for example, Surrey, which is obviously critical community in bc was the youngest community in bc Well now through the 2036 it's going to meet the provincial average in terms of age In fact the demands in Surrey for care are going to increase And that is why we're building for example a new cancer care center at the new hospital in Surrey So I think you're going to see that increase in that aging population equalized across the province But you see in this agreement and we haven't got into all of the details of it more supports for rural care And that the changes we're making in practice some of which actually started in smaller and rural communities are now bringing Turban centers are going to are flexible enough to meet the needs of everyone because you're right Some communities that are younger need more episodic care and need to connect that care into the system Some younger people don't really feel they need a family doctor. Maybe when we're 27 and we're in very good health we may not see that but we may if we're You know playing frisbee football or something and injure our legs suddenly need care And need rehabilitation care over a period of time And so those communities will need to strengthen out episodic care younger communities You can imagine what some of them Might be in bc. I think nelson's probably an example of that and you have communities such as victoria that have A lot of seniors who really will require a full service family doctor Or nurse practitioner or someone providing care and a full service clinic to support them with their varied health needs now bc has Extraordinary levels of public health One of the longest life expectancy of our country in the world are very few places on earth Switzerland and japan maybe two of them which have longer life expectancy But that means we have more and growing demands than our health care system So we have a flexible arrangement which will improve care in in rural bc improved care in urban bc And allows the doctors to focus on care More than they ever have before Thank you rigid for the question. I'll just respond and reiterate some of minister dick's remarks for the latter part of the question Absolutely, there's a role for nurse practitioners and many of our allied health care professionals to help provide Team-based care and we know that to manage all of our patients needs in this province It cannot be done alone And what i'm hoping is this new payment model is the anchoring is the foundation to create the condition In which our patients can get the best type of quality care that they deserve We need health care equity across the province and we also understand that our rural and remote Communities their needs need to be met I've met with many of our communities across the province and what I can tell you is That rural and remote voice is always at our table as well at doctors of bc So whatever we are building our hope is that the new future Is upon us and this transformational change will have the needs of everyone And that's why i'm also hopeful about the physician master agreement that it's building in health care equity These concepts as we know are so essential that Every patient Deserves a family doctor and to anchor in the supportive system of primary care This looks like the way to kind of move in this direction And really transform the way that we've been able to provide the care for our patients in the community And again alongside us we would benefit from all of our nurse practitioners Our colleagues that can work alongside us and within their scope of practice Alongside ours, but now we're having conditions that will allow us to provide the type of care that we all train to provide So this is again a very exciting time for us and there is still much work to do But this is a start and we appreciate the collaborative efforts of this government Our next question is from Amy Smart, Canadian Press. Please go ahead Hi Amy Hi, I just have a question about the rock strength system. Will it be a first come first serve basis? Or will there be a way to prioritize urgency? Well, we'll get the family doctor first Yeah, and we'll certainly be building on we expect that rostering system to be in place the middle of next year as we work through these extraordinary changes and Obviously that takes some time. We have such systems in place now But obviously what the priority will be in part be provided by people who Who require a full service family doctor? And so we want to ensure that their Their needs are met and that they'll have a place to go To get access to care and that's important and so we'll have Inevitably there is a prioritization that occurs in that and that's the first thing The second is for people who may not want that but need their episodic care to be better integrated And so both of those things are going to happen and we're going to use our places of episodic care whether they be walk-in clinics and And and urgent primary care centers and others to to build out attachment across the board So I think that will certainly be providing more details on rostering But that is a it's a significant change to find to lay out who's attached Who who's attached to a particular clinic and then be able to see where the opportunities are for people to Both add to add a family doctor and to and to find have one place they can go to do so So I think all of that is of value inevitably in the system if you need care And you've gone to an emergency room or gone to an urgent primary care center or other or a walk-in clinic or other place And you clearly need Full-service family practice that will obviously you'll obviously have the other places you can link in as well So the rostering system is new. It's something that we've wanted to do for a long time I think together and it's a it's a key aspect for patients in what we've agreed to today And did you have a follow-up? Yes, one of the measures that you say will be compensated is the complexity of the patient. How do you measure that? Oh I'm going to ask Dr. DeSanche who deals with complexity of patients a lot to talk about that because it's an important part of the agreement but I I think Here's here's what I'd say That There are ways and we've been I think as a system trying to do this for a long time Someone in my circumstance who has Type 1 diabetes. I'm walking in with type 1 diabetes to every appointment I go and see Dr. DeSanche and whatever's bothering me on the day and whatever I need to see the doctor about on the day And that adds to the complexity. It's the reason why people with chronic disease really need Um a full-time healthcare practitioner to support them and to understand when they walk in so I don't have to explain Oh, I'm a type 1 and here's somebody here's what's happening. They know because they have those results We're seeing an increasing complexity of patients across the board And so there are ways and what you have is a detailed system of measuring complexity of patients If you have for example Um a patient roster that's dramatically older or has a very significant group of people who have Let's say mental health and substance abuse issues by definition You have to spend more time with those patients But the overall patient population is also increasing in complexity and this agreement reflects that And so at different times We may have Significantly different needs of our healthcare system. We always need it at different times those needs may be More intense for whatever reason we're diagnosed with a chronic disease Obviously our whole maternity system Is the requirements of that is we're younger we require we have different needs than if we get Into our teenage years So I think what you need and what we have is a flexible model that Focuses us on the needs of patients and allows doctors to focus on care But there are lots of ways to measure complexity We have them in the agreement and I'll ask doctors to speak a little bit about how she does it in her practice Thank you for the call And just not to get too much into the details of the agreement But the understanding that all healthcare systems around the world, especially primary care Healthcare systems and the evaluation of them and we've got in canada obviously all of our research and healthcare policy Abilities to be able to look through either msoc scores, which may not Maybe irrelevant to everyone listening. I may not know the details of that But really what you look at is exactly that some of that minister Dix just spoke of is that that time with the patient What is the chronic condition or the disease and how does that burden the patient? But also the needs of based on how many consultations they mean need or how much The the time they take with you in your clinic office setting and it's not necessarily just on aging But we've known that many of our aging populations and our geriatric populations do have needs for more time And the assessments in your office take a little bit longer But also I could say that the opposite for some of our Younger patient populations with complex either they've got Some conditions that require a lot more work and effort or some of our BC cancer patients that need more time and Those are the issues and conditions that are Systemically built an assessment on a diagnosis code that physicians will input sometimes into their electronic medical record or To look at through the msp billing guide that there's an opportunity to look at those individual codes and the Complex care required by that patient or how many times that patient may have accessed the emergency room or the primary care setting or required diagnostics or tests and and that's where we look at that data and that's when we look at chronic complex Patients we are not saying everyone does deserve care and access to primary care And that is our hope is to build a foundation to really Work into the preventative aspect because right now we need to anchor all those patients that don't have a physician But we also need to recognize our need for health care prevention And to focus on wellness and well-being of our patient populations along with our public health experts and our People that are doing this work, especially in our pediatric populations our mental health populations and our female populations and again like Minister Dix has said in our physician master agreement We actually have embedded gender equity and this is the first time we're seeing this and hopefully even the fee for service schedule We can modernize that payment schedule to reflect the needs of All patients and that is what i'm saying is building on health care equity. This is a milestone for that Question is for mollum Palmer think over son. Please go ahead Um, hi, I just wanted to check uh based on the answers we've had so far you're Not you do not have an estimate Of how many family doctors this will add to the number we have now And you do not have an estimate Of how many patients who do not now have a family doctor We'll be able to get one as a result of these changes. Is that correct? Uh, I think I think the answer is yes and no We know from the changes we've made already that uh, that these these new arrangements are going to increase the attractiveness Of family medicine and a family practice and a full-service family practice We've seen that already with our new to practice contracts. We've seen that in the work we've done with our stabilization fund So we've seen the impact of that Secondly, um, I think that uh, what we see is that uh, and you don't know Exactly how something's going to work, but this is only one part of a number of measures So this is foundational this improves and incentivizes family practice and improves things for patients as well by building out Team-based care for them And so I expect this will lead to more people and more doctors practicing for longer being So existing doctors being stabilized in their in their practices and attracting new people To full-service family practice. So our expectation is that that will significantly increase things, but it is not A one-step response to a broader problem. We have a health human resources plan that has 70 items in it We need to address residency spaces this agreement supports that by by ensuring that those Doctors who are supporting residency programs are properly remunerated and allows us to do what we've done Which is expand out residency programs when you dramatically increased by 128 at ubc The number of spaces when 92 of those doctors stay in bc, you know, that's going to mean more for full-service family practice So, uh, the goal of this agreement in connection with the actions we're taking on internationally educated doctors The actions we're taking with respect to training more doctors and and the focus on family practice and equalizing Family practice against other kinds of medicines. It's going to have a very very positive effect We can't be exact. I think that's what you're asking about what that effect will be But we know that it will be positive and it'll provide more care and support our primary care system So that's the intent. That's the goal all of the indications show that it is going to significantly improve things This is an improved investment in that system And the other part of rostering is it will allow us to more clearly monitor the effects of that on the system So if you're asking This agreement does this mean x number of new patients will be attached to a family doctor You can't say that and guarantee that for sure because we will have to see how it happens in practice But we will know we know For a fact that will make things much better both for patients and for doctors and it's going to have a positive effect But we can't just do this. We have to do all of the other things that we're proposing There are 70 actions in our health human resources plan. We have to do all those things together So it's building brick by brick in response to this massive period of demand on on the health care system of pandemic And the overdose public health emergency In that context we have to keep doing that. So this is one important action. It's foundational We need to do other things as well Fine, did you have a follow-up? Yes, please. I'm still trying to understand the The new model payment for a full-time fte full-service family physician. So The 385 thousand Is is that a max? because I also Think I heard I think as I read it that Um They're not there's a there's a minimum number of patients you have to see but there isn't a max and so if you exceed the Basic hours or the number of patients or the number of counters or all three Can you go above that and is there any ceiling on that? well There are as you know, uh, if you look at it's published every year. So everybody knows there's no Secrets and in what we pay doctors as individuals or collectively We know that there are doctors who work Very long hours and are very focused on that and and they That group of doctors will also be supported by them So we don't want a situation where someone is committed to doing that for their patients And is restricted in some way from doing that and so that that's the idea But we're very specific and the new payment model and we'll go through it because I think we did that in the In the briefing Vom but we didn't do it in as great a detail here is based on providing 1680 hours work 1250 patients of average complexity So a doctor who might have higher complexity might have fewer than that conceivably And that's one of the elements of the agreement 5000 encounters a year And what this does is and as a goal it equalizes family full-service family practice against other types Of medicine so you're right It may be possible if a doctor works well beyond that for them to earn more than that and that would make sense but this Links the the amount doctors get paid to the care they provide And it's very important based on the previous question to understand this If you're in a fee-for-service system your economic interests would be supported by having a very average patient base For not not necessarily and patients sometimes complain about this They say I have very complex needs and I'm going to need to see my doctor for a period of time And I have a difficult time finding a doctor they might say for that reason I think many doctors make allowances for that and we know that this happens every day in the system So what we have is a payment model based on the work done and based and focused on care That addresses doctors issues around overhead So if you're going to do that the fee-for-service system says you get a fee for service to do more services You get paid more that system hasn't been working for patients hasn't been working for doctors for some time This provides a base Structure that says this is the work you do and this is your remuneration There will be some people who it might work and you can work as little as 0.2 For example one day per week and obviously if you work 0.2 you get paid less If you want to work more in the system and provide more care That we don't want to limit that because that's care for patients Patients and all those patients who are both unattached and attached to get the care that they need so This is this is The base it lays out a base and it provides an alternative And it is I would argue significantly we would expect Very significant number of doctors to take on This new program And there may be some who stay on fee-for-service, but this is I think An arrangement that doctors themselves co-designed And I think addresses the needs of the system. So what you're talking about Vaughan, you're quite right That is the base you can do more than that if you do more work than the base And of course if you're working say 0.2 hours you would a week you would get paid less than that Our next question it's from April. Let's check news. Please go ahead Oh, hi, thanks very much. Um, my first question is for a colleague who's working up island today She's wondering how this agreement Will make a difference if at all for rural hospitals like Port Hardy where The er has been closed there since Friday evening because of staffing issues and isn't going to open again Till tomorrow morning in addition to what you're announcing today what else is being done to improve health care in places like Port Hardy So it's different in different communities, right the issue In clear water say has primarily been a nurse issue And you'll note that there hasn't been closures in clear water as we've worked through those issues The issue in clear water was has been in part An access to housing issue when we try and solve problems And we've worked with the local community there To get housing temporary housing for people coming in and to support that emergency room the issue in in northern northern and vanker island communities has tended to be access to doctors and and really the core primary care Doctor in a community Such as port Hardy and such this point Port McNeil is one of the things we've had in mind In the various elements of this agreement and You know, I've been told not to do 15 minute answers So I'm not going to do that in this case although I although We certainly will Be happy to brief on that questions, but this supports Primary care doctors working in small communities in large There's specific arrangements to support health care in rural bc to support The mo cap program which is important for many communities in bc And I think it's in general supporting that core Of primary care doctors who also in many communities the core of providing emergency services and In smaller hospitals such as in port Hardy So I think in that sense it will be supportive of that But again, it's not one answer but many to dealing with health human resources. We have added 38,000 people net to the health care system 600 new family doctors in five years and yet We've also added dramatically to the demands on the system and we're living through two public health emergencies So we have to continue to do that work in some communities This agreement will be very helpful in other communities where the issue around the emergency room is not doctors but nurses We have to take other steps as well Do you have a thought Yeah, um, when I I think maybe for dr. Desange, um, obviously one of the key goals here is connecting people with with family doctors But I'm wondering for those British Columbians who do already have a family doctor. What sort of real Changes if any will they notice once this new payment model comes into effect? Thank you for that question I think an immediate sigh of relief which i'm hearing from many of my colleagues who just Are watching probably this briefing this morning and also may have received my president's letter that went out this morning from doctors to bc I've been hearing already and I think the moral distress that when we speak of and the burdens and the administrative Tasks that in a day that you're inundated with lab results or diagnostic reports or that pull you away from your patient encounters And for all those physicians that have needed to be compensated for the time because maybe it takes longer Or they work at a different pace than some of my other colleagues I know I was one of them And to be able to be compensated for a block of time and to be able to take that time with your patient if need be As well as seeing them with their complexities and really getting time and building space for even your clinical teaching without having to take another Break or Allowing the capacity to change so really a renewed sense of hope and optimism that A lot of family doctors have been facing and addressing the overhead and the rising costs of business is a major one in this new payment model And also another way of allowing our family doctors to know that we've been listening We did some robust engagement Early summer and we've been doing that through our divisions of family practice across the province for many years And I feel that finally they have been heard and we've listened carefully and co-created this model with a lot of significant input From the physicians on the ground. They've been telling us what they need to be able to serve their patients better And I truly believe that this is the way forward I think that when we think about primary care and health care systems and What we need to build in the 21st century in this province to be evidence to be able to be a reputable Healthcare system that provides the needs for all of our patients. This is the first step And I really am Truly excited in barking on this journey because I truly think that our patients Will see a little bit more livelihood and a breathing room with the locum The commitment to locum coverage for our physicians that have never never been able to take Time off or step away from their office because of the needs and the demands on them This will enable them to have a healthier working environment And that's all we can hope for is to create better working environments and conditions that foster better care for our patients Because we know healthier physicians and doctors make healthier patients and this is the way that we need to be working For our final question today, we're going to come back to the room. Please go ahead Question for Minister Dix in English and in French, if you please To what I understand doctors were paid before 30 to 40 dollars per visit. Can you help us understand How much they can get now under this new system? So this is a change We went we're going from a fee for service system Where your payment depended on the number of services you provided all of which had their own fee codes So they're different fee codes for different services But you're you're not in the wrong range there when you're talking about what you're talking about So it depends it depended but Really your ability to make A living and to pay your administrative costs and your staff and everyone else involved Depended on the number of services you provide Number of services that you are remunerated for by a specific fee for each service Here we're changing the dynamic significantly There was an alternative previously which tended to be contracts So you were salaried and there was and between those two options There was not a lot of flexibility, right? And so This changes that it focuses the payment on the care provided the hours of work provided The patients attach the complexity of those patients So it creates a whole number of new factors that aren't just about Having a large number of people come through the practice and providing them with care care care care Individually it pays for the continuum of care The work doctors do outside of the direct care for patients And it and it also allows them to get supported for the complexity of their patient panel So we have a minimum patient panel We have a minimum number of hours worked every year a number of visits that need to be provided But it gives doctors more flexibility. They're not simply paid If they want to increase their salaries by bringing more patients through or taking more time at the practice and providing You know, what is not cookie cutter care? Because that's not the care doctors provide but is paid before like cookie cutter care And so this is a fundamental change. This is an option that allows Doctors to continue to run Their medical practice with independence But recognizes the work that they do and it is a I think a fundamental change from a system That's been 80 fee for service In terms of msp billings Right up to recent years has gone down a little bit in the last couple of years But the most fee for service problems to one where a lot of doctors are going to be working on this new model I think that's good news for patients and everywhere else I would say in French that we currently have a system that pays a doctor specifically for a service For a service for 10 years, 27 hours, a visit individually or whatever There are different fees for different services. It's a little bit complicated to develop together now This is going to change We're going to put the focus on care Give to the people who visit To the people, to the patients This is essential in a system where we want a transformation So it's not fee for service actually A fee for each service But we're going to pay for hours to work For the complexity of the people who receive the care of a doctor In general And who will also give support Support for administrative fees for doctors So it's a model that puts the focus on the patients And not on a almost industrial system To give them care It was okay in the past And it was also an exit from the doctors in the past But it's the doctors themselves with us Who have said that this system doesn't work, doesn't work anymore And it needs a change And this is a fundamental change in this system Question for Dr. Dossange You said often that you wanted to abandon the fee for service system How satisfied are your members now? And how many do you hope will opt for this? And also what will happen after three years? I think my hope is we've built what they've asked for In a sense of the most desirable outcome When we think about the care that our patients deserve And the conditions that we deserve to work in So I'm hoping that there will be great uptake I think a lot of it is going to be telling our members Not all of our physician members are yet aware of it So we have to speak about the process And what it looks like And how we switch on February 1 Like Minister Dick says, this is not a contract And this is not the fee for service But it's a middle road in which we can provide the ability And opportunity for physicians to work in a new way And really that's considering all of the burdens And the tasks we're hearing about the indirect care So checking your labs, speaking to your consults And really organizing all of the needs and demands From your office work And being able to be compensated from that As opposed to doing it on the side of your desk Or when you take it home later in the evening Or also noticing that the renumeration for the time That you're spending for your patients So the base rate, hourly rate And then encounter rate on top of that To really acknowledge that time that you're spending For patients and their complexity of care And also again to address the rising costs of business I know that from many of our members That heard even of the stabilization in term funding That Minister Dixon and I announced earlier this year That was really hopeful for many of the physicians On the ground and what I really want to reiterate Today is that people that feel the value Family physicians have eroded the sense of their value For their patients over time because of the working conditions And unfortunately some of the systems Compensate transactional care And what we are trying to provide is this real attention To the need for longitudinal primary care And family medicine and the needs of that All citizens and all of our patients In this province and this country deserve that type of care Someone to look after all of their needs And their family needs and know them well In a relationship based setting Also to prevent things from happening From knowing their genetics and knowing their history And anchoring whatever virtual supports we're providing For care into this longitudinal family practice Because we know that those physicians know their patients Best and it also simplifies care with our specialist Colleagues when you're consulting There's someone else that's championing that care And that fine thread that links you all together So to be able to provide that support I really will be looking forward to meeting Many of my colleagues this week And the weeks coming up to see the robust uptake And really that hope and optimism Of shifting into a new way of doing things We've all known what it takes to provide quality care We learn it, healthcare systems Many of us are interested in it How to reform this primary care system And here we are, we're here with the new dawn And hopefully thinking that we're leading into this With intention for our patients And to serve their needs higher than all other priorities We know that they need our help And as physicians, we do that in our clinics We do that in our hospitals And allow us to be able to be inputting into the way That we actually are compensated and valued for our time Thank you very much Dr. DeSange I just want to say, you know I think what we're doing today is both historic And foundational And it is there In place to allow us both to stabilize And support our current practices To make it more attractive for people to come family doctors We've already seen how that works To reflect the growing complexity Of primary care needs of people As we get older, our needs become more complex This agreement does that To support healthcare provision in rural and remote communities The agreement does that But it's not anything more than one step But a foundational one This transformation of our primary care system That we've worked on together Is critical It will require continued investment And effort in other areas To ensure that we add medical school spaces We're doing that To ensure it's easier And we support team-based care Which we're doing And we need to do more of To provide better care to people So this is one step It's a foundational step And it's good news for patients today And it's good news for Not just now For doctors now But in the future The new payment model is simply put A much better arrangement Than continuing on in fee-for-service And we're confident That it's a much better arrangement for patients And we're going to see progress On all of the issues we make together One agreement doesn't solve All of the issues that we face But again, it allows us To take all of the measures we need to take together To improve access for those who are unattached Those who need episodic care And those who are already attached To get better care And better fundamental care in the province And that's the work we have to continue to work on This is one step But I would say it's a pretty big step And it's one that people have been waiting for For a long time And we got here Because we worked together And we're going to continue to work together To make sure the needs of patients Living in communities big and small Around BC Get the care they need in primary care That helps us them stay healthy And it helps us also In providing all the other care we do In our health care system I want to thank you all for joining us today And I look forward to seeing you soon We'll take a picture