Reviving full-service family practice in British Columbia.

In 2003, British Columbia created a joint committee of doctors and government representatives to reverse the deterioration in full-service family practice, particularly evidenced in poor morale among family physicians. The committee introduced an array of innovative programs into the province's fee-for-service system of solo and small-group practices, focusing on operational rather than structural changes. Incentive payments for managing chronically ill patients were followed by maternity care bonuses, training to enhance clinical skills and to support practice redesign, recruitment incentives for new family doctors, and other patient care initiatives. The programs, which are open to all general practitioners, have reduced health care spending on high-needs patients, research shows. Moreover, British Columbia now has the lowest hospitalization rate in Canada for seven medical conditions. The experience dem­onstrates that coordinated, operational reform of full-service family practice can improve care and reduce costs without radical restructuring of the primary care system.

Transforming family practice in British Columbia: the General Practice Services Committee.

OBJECTIVE: To describe a new approach to primary care reform developed in British Columbia (BC) under the leadership of the General Practice Services Committee (GPSC). COMPOSITION OF THE COMMITTEE: The GPSC is a joint committee of the BC Ministry of Health Services, the BC Medical Association, and the Society of General Practitioners of BC. Representatives of BC's health authorities also attend as guests. METHOD: This paper is based on the 2008-2009 annual report of the GPSC. It summarizes the history and main activities of the GPSC. REPORT: The GPSC is currently supporting a number of key activities to transform primary care in BC. These activities include the Full Service Family Practice Incentive Program, which provides incentive payments to promote enhanced primary care; the Practice Support Program, which provides family physicians and their medical office assistants with various practical evidence-based strategies and tools for managing practice enhancement; the Family Physicians for BC Program to develop family practices in areas of identified need; the Shared Care Committee, which supports and enables the determination of appropriate scopes of practice among GPs, specialists, and other health care professionals; the Divisions of Family Practice, which are designed to facilitate interactions among family doctors and between doctors and their respective health authorities; and the Community Healthcare and Resource Directory, a Web-based resource to help health care providers find appropriate mental health resources. CONCLUSION: Early results indicate that the GPSC's initiatives are enhancing the delivery of primary care services in BC.