GENERAL PRACTICE SERVICES COMMITTEE

ANNUAL REPORT2006-2007

Library and Archives Canada Cataloguing in Publication Data BritishColumbia.GeneralPracticeServicesCommittee. Annualreport.--2006/2007-

Annual. ISSN1913-7508=Annualreport(BritishColumbia. GeneralPracticeServicesCommittee)

1.BritishColumbia.GeneralPracticeServicesCommittee-Periodicals. 2.Physicians(Generalpractice)-BritishColumbia-Periodicals. 3.Familymedicine–BritishColumbia–Periodicals.4.Primarycare (Medicine)–BritishColumbia–Periodicals.5.Medicalpolicy–British Columbia–Periodicals.I.Title.II.Title:GeneralPracticeServices Committeeannualreport.

RA185.B7 353.6’0971105C2007-960173-1

Mandate

Organization Structure

Background

General Practice Services Committee Report on 2006/07 Activities I. Chronic Disease Management

II. Maternity Care

III. Improved Care of the Frail Elderly, Patients Requiring End-of-life Care, and Increase

Multidisciplinary Care Between General Practitioners and Health Care Providers

Incentive Payments I. Complex Care Fee

II. Prevention

III. Attraction and Retention of Family Practitioners

IV. General Practitioner Non-Compensation Funding

V. One-Time Allocation

Upcoming 2007/08 General Practice Services Committee Activities

Appendix A: General Practice Services Committee Membership 2006/07

Appendix B: Primary Health Care - Health Authority Leads Committee Membership 2006/07

Appendix C: Ministry of Health/BC Medical Association 2006 Agreement, Article 7

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� General Practice Services Committee Annual Report 2006-2007

Mandate

Organization Structure

TheGeneralPracticeServicesCommittee(GPSC)wasoriginallyestablishedundertheMinistryofHealth(MOH)/BCMedicalAssociation(BCMA)Subsidiary Agreement for General Practitioners, November 2002withthemandateoffindingsolutionstosupportandsustainfullservicefamilypracticeinB.C.

Thismandatewasrenewedunderthe2004MOH/BCMAWorkingAgreement,andmostrecentlyundertheMOH/BCMA2006Agreement.

TheGPSCisajointcommitteeoftheB.C.MinistryofHealth(MOH),theBCMedicalAssociation(BCMA),andtheSocietyofGeneralPractitioners(SGP)ofB.C.BoththeMOHandtheBCMAhavefourappointedmembersonthecommittee(AppendixA).

AlldecisionsoftheGPSCaremadebyconsensus.

In2006/07,membersoftheB.C.PrimaryHealthCare-HealthAuthorityLeadsCommittee(AppendixB)participatedinGPSCmeetingsonarotatingbasisasmeetingguests/observers.

�General Practice Services Committee Annual Report 2006-2007

WhereastherearemanypointsofpatientcontactwiththehealthsystemandB.C.patientsrelyonvariousmembersofthehealthcaresystemtoidentifyandmeettheirchanginghealthneeds,therelationshipbetweenpatientsandtheirgeneralpractitioner(GP)remainsunique.Specifically,thephysician/patientrelationshipinvolveslongitudinal,comprehensivemedicalcareforanindividualwithinthecontextoftheirfamilyandcommunity.Asaresult,thisrelationshipprovidesthebestopportunitytoidentifyareasofhealthconcernandappropriateintervention.

TheimportantroleGPsplayinhelpingtoensurethesustainabilityoftheB.C.healthcaresystemwasrecognizedintheMOH/BCMA2002WorkingAgreementinwhich$20millionwasallocatedtobettersupportthecarethatoccursinthecommunitybyGPs.ThroughthisAgreement,theGPSCwasformedandtaskedwiththeresponsibilityofworkingwithB.C.’sGPstodevelopfinancialincentivesaimedathelpingaddressthefollowingchallengesfacingfullservicefamilypractice(FSFP)inB.C.:

• DecliningnumberofGPschoosingfullservicefamilypractice; • Decliningnumberofmedicalstudentschoosingtoentergeneralpractice; • DecliningnumberofGPsprovidingobstetriccaretowomenintheircommunity; • Increasingnumberofpatientsrequiringfullservicecomplexcareoveralongperiodoftime (chronicdisease,mentalillness,frailelderly,endoflife);and • Regardingorganizationofthehealthsystemtoepisodic/acuteepisodesratherthanlongitudinalcare.

In2003/04,throughthe$20milliontargetedforFSFPinthe2001WorkingAgreement,theGPSCestablishedtheFullServiceFamilyPracticeIncentivePrograminwhichthefollowingincentivepaymentswereintroducedtohelpaddresssomeofthechallengesfacingFSFP:

Full Service Family Practice Condition Based Paymentswereaimedatsupportinghighqualitymanagementofcongestiveheartfailureanddiabetes.Physicianswereeligibletoreceiveanannual$75incentivepaymentforeachpatientwithdiabetesand/orcongestiveheartfailurewhoseclinicalmanagementwasconsistentwithrecommendationsintheB.C.ClinicalPracticeGuidelinesdevelopedthroughtheMOH/BCMAGuidelinesandProtocolsCommittee.

Family Physician Obstetrical Premiumwasintroducedtoencourageandsupportlowtomoderatevolumedeliverypractice.Generalpractitionerswereeligibletoreceivea50percentbonusonthecurrentvalueofthefee-for-servicedeliverypayment(feecodes14104or14109).Thebonuspaymentispayableuptoamaximumof25deliveriespercalendaryear.

Sessional Funding for Structured Collaborative ParticipationwasintroducedtoenableGPstoattendchronicdiseasequalityimprovementstructuredcollaborativessessionswithoutexperiencingalossinpracticeincome(fundingended2003/2004).

Background

� General Practice Services Committee Annual Report 2006-2007

In2004/05,theFullServiceFamilyPracticeConditionBasedPaymentsandtheObstetricalPremiumsawcontinuedfundingasaresultofthe2004MOH/BCMAWorkingAgreementinwhich$37millionwasallocatedforFSFP.UnderthisAgreement,theGPSCalsointroducedthe:

Maternity Care Network PaymentthatwasinitiatedasabridgingprogramuntiltheMaternityCareEnhancementCommittee(createdunderthe2004WorkingAgreementbetweentheBCMedicalAssociationandtheProvinceofBritishColumbia)developedalong-termandsustainablematernitycarestrategyforB.C.Underthisnetworkpaymenteligiblepractitionersreceiveda$1,250quarterlypaymenttosupportagrouppracticeapproachtoGPprovisionofobstetricalcare,wherebydoctorsformingtheirownsharedcarenetworksworkasateamsothatatleastonephysicianisalwaysavailabletodelivertheirpatients.

Professional Quality Improvement Days (PQIDs)thatweredesignedanddeliveredundertheauspicesoftheGPSCasaprovincewideconsultationwithB.C.GPsonhowbesttorenewtheprimaryhealthcaresystemforimprovedqualityofpatientcareandGPprofessionalsatisfaction.ThePQIDsengagedapproximately1000GPsfromacrossB.C.andresultedinthedevelopmentofideasandstrategicdirectionforaddressingchallengesfacingFSFPphysicians.

TheprioritiesidentifiedduringthePQIDswereusedtosetdirectioninthenegotiationoftheMOH/BCMA2006Agreement−Article 7: Supporting Access and Improvement to Full Service Family Practice,andinthedevelopmentoftheBCMinistryofHealth’s,Primary Health Care Charterwhichsetsoutastrategicplanforincreasingthecapacityoftheprovince’sprimaryhealthcaresystemforimprovedpatienthealthoutcomes.

�General Practice Services Committee Annual Report 2006-2007

AspartoftheMOH/BCMA2006Agreement−Article7,$382millionoverfouryearswasallocatedforFSFP(AppendixC).Throughthisfunding,theFullServiceFamilyPracticeIncentiveProgramwasexpandedtoaddressthefollowingpriorityareasforsupportingandsustainingFSFP:

Chronic Disease Management

Overthepastfouryears,B.C.hasmadein-roadsinclosingcaregapsinthemanagementofchronicdisease,andhastakenaleadershiproleindevelopingcollaborative,evidence-basedapproachestothemanagementofdiabetesandcongestiveheartfailure.

InApril2006,theincentivepaymentsforprovidingguidelinesbaseddiabetes(14050)andcongestiveheartfailure(14051)carewereincreasedfrom$75perpatient/peryearto$125.

Hypertensionisamajorriskfactorforheartattackandstroke,cardiovasculardisease,andchronickidneydisease.Assuch,theGPSCintroduceda$50hypertensioncareincentive(14052)tohelpensurepatientswithhypertensionaremanagedaccordingtoB.C.ClinicalGuidelinerecommendations.

Table1showsthenumberofGPswhoparticipatedintheconditionpaymentsin2006/07,andthenumberofpatientswhoreceivedcareinaccordancewiththeB.C.ClinicalGuidelinerecommendations.

Table �. Summary of Condition Based Payments for �006/07 1

Inrecognitionoftheiraccomplishmentsinprovidingoptimaldiabetescare,inFebruary2007,lettersofcongratulationsweresenttothe650B.C.GPswhoprovidedguidelinesbaseddiabetescareto75percentormoreoftheirdiabetespatientcaseload.

1. All statistics reported in the annual report reflects billings paid as of March 31, 2007.

GPSC Report on �006/07 Activities

Diabetes

Congestive Heart Failure

Hypertension

GP ParticipationPatients ReceivingEvidence Based Care

Expenditures

2,783

1,540

2,224

109,079

12,711

171,487

$13,652,250

$1,591,375

$8,348,600

� General Practice Services Committee Annual Report 2006-2007

Maternity care

B.C.GPsfacechallengesinprovidingmaternitycaresuchasincreasedcomplexityduetoincreasingmaternalageatfirstbirth,andlimitedsurgicalback-upandstaffingsupportinruralandremoteareasoftheprovince.Whereas,therewere1,400GPsdeliveringbabiesinB.C.in1999/00,overthepastfiveyearsthenumberofGPsprovidingmaternitycarehasdeclinedby33percent.Overthepast4yearshowever,thereappearstohavebeenalevellingoffinthedropinthenumbersofdeliveriesinvolvingGPs,withaslightincreaseinthemostrecentyear.Itistooearlytotellyetwhetherthistrendwillcontinue.Inordertohelpensurethatwomenareabletoreceiveobstetriccareintheircommunity,inApril2006,fundingwasallocatedtocontinuetheObstetricPremium,andinJanuary2007,thepremiumwasextendedtofeeitem14108(electivec-sectionandpostpartumcare).

In2006/07,805GPsparticipatedintheObstetricPremium,providingmaternitycareto13,050womenintheircommunities(2006/07expenditure-$3,400,888).

PertherecommendationsoftheMaternityCareEnhancementCommitteereport,fundingwasalsocontinuedfortheMaternityCareNetworkPaymentstartingwiththe3monthperiodendingJune30,2006.EffectiveDecember31,2006,theMaternityCareNetworkPaymentwasincreasedto$1,500perquarter.AsofMarch31,2007,113GPnetworks(total700GPs)wereregisteredaseligibletoreceivetheMaternityNetworkPayment(2006/07expenditureasofApril30,2007-$2,945,000).

InMarch2007,theGPSCapprovedtheexpenditureofupto$1milliontomakeamaternitytrainingprogramavailabletoB.C.GPswantingtoupdatetheirmaternityskills.Thistrainingwillincludesupportforuptoeightweeksoftrainingforbothurbanandruralphysicians,tomeettherequirementsforGPObstetricprivilegesestablishedbytheirlocalhospital.

Thedeliverymodelforthematernitytrainingisbaseduponasponsorship/mentorshipmodel.Interestedphysicianswillbefundedtoshadowasponsoringphysicianwithobstetricalcredentialsattheircommunityhospital.Fundingwillbeprovideduntiltheycanmeetthedeliveryrequirementstobecredentialedthemselves.Eligibilitywillbeofferedtobothruralandurbanphysicians.Assuch,GPSCfundinghasbeenallocatedtotheBCMAtoadministerthematernitycaretrainingprogram.ThismaternitytrainingprogramwillbeavailabletoGPsinFall2007.

6General Practice Services Committee Annual Report 2006-2007

Improved care of the frail elderly, patients requiring end of life care, and increased multidisciplinary care between general practitioners and health care providers:

InApril2006,aFacilityPatientConferenceFee(14015)andaCommunityPatientConferenceFee(14016)weremadeavailabletobettersupportGPsinworkingwithpatientsaspartners,otherhealthcareprovidersandpatientfamilymembersinthereviewandongoingmanagementofpatientsinafacility,andforcreationofacoordinatedclinicalactionplanforthecareofcommunity-basedpatientswithmorecomplexneeds,respectively.

Thesenewfeesareaimedatsupportingthecareneedsofthefrailelderly,patientsrequiringpalliativecareorendoflifecare,patientswithmentalillness,andthosewithmultiplemedicalneedsorcomplexco-morbidity.

In2006/07,798GPsparticipatedintheFacilityPatientConferenceFee,providingcollaborativeplanningfor3,784patients(2006/07expenditures-$312,627).Moreover,clinicalactionplansweredevelopedfor7,920patientsundertheCommunityPatientConferenceFee(billedby1,073GPsin2006/07).2006/07expendituresforthisfeewere$666,785.

7 General Practice Services Committee Annual Report 2006-2007

Complex Care Fee

Aspatientsgrowolderitisnotuncommonthattheyexperienceacombinationofchronicdiseases.ThiscomplexityrequiresthoughtfulplanningandcarecoordinationbytheGP,medicalspecialistsandotherhealthcareprofessionals.Italsorequiresthefullinvolvementofthepatients,andofteninvolvestheirfamilies.

The2006Agreementallocated$25millionforthedevelopmentofachroniccarefeethatispayableinadditiontoanofficevisit,whichenablesGPstotakethetimeoutoftherapidepisodiccaresystemandspendthetimenecessarytodevelopandimplementapersonalcareplanforeachpatient.

EffectiveApril1,2007,GPsareabletoaccesscomplexcarepaymentforthecareoftheirhigh-riskpatientswithtwoormoreofthefollowingconditions:

• DiabetesMellitus • Endstagekidneydisease • VascularDisease,limitedto: CongestiveHeartFailure IschemicHeartDisease CerebrovascularDisease(stroke) • RespiratoryDisease,limitedto: ChronicObstructivePulmonaryDisease ChronicAsthma

GPswillbepaidamaximumof$315peryear/perhighriskpatientintheprioritydiseasecategories,andforeachqualifyingpatienttheGPcanchoosetobepaidinoneofthetwofollowingways:

Option1:Consistsof6feesforthefollowingfacetofaceinteractions:initialreviewofchartanddevelopmentofpersonalcareplanat$100,reviewofcareplanlaterintheyearat$75,and4inter-sessionalvisitsat$35pervisit.Allarebilledinadditiontotheofficevisit.

Option2:Annualpaymentof$315plusablockpaymentequivalentto6visitsperyearforeachhighriskcomplexpatientforthecareforthoseco-morbidconditions.Careunderthisoptioncanbeface-to-face,couldbeprovidedbygroupvisitorbyanurseorotherhealthprofessional,telephoneore-mail.

ConferencingwithotherhealthprofessionalsandfamilyiscoveredbyGPSC’sCommunityPatientConferencingFee(14016).

Incentive Payments - Effective April �, �007

�General Practice Services Committee Annual Report 2006-2007

Prevention

EffectiveApril1,2007,perthe2006Agreement,5percentoftheannualbudgetallocatedforFSFPunderthe2006AgreementwillbeusedtodevelopandimplementevidencebasedpreventionactivitiesdeliveredinGPofficestohighriskpatients.

TheGPSChasdevelopedanincentivepaymentforGPsundertakingacardiovascularriskreductionassessmentwiththeirat-riskpatients(effectiveApril1,2007).Ifmajorriskfactorsarepresent,apersonalactionplanwillbedevelopedbytheGPandpatientthatincludesthefollowingelements:

• Patient’sgoalsrelatedtodiet,tobaccouseandmoderateexercise; • ClinicalelementsdeterminedbyreferencetospecificGPACguidelines(e.g.diabetes,hypertension, lipid)andthenewcardiovasculardiseaseprimarypreventionguideline(whichrecognizesthe importanceofmajorindividualdiseasespecificguidelinesandthecriticalimportanceofappropriate lifestylemodificationsforallpatients);and • Approachestoenablepatientstounderstandandbeanactivepartnerindefiningandachievingtheir keyclinicalandpersonalgoalstoreducethemajorriskfactors.

A$3000paymentwillbemadefortheassessmentofaminimumof30patientsoverthecalendaryear;billingwillbedoneonanindividualpatientbasisforamaximumof30suchpatients.Thebudgetforthispreventionincentiveiscappedat$5millionfor2007/08.

Attraction and Retention of Family Practitioners

Asperthe2006Agreement,theGPSCapprovedtheexpenditureof$10millioninone-timefundingtoattractandretainrecentlyqualifiedphysiciansinfullservicefamilypracticeinthoseareasoftheprovincewheretheGPSCidentifiedincollaborationwithregionalhealthauthoritiesthatthereisademonstratedneedforadditionalFSFPphysicians.

GPswhohavebeeninpracticefrom0–10yearsmaybeeligibletoreceivethefollowingone-timefundingtoamaximumof$100,000asfollows:

Upto: $40,000forstudentdebtforgiveness, $52,000asaNewPracticeSupplement, $40,000tosetuporjoinagrouppractice,and $1,500asanadditionalbonusforobtainingfullhospitalprivileges.

Tobeeligibleforthisfunding,GPsmustagreetoathreeyearreturnofservice,anditisexpectedthattheyparticipateinchronicdiseasemanagement,andtakeonorphanpatients.ThisincentiveprogrambecameeffectiveJune2007,butinthefirstyear,paymentwillbeavailableforpracticesstartedsinceApril1,2006.

� General Practice Services Committee Annual Report 2006-2007

GP Non-Compensation Funding

Perthe2006Agreement,$20millioninone-timefundingwasallocatedtosupportprimarycarerenewalinthefollowingspecificpriorityareas:

• Improvingclinicalpracticethroughe-healthtechnology; • Increasinggroupandmulti-disciplinarypractice; • Retainingandupgradingphysicianskillstobettermeettheneedsofprioritypatientgroups;and • Establishingcross-disciplinaryqualityimprovementandprovinciallearningnetworks.

Duringthe2005/06PQIDconsultation,B.C.GPsidentifiedpracticeenhancementandsystem-redesignastwoissuesofimportanceinsupportingandsustainingfullservicefamilypractice.Inresponse,theGPSCallocated$6.4millionfor2006/07fiscalyeartosupportthePracticeSupportProgram(PSP).ThisprogramwillprovideGPswiththeresourcesandsupporttoidentifyandmakethechangestotheirclinicalpracticeforimprovedpatienthealthoutcomesandphysicianprofessionalsatisfaction.

ThePSPwillofferamenuofpracticeenhancementtrainingmodulesspanningthreedomains:clinical,practicemanagement,andinformationtechnologythatincludes:

• DevelopingPatientRegisters, • ManagingPlannedCare, • EnablingPatientSelf-Management, • IntroducingGroupVisits, • ExpandingtheMedicalOfficeAssistant’s(MOA)Role,and • AdoptingtheCDMToolkit.

Thetrainingmodules(jointlydevelopedbytheMoH,BCMA,HealthAuthorities&IMPACTBC-HealthyHeartSociety)willprovidetoGPspractical,evidence-basedstrategiesandtoolsformanagingpracticeenhancementchange.ThePSPisbeingdeliveredregionally,andeachofBC’sfivehealthauthoritiesreceived$1millionofthe$6.4allocationfortheestablishmentofregionalchangemanagementteams.Theregionalchange-managementteamswillprovideexpertiseforclinical,practiceandinformationmanagement/technologytransformationusingacollaborativeapproachandengagingwithfamilyphysiciansandotherhealthprofessionalstointroduceandembedevidence-basedchangesintoclinicalpractice.

OnApril11-13,2007,thePSPheldathree-dayregionalsupportteamorientationworkshopthattrainedtheregionalsupportteamsonhowtoeffectivelymentorandsupportphysiciansandMOAsinmanagingchangestotheirpractice.

InMay2007,B.C.GPswereinvitedtoattendaonedayPSPworkshopwheretheyweregivenanoverviewofthePSPandofthenewcultureforHA/GPengagement;atthistimeGPswerealsointroducedtothepracticeenhancementtrainingmodulesandmentorshipsupportavailabletothem.AbillingseminarontheapplicationoftheGPSCincentiveswasalsoincluded.Additionalfundingwasmadeavailablefromthe$20millionallocationforthisactivity.

�0General Practice Services Committee Annual Report 2006-2007

One-time Allocation

Perthe2006Agreement,GPswhoasofApril1,2006,billedthechroniccareincentivepaymentforatleast10patientswithdiabetesorcongestiveheartfailurebycompletingthepatientflowsheetssincetheinceptionoftheprogramin2003,and/orperformedatleastfivedeliveries(feecodes14104or14109)inthepreceding12months,wereeligibletoreceiveaonetimepaymentof$2,500.Inaddition,GPswhoasofJune30,2006,providedthecarementionedaboveinthelast12monthswereeligibletoreceiveaonetimepaymentof$7,500.

Intotal,2,879GPsreceivedpaymentsunderthisprogram.Totalexpendituresforthese2one-timepaymentswere$28,175,000.

�� General Practice Services Committee Annual Report 2006-2007

InMarch2007aRequestforProposalstoevaluatetheimpactoftheFullServiceFamilyPracticeIncentiveProgramandthePracticeSupportProgramwaspubliclytendered.AcontractwiththesuccessfulproponentisexpectedtobenegotiatedbyAugust2007.

Perthe2006Agreement,in2006/07,theGPSCformedaprojectgroupthatundertookthereviewandformulationofrecommendedapproachesthatsupportthecontinuedrolesofGPsinprovidinghospitalcare.Recommendationswillbeissuedin2007.

In2007,theGPSCwillparticipateonatrilateralSharedCareandScopeofPracticecommitteetodeveloprecommendationstobetterenablesharedcareamongGPsandspecialistsandappropriatescopesofpractice.ThiscommitteewillissueitsreportnolaterthanMarch31,2009.

Perthe2006Agreement(re:Section7.5(d)–HealthAuthorityContractswithGPs),$5.5millionwillbeavailabletosupportGPswho,wheredirectly,orthroughhealthauthorities,wishtocontractwithotherhealthcareproviderstoprovidemultidisciplinarycarefortargetedpopulations.AGPSCprojectgroupwillpresentitsrecommendationstotheGPSCin2007.

GPSCmembersareparticipatingonajointTariffCommitteeworkinggrouptodeveloprecommendationsonpotentialwaysofre-profilingthe0120counsellingfeeseriestobettermeetpatientandpractitionerneeds.RecommendationsweretabledatGPSCearly2007.

Upcoming �007/0� GPSC Activities

��General Practice Services Committee Annual Report 2006-2007

Dr.WilliamCavers(BCMA)Co-ChairValerieTregillus(MOH)Co-ChairPhyllisChuly(MOH)Dr.StevenGoodchild(SGP)JudyHuska(MOH)Dr.ArtMacgregor(MOH)Dr.GeorgeWatson(SGP)Dr.BrianWinsby(BCMA)

Appendix A: GPSC Membership �006/07

Staff Support Dr.DanMacCarthy(BCMA)Dr.CathyClelland(SGP)AngelaMicco(MOH)

Committee SecretariatAngelaMicco(MOH)Alternate:GregDines(BCMA)

Ex-Officio MembersDr.StephenBrown(MOH)Dr.MarkSchonfeld(BCMA)

Laurie GouldExecutiveDirectorHealthPlanning&SystemsDevelopmentPrimaryCare&ChronicDiseaseManagementFraserHealthAuthority

Judy HuskaRegionalManagerHealthServicesIntegrationNorthernHealthAuthority

Victoria Power-PollittDirectorPrimaryHealthCareandChronicDiseaseManagementVancouverIslandHealthAuthority

Appendix B: Primary Health Care - Health Authority Leads Committee Membership �006/07

Robert TurnbullDirectorPrimaryHealthCare&ChronicDiseaseManagementInteriorHealthAuthority

Nancy RiggExecutiveDirectorCommunityCareNetworkVancouverCoastalHealthAuthority

�� General Practice Services Committee Annual Report 2006-2007

ARTICLE 7 - SUPPORTING ACCESS AND IMPROVEMENT TO FULL SERVICE FAMILY PRACTICE

7.1 General Practice Services Committee

(a) EffectiveApril1,2007,themembershipoftheGPSCwillbereconstitutedsuchthatthereisequal representationfromtheGovernment,theBCMAandtheHealthAuthorities.Thetotalnumberof membersofthereconstitutedGPSCwillbenine.

(b) AlldecisionsoftheGPSCwillbeconsensusdecisions.IftheGPSCcannotreachaconsensus decisiononanymatterthatitisrequiredtodetermine,theGovernmentand/ortheBCMAmay makerecommendationstotheCommissionregardingsuchmatterandtheCommission,orits successor,willdeterminethematter.

7.2 Costs of GPSC

7.3 The costs of:

(a) administrativeandclericalsupportrequiredfortheworkoftheGPSC;and

(b) physician(otherthanemployeesoftheparties)participationintheGPSC,

ARTICLE 7 - WILL BE PAID FROM THE FUNDS TO BE ALLOCATED BY THE GPSC PURSUANT TO THIS AGREEMENT

7.1 Full Service Family Practice Funding

(a) Thevehicleofthere-constitutedGPSCwillbeusedtofurthercollaboratewithGeneralPractitioners toencourageandenhancefullservicefamilypracticeandbenefitpatientsthroughincreasestothe existing$10millionannualfundinglevelforfullservicefamilypractitioners,asfollows:

(i) effectiveApril1,2006,$60million(inclusiveof$5millionforaMaternityCareNetwork InitiativePayment); (ii) effectiveApril1,2007,anadditional$20million; (iii) effectiveApril1,2008,anadditional$25.5million;and (iv) effectiveApril1,2009,anadditional$31million;

(b) suchincreasestobeallocatedbytheGPSCtotheareasidentifiedinsections7.2(a)and7.3,ortoany otherareasthatmaybedeterminedbytheGPSC.

(c) ThepartiesagreethatnofurtherfundswillbeavailableorprovidedpursuanttoArticle6.6ofthe 2004SubsidiaryAgreementforGeneralPractitioners.

Appendix C: Ministry of Health/BC Medical Association �006 Agreement, Article 7

��General Practice Services Committee Annual Report 2006-2007

7.2 Allocation of Full Service Family Practice Funding to March 31, 2007

(a) Theprioritiesfortheallocationofthefundsreferredtoinsection7.1(a)(i)uptoMarch31,2007will beasfollows:

(i) GeneralPractitionerswho: (A) asofApril1,2006,haveprovidedcareandbilledthe13050CDMIncentivePaymentfor atleasttenpatientswithdiabetesorcongestiveheartfailure;or (B) inthe12monthsprecedingApril1,2006haveperformedatleastfivedeliveries;

(ii) willreceiveaonetimepaymentof$2500.Thispaymentwillbefundedfirstfromthe unexpendedportionofthefullservicefamilypracticefundreferredtoinArticle6.1ofthe2002 SubsidiaryAgreementforGeneralPractitioners(approximately$4.7million)andthebalance fromthefundsreferredtoinsectionArticle7-7.1(a)(i);

(iii) GeneralPractitionerswho: (A) asofJune30,2006,haveprovidedcareandbilledthe13050CDMIncentivePaymentor thenewincentivepaymentreferredtoinsectionArticle7-7.2(a)(v)foratleastten patientswithdiabetes,congestiveheartfailureorhypertension;or (B) inthe12monthsprecedingJune30,2006haveperformedatleastfivedeliveries;

(iv) willreceiveaonetimepaymentof$7500(approximately$25millionexpenditure);

(v) effectiveApril1,2006,the13050CDMIncentivePaymentwillbeincreasedtoanannual amountof$125perpatient.Inaddition,anewincentivepaymentwillbeimplemented effectiveApril1,2006,intheannualamountof$50perpatient,fortheguidelinebasedchronic careofhypertensionwherethisisnotcoveredintreatingdiabetesorcongestiveheartfailure, whichwillbepaidinaccordancewithguidelinesandcriteriasetoutbytheGPSC;

(vi) effectiveApril1,2006,apatientcasemanagementconferencefeeandacomplexpatientclinical actionplanfeewillbeimplemented,inaccordancewithguidelinesandcriteriasetoutbythe GPSC,forGeneralPractitionersprovidinglongitudinalcaretotheirpatients.Thesefeeswill notbeavailabletophysicianswhoarecompensatedthroughaServiceContract,Sessional ContractorSalaryAgreement;

(vii) $5millionwillbeavailableineachyeartoreinstateandsupporttheMaternityCareNetwork InitiativePayment;and

(viii)anyofthefundsreferredtoinsectionArticle7-7.1(a)(i)thatremainunexpendedforservices renderedonorbeforeMarch31,2007willbepaidasaonetimepaymenttothoseGeneral Practitionerswho: (A) haveprovidedcareandbilledthe13050CDMInitiativePaymentorthenewincentive paymentreferredtoinsectionArticle7-7.2(a)(v)foratleasttenpatientswithdiabetes, congestiveheartfailureorhypertension;or (B) inthe12monthsprecedingApril1,2007haveperformedatleastfivedeliveries.

(b) PhysicianswhoarecompensatedthroughaServiceContract,SessionalContractorSalaryAgreement, andwhohaveprovidedtheservicesidentifiedinsectionsArticle7-7.2(a)(i),7.2(a)(iii)and/or 7.2(a)(viii),willbeeligibletoreceivetheonetimepaymentsidentifiedinthosesectionsinadditionto theirservice,sessionalorsalarypayments.

�� General Practice Services Committee Annual Report 2006-2007

7.3 Allocation of Full Service Family Practice Funding Commencing April 1, 2007

CommencingApril1,2007,theGPSCwillusethefundsthenavailabletoitpursuanttosection7.1(a)as follows:

(a) thepaymentsreferredtoinsectionsArticle7-7.2(a)(v),7.2(a)(vi)and7.2(a)(vii)willcontinue;

(b) fivepercent(5%)ofthefundswillbeallocatedbytheGPSCtoimproveddiseaseprevention;

(c) acomplexcarefee(whichwillbebillablenomorethansixtimesperyear,perpatient)willbe developedandimplementedbytheGPSConApril1,2007which,provideditsbillingincludesthe diagnosticcodesforeachchronicdiseasewithwhichthepatientpresents,willbepayablein additiontoanofficevisit(feeitems12100,00100,16100,17100and18100intheMSPpayment schedule)forpatientswithtwoormorechronicdiseases,including: (i) asthmaorchronicobstructivepulmonarydisease; (ii) diabetes; (iii) hepatitis; (iv) hypertension; (v) chronickidneydisease;and (vi) congestiveheartfailure;

(d) $5.5millionwillbemadeavailabletoprovidefundingtoHealthAuthoritiesforcontractswith GeneralPractitionersfortargetedpopulationsandtosupportGeneralPractitionerswho,whether directlyorthroughHealthAuthorities,wishtocontractwithotherhealthcareprovidersfor multidisciplinarycare;and

(e) theGPSCwillsetpatientcentredmeasurablegoalsandwillplacepriorityonthefollowingareas: (i) improvedchronicdiseaseidentificationandmanagementfor: (A) depression/anxiety; (B) arthritis; (C) asthmaandchronicobstructivepulmonarydisease; (D) gastroesophagealrefluxdisease;and (E) twoormorechronicconditions; (ii) improvedcareforthefrailelderly,includingthoseinLongTermCareandAssistedLiving facilities; (iii) increasedsupporttopatientsrequiringendoflifecare;and (iv) increasedmultidisciplinarycarebetweenGeneralPractitionersandotherhealthcareproviders.

7.4 Carry Forward of Funding

Anyfundsidentifiedinsections7.1(a)(ii),7.1(a)(iii)and7.1(a)(iv)thatremainunexpendedforservices renderedinaFiscalYearwillbeavailabletotheGPSCinthesubsequentFiscalYearforuseasonetime allocationsinthatsubsequentFiscalYear.

7.5 Support for General Practitioners’ Role in Hospital Care

TheGPSCwillreviewandrecommendapproachesthatsupportGeneralPractitioners’continuedrolein providinghospitalcare,includingtherelationshipbetweenthatroleandtheroleofhospitalists.The GPSCwilldeterminethekeyelementsormodelsofcarewithindicatorsthatdemonstrateandsupport optimumpatientoutcomes.Therecommendationswillproposehowbesttoutilizeexistingallocationsfor primarycaresupportofhospitalizedpatients.

�6General Practice Services Committee Annual Report 2006-2007

7.6 One Time Funding to Attract and Retain Full Service Family Practitioners

Inadditiontothefundsreferredtoinsection7.1(a),theGovernmentwillprovidenewonetimefunding of$10milliontobeusedbytheGPSCtoattractandretainadditionalrecentlyqualifiedphysiciansinfull servicefamilypracticeinthoseareasoftheprovincewheretheGPSCdeterminesthatthereisa demonstratedneedforadditionalfullservicefamilypracticepractitioners.Physicianswillbeeligibleto receivesupportfromsuchfundsonlyiftheycommittofullservicefamilypracticetomeetpatientneeds intheareaandarerecentlyqualifiedGeneralPractitioners(i.e.thosewithinfiveyearsoflicensureto practice).Inexceptionalcircumstanceswhereaninsufficientnumberofrecentlyqualifiedphysiciansis willingtocommittoprovidingfullservicefamilypracticeinareasoftheprovincewheretheGPSC determinesthatthereisademonstratedneedforadditionalfullservicefamilypractitioners,theGPSC willhavediscretiontoprovidefundstoGeneralPractitionerswithmorethanfiveyearsofpracticesince licensureiftheGPSCbelievesdoingsowillattractandretainfullservicefamilypractitionersonalong termbasisinsuchareasoftheprovince.TheGPSCmayusethesefundstoprovide:

(a) repaymentofstudentloandebtofupto$40,000underareturnofserviceagreementschemethat requiresfiveyearsofserviceforthefullamount; (b) supportforthecostsofestablishinganewfullservicefamilypracticegrouptoamaximumof $40,000(supportforsolopracticesmaybeconsideredforremoteruralareas);and/or (c) alternativepaymentarrangementsforthesefullservicefamilypracticerecruitmentsforalimitedtime whiletheybuildupapatientbasetoprovidepatientswithaccesstofullservicefamilypractice.

ARTICLE 7 - A FORMAL APPLICATION AND APPROVAL PROCESS AND GUIDELINES WILL BE ESTABLISHED BY THE GPSC TO IMPLEMENT THIS INITIATIVE.

7.1 Non-Compensation Funding

Onetimenon-compensationsupportforfullservicefamilypracticewillbeprovidedusingthe$20 millionfundforprimarycarerenewalreferredtoonpage8inArticle5(b)(ii)oftheLetterofAgreement (RelatedMatters).ThisfundingwillbeusedtosupporttheachievementoftheGPSCprioritiesreferred toinsectionArticle7-7.3(e)andtoprovidechangemanagementsupportthroughregionalfullservice familypracticepatientaccessandclinicalimprovementinitiativesinthefollowingspecificpriorityareas:

(a) improvingclinicalpracticethroughe-Healthtechnology; (b) increasinggroupandmulti-disciplinarypractices; (c) retrainingandupgradingphysicianskillstobettermeettheneedsofprioritypatientgroups;and (d) establishingcross-disciplinaryqualityimprovementandprovinciallearningnetworks.

7.2 GPSC Work Plans

Onanannualbasis,theGPSCwilldevelopaworkplan,ensurethatevaluationstomeasureoutcomesare anintegralpartoftheplan,andreportannuallyonprogressandoutcomestotheGovernment,the BCMAandtheHealthAuthorities.