Service scope

Updated September 6, 2023

Purpose

FPSC's After Hours Care Program pilot is designed to address urgent and semi-urgent issues when community-based clinics are closed. The goal is to reduce the burden of after hours care for participating primary care family physicians and nurse practitioners. This program provides family physicians with a solution from HealthLink BC that meets the College of Physicians and Surgeons of BC requirements for after hours care for longitudinal patients. Per these guidelines, physicians must provide care to their patients outside regular office hours for issues that the patient deems require attention. Through this program, issues will be triaged, and administrative ones and those without symptoms will be redirected as appropriate. Trained nurses will triage the remaining issues so that only those that will benefit from a physician's guidance after hours will be connected to a physician.

  • The After Hours Care Program service is not intended to address obvious emergent issues as these will be flagged by triage nurses and directed to 911/BC Emergency Health Services as appropriate.

  • Navigators/triage will direct all routine issues and administrative issues as appropriate and not to the After Hours Care Program.

The pilot is open to:

  • Longitudinal family physicians and nurse practitioners with attached patients who are members of a division of family practice participating in the pilot (Langley, South Okanagan Similkameen, South Island, Thompson Region, Victoria) can sign up to use the service with their patients.

  • Family physicians who are members of one of these divisions of family practice can also sign up to staff the service.

As per the guidelines of the College of Physicians and Surgeons of BC, physicians must provide care to their patients outside regular office hours for issues that the patient deems require attention. Through the After Hours Care Program, issues will be triaged, and administrative ones and those without symptoms will be redirected as appropriate. The remaining issues will be triaged by trained nurses so that only those that will benefit from a physician's guidance after hours will be connected to a physician.

Out of scope

The following items are considered out of scope; however, a clinician’s judgment will always override this list as in any given situation an alternate path may be appropriate.

  • Emergent issues/emergencies, such as inability or difficulty breathing, typical chest-pain, imminent loss of life or limb, or mental or physical trauma.

  • Routine issues that can be handled by the patient's MRP (most responsible provider) in a reasonable timeframe.

  • Administrative issues, such as appointment bookings or prescription refills.

  • Calls that can be resolved by HealthLink BC nurses or pharmacists.

  • Calls looking for way finding.

  • Calls without symptoms.

  • Calls requiring diagnostic imaging, bloodwork, other investigations or referrals, unless determined appropriate by the clinician working the service.

  • New prescription starts.

  • Renewals of opioids, cannabinoids, opiate agonist therapy (OAT), and benzodiazepines unless deemed appropriate by the clinician working the service.

During the pilot, the following are considered out of scope, subject to the caveats above and the clinician’s comfort level with handling these issues:

  • Maternity/palliative/in-hospital care/long-term care. During the pilot, existing after-hours groups for these will need to continue. In communities without an existing after-hours group for these services, the involved clinicians will need to identify an appropriate solution.

In scope

  • Patient calls about anything that isn’t out of scope.

  • Urgent calls from lab/pharmacy on behalf of MRPs (Most Responsible Provider) participating in the service.

  • Laboratory calls about critical values/tests.

  • As per the College of Physicians and Surgeons of BC Practice Standard for Care Coverage Outside Regular Office Hours, medical imaging calls about critical medical imaging results.

  • As per the College, pathology calls about critical pathology results.

  • If determined appropriate by the clinician, diagnostic imaging, bloodwork or other investigations, referrals (e.g., sending encounter note to a local ER), and prescriptions.

Call escalation

  • During any virtual encounter, if it is determined by the answering clinician that the chief complaint is an emergency and if the clinician feels unable to immediately address the issue, then the patient will be advised to call 911.