Of the dozens of promises rolled out on Alberta's campaign trail, few have proven more controversial – and, according to one poll, popular – than one: family care clinics.
The Progressive Conservatives would introduce a total of 140 collaborative care clinics – a model used in several other provinces, with nurses, doctors and other practitioners under one roof – and the idea is a pillar of the campaign. PC Leader Alison Redford has championed it as the future of front-line care, and a poll this month showed the public sees it as the election's top pledge, just ahead of building new schools.
Under the model, which other provinces are bringing in, clinics would allow other professionals to handle routine or specialized cases (such as dietary consultation or a basic rash) while freeing up doctors to provide more complex care and reducing demand on emergency rooms. Physicians have grumbled it may remove appropriate oversight, but it's envisioned as a way to boost care – particularly in small communities – at a time when doctors are in short supply, the population is aging and complex care needs are emerging.
“It's going to change the way that we think about accessing health care,” Ms. Redford said on a telephone town hall Saturday.
The notion of more community-level health care is, of course, popular in theory, and experts agree multidisciplinary care is a worthy goal. “[Doctors]do a great job in what they're doing, but people's needs are greater than just that,” says University of British Columbia associate professor Sabrina Wong, who studies primary health care.
How to implement such a system, however, is not so clear – and Ms. Redford's campaign pledge has become a flashpoint.
The Alberta Medical Association fired back at the idea, saying the family care clinic model is “untried and unproven” and will trample over Alberta's fledgling Primary Care Networks. When Ms. Redford opened three pilot-project family care clinics just before the campaign began, she forced the closure of an existing east Calgary PCN clinic.
“It was in the same location and providing the same services – at least, as nearly as we can tell – so we felt it was overkill in terms of services and over-duplication,” says Calgary doctor Mark Sosnowski of the Mosaic PCN, which closed its centre one business day before the government clinic opened.
Ms. Redford has also been cagey on who will pay for the clinics, saying they'll be covered by the existing $3.9-billion PCN annual budget. Her chief opponent, the Wildrose Party, says the new clinics will cost at least $700-million annually.
As such, in making her pledge, Ms. Redford triggered a spat with doctors, big-footed an existing clinic and hasn't clearly said how she'll pay for it all.
Nonetheless, observers say family care clinics would help ease backlogs in Alberta's health system, which last year was the second costliest per capita in Canada, behind Newfoundland, according to the Canadian Institute for Health Information. And other provinces, including British Columbia and Ontario, are developing similar models.
“The family care clinics are obviously a new model in Alberta, but collaborative care is not new in Canada,” says Patricia Sullivan-Taylor, CIHI's manager of primary health-care information. The problem, she says, is there are no standardized guidelines on how such systems should work, making it impossible to say which is better.
“I think the end goal is pretty much the same in all jurisdictions, but I think the means to that end is a bit different and is still very much being still explored,” she said. “… One of the things that we're seeing is we can't just assume that we're just going to put these things in place and all the things are going to happen overnight – that we do need to allow some time for these things to occur.”
Critics say that's precisely what Ms. Redford did not do when she embraced family care clinics. Since 2003, Alberta has been developing PCNs, which are jointly owned by doctors and the province. They're loose coalitions of different clinics that team up to smooth out access to the health system; in exchange, PCNs get $50 in funding for each patient they serve, above and beyond the funding for services they provide. Ms. Redford has said her 140 clinics may build upon PCNs, but has also criticized the model, saying Albertans likely don't know they're even a part of them.
The AMA, however, thinks the government should give PCNs a chance.
“We think we already have a model that's out there, been evaluated, been shown to be providing good primary care. It needs to evolve and it needs increased funding to allow some innovation to occur … and this announcement just really flies in the face of supporting primary care networks down the road,” AMA president Linda Slocombe says.
Doctors have a reason to fear a new system – it might shift funding away from a fee-for-service model (one where funds are channelled through doctors, who then hire staff) to directly paying other staff in a clinic. Dr. Slocombe says she's not concerned that doctors may face a pay cut, and UBC's Prof. Wong says some doctors – particularly young ones – are eager to move away from a system that strictly pays doctors who then hire staff.
“Basically you're incentivizing some types of care over others,” with the existing system, said Prof. Wong, who is also a registered nurse. She believes collaborative care is the future. “As the population gets more complex, in terms of their care needs, there needs to be other people involved in their care,” she says.
Albertans go to the polls Monday, with Wildrose Leader Danielle Smith believed to be the front-runner but Ms. Redford's party said to be close behind. Polls show health care is a major issue.
Wildrose, for one, will bring in a patient waiting-time guarantee, that would allow patients on one of 10 waiting lists to have the province cover an out-of-province or private clinic procedure after a certain period of time. Critics call it private care; Wildrose says that's an oversimplification, saying every doctor's office is technically privately owned. Ms. Redford, too, talks of “publicly funded” health care (raising questions of who provides it) but has staked her health policy on family care clinics.
If Ms. Redford pulls off a comeback win, family care clinics will dramatically redefine primary care in Alberta, but may also throw away years of development work done with PCNs. Most clinics would mean hiring additional staff in existing buildings, rather than building a new clinic, the PCs say, though details have been vague. Dr. Sosnowski, for one, says he's frustrated the government's sudden infatuation with family care clinics forced his team to close one of its clinics, but doesn't blame the public for getting on board with the idea.
“I think the reality is we weren't very good at publicizing what we were doing [with PCNs] 'family care clinic' is almost a motherly thing - how could you be against a family care clinic that's going to provide this excess care?” Dr. Sosnowski said. “I don't think people realized that those services were already in place, and were being provided – perhaps not to the same degree, but certainly being provided in a strong way.”