Dr. Linda M.

Slocombe

April 5, 2012 Dear Member: In this letter: AMA will continue to publish non-partisan election ads. Promise of 140 family care clinics (FCCs) flies in the face of health quality councils No. 1 recommendation. Election advertising The Alberta Medical Association (AMA) will continue with its non-partisan advertising for the remainder of the current provincial election campaign, the Board of Directors has agreed. The decision follows a letter from the chief electoral officer who cautioned that the AMAs ad, Health care needs your voice, could be in contravention of provincial legislation that limits third-party political advertising to $30,000 during a provincial election. The AMA has developed four ads, which are posted on our website: 1. 2. 3. 4. Health care needs your voice. Were not waiting to reduce wait times. What are your ideas for improving access to family doctors? Who do you want looking at your personal health information?

140 family care clinics An election promise from the PC party to create 140 family care clinics (FCCs) over three years flies in the face of the No. 1 recommendation from the recent report of the Health Quality Council of Alberta (HQCA). Moreover, there is no evidence to support this explosion in the number of FCCs from the three pilot-project clinics which just opened. In its recent report, the HQCA recommended the government and Alberta Health Services: undertake no further major restructuring in Albertas health care system without first having a clear rationale for the change including a transition plan that specifies the potential ramifications to safety and quality of patient care, the well-being of front-line providers, and the overall integrity of the health care system. 2

The Presidents Letter April 5, 2012 Page 2

Lets be clear: 140 FCCs in just three years will mean massive change at a time when those within the health care system are looking for some stability. And, there is no transition plan. The overall integrity of the health care system will be challenged. What will happen to continuity of care? Where will the staff come from? As for the well-being of front-line providers, there has been no engagement of family physicians and no engagement of the health care teams associated with the 40 primary care networks (PCNs) that now provide care to 2.8 million Albertans and involve 90% of all family doctors. Nor was the AMA involved in the design and implementation of the pilot-project clinics. The AMA supported the pilot-project clinics because our (mis)understanding was that their performance would guide their future. Now, out of left field, comes this announcement just hours after the pilot-project clinics opened their doors thereby making a true and valid evaluation impossible. On the other hand, the value of PCNs has been demonstrated in an independent $1.9 million evaluation by Malatest Program Evaluation & Market Research. As my predecessor, Dr. Patrick J. (P.J.) White wrote in his June 15, 2011, Presidents Letter: Primary care networks have changed the face of primary medical care. Next is to have PCNs change the face of primary health care. Lets build upon what weve already achieved. What will happen to the family doctors office? This has left family physicians and PCN health care teams and staff bewildered and anxious for their futures. Will FCCs enjoy a favored child status in terms of government funding, and resources and support from Alberta Health Services? What will happen when an FCC sets up shop next door to a current physician clinic? (A medical office in Calgary announced its closing because an FCC pilot project was opening nearby.) FCCs will be open 7 a.m. 9 p.m. Many family physician offices currently have extended office hours as well as physicians being on-call 24 hours a day and could be open longer if they had more resources. Preventive medicine Many family physicians and PCN health care teams currently offer preventive medicine and they would like to do more. The AMA has made a number of proposals for this to happen, but government has consistently rejected our ideas. 3

The Presidents Letter April 5, 2012 Page 3

As for health professionals, the FCCs just like PCN health care teams will be staffed by nurse practitioners, registered nurses, licensed practical nurses, social workers, mental health counselors, psychologists, pharmacists, dieticians, physiotherapists, family physicians and others. At FCCs, a patient will not always be seen by a physician. This already happens within PCNs, but the government has balked at AMA proposals to expand the delivery of care by other health care professionals within the physicians office and within a PCN. Annual funding for each FCC is set at $5 million. This establishes a new benchmark for supporting primary care in Alberta, a standard that should be applied fairly throughout the health care system, e.g., funding and resources for family physician offices and for PCNs. Primary care for the 21st century Health and Wellness Minister Fred Horne has been consistent and adamant in his support for PCNs. What is confusing and not so clear is the governments intention for the future of primary care, including the role of the family physician and the relationship between PCNs and FCCs. Over the past decade family physicians have changed the face of primary care throughout the province. Their leadership, innovation and entrepreneurship created health care teams and, in doing so, revamped the delivery of primary care for the 21st century. The medical home has the support of family physicians and the evidence to proceed. Albertas primary health care system cannot afford unnecessary (and costly) duplication and fragmentation. Alberta cannot afford to further alienate physicians. Alberta should not be experimenting with an untried and unproven concept that could threaten the viability of the family doctors office. Albertans have too many bad memories from erratic and impulsive changes in the health care system, whether it was a hospital being blown up in Calgary or a monopoly being created through Alberta Health Services. One cannot simply impose 140 new clinics on top of the existing system. Albertans dont need another history lesson in how not to pursue change. Yours truly, Linda M. Slocombe, MDCM, CCFP President