The GPSC’s A GP for Me program, sometimes known as the Attachment initiative, recognizes the importance of continuous doctor-patient relationships and is aimed at improving primary care in BC. Announced in February, 2013 at the same time as the In-patient Care program by the BC Medical Association and Ministry of Health, A GP for Me strives to:

• Confirm and strengthen the relationship between family physicians and patients
• Better support the needs of vulnerable patients
• Increase capacity within the system
• Enable patients who want a family doctor to find one.

The program includes $60.5 million for two years for new family physician fees, effective April 1, 2013, including:

• Zero Sum Attachment Participation Code
• Telephone Management (Visit) Fee
• Expanded Complex Care Management Fee
• Patient Conference Fee
• Unattached Complex/High Needs Patient Attachment Referral Fee

It also includes $40 million to Divisions of Family Practice over the next three years to:

• Conduct research to evaluate the number of people looking for doctors in their community, the needs of the local family physicians, and the strengths and gaps in local primary care resources
• Develop a community plan for improving local primary care capacity, including a mechanism for finding doctors for patients who are looking for one

Documents containing more information for physicians about A GP for Me/Attachment can be found below. Information regarding the original announcement and the prototype communities can also be found at agpforme.ca

Overviews

• Physician Overview of A GP for Me Initiative
• A GP for Me and In-Patient Care overviews and incentives
• A GP for Me Summary of Practice-Level and Community-Level Supports

Fee Codes and Descriptors

• NEW GP Locum Attachment Participation Code (May 30, 2013)
• Attachment and In-patient Care Fee Information
• A GP for Me Billing Tutorial video
• A GP for Me and In-patient Care Q & A video

Information for patients (printed copies for your office can be ordered from Hayley Gordon)

• A GP for Me Patient Handout
• A GP for Me poster for physicians’ offices
• Detailed poster for physicians' offices

Frequently Asked Questions

1. What is A GP for Me, also called the ‘Attachment Initiative’?
2. What is the In-Patient Care initiative?
3. What funding is available to family doctors?
4. How can doctors access this money?
5. Do I need to be a member of my local division to qualify for the attachment fees?
6. What is meant by my needing to ‘confirm your doctor-patient relationship with your existing patients’ in Q4?
7. Isn’t attachment just another term for capitation?
8. What are the criteria for billing the new attachment fees?
9. What proof will the Ministry require that doctors are confirming their relationships with existing patients?
10. Are we expected to take on new patients?
11. Are we expected to work longer hours?
12. How will these programs help doctors?
13. How will this initiative help patients?
14. How do you know this program will be successful?
15. Were any doctors consulted in the development of these programs?
16. Will we be allowed to drop patients from our practice, or are we committed to them forever by the attachment program?
17. How many people in BC need a family doctor?
18. I had heard there was going to be an attachment fee for each confirmed patient in a doctor’s practice. Has this changed?
19. I provide longitudinal care but my practice is already full. So a new doctor can access these new fees and reap economic benefits, as can doctors that haven’t previously been providing longitudinal care. Why can’t I?
20. I’m a member of a local division but I don’t want to participate in this initiative. How do I know that the division won’t move ahead in doing this work even though I don’t want to?
21. I want to participate, but I don’t have a local division that is participating. What can I do?
22. Are health authorities involved in this attachment work?
23. Does the College of Physicians and Surgeons support the telephone fee code?
24. How does the unattached complex high needs patient attachment fee work?
25. Are there any fee codes that relate to physicians attending to patients in a residential facility?
26. If a participating family physician accepts only some patients and not all patients required, will there be repercussions from the College of Physicians and Surgeons?
27. Do I have to register with a Division of Family Practice to access the new fee codes through the A GP for Me initiative?
28. What if only half of my patients are eligible for the new fee codes? Do I only register those who are eligible or all of my patients?
29. How does A GP for Me and the associated fee codes work with EMRs?
30. Which of the Attachment incentives, if any, can a locum bill when working in an Attachment participating practice?

Click here for a printable PDF version of the FAQ.

1. What is A GP for Me, also called the ‘Attachment Initiative’?
A GP for Me is a program sponsored by the Ministry of Health (MoH) and the BC Medical
Association (BCMA) to support doctors providing longitudinal patient care, support existing
doctor patient relationships, and provide access to family doctors for those British
Columbians who want one. The initiative has also been called the Attachment initiative. The
terms are interchangeable.

2. What is the In-Patient Care initiative?
The In-Patient Care initiative is intended to ensure patients have access to care by a family
physician during their vulnerable time in hospital, and to better support physicians who
provide this aspect of care.

The General Practice Services Committee (GPSC) has agreed to provide funding for inhospital
support for two years while the overall issue is being more completely explored with
MoH, BCMA, and health authorities.

These supports are separate from, but complementary to, the Attachment initiative above.
The funding will replace all existing doctor of the day and other service contracts in place for
GP in-hospital care.

3. What funding is available to family doctors?
A total of $132.4 million is being provided by the GPSC and the Ministry of Health for A GP
for Me and In-Patient Care. The funding is allocated to these initiatives as follows:

A GP for Me:

• $40 million to Divisions of Family Practice over the next three years to develop and
  implement local plans to improve primary care capacity and find doctors for people
  looking for them.
• $60.5 million for two years for a new suite of attachment fees available to family
  physician fees available as of April 1, 2013, including:
• Patient-family doctor telephone consultations;
• Enhanced fees to care for patients with chronic conditions;
• Fees for taking on new patients with complex care needs.

In-Patient Care:

• $31.9 million over two years to better support family physicians caring for patients
  who are in hospitals.

4. How can doctors access this money?
For A GP for Me, local divisions of family practice will administer the portion for the
community-based planning and implementation. Local divisions will not administer the
Attachment fee codes; these will be submitted through MSP Teleplan.

The fee codes for the Attachment initiative will be available to all family doctors who submit
the MSP fee G14070 ‘GP Attachment Participation Code’, a zero-sum amount, at the
beginning of each calendar year. This will in turn open the door to the new Attachment
initiative suite of fees. Billing the zero sum fee code signifies that:

• You are providing full-service family practice services to your patients, and will continue
  to do so for the duration of that calendar year;
• You are confirming your doctor-patient relationship with your existing patients through a
  standardized conversation or ‘compact’. See Q6 for details.
• You have contacted your local division of family practice to share your contact
  information and to indicate your desire to participate in the community-level Attachment
  initiative as you are able. See Q20 and Q21 for more information.

Prior to submitting the GP Attachment Participation Code, each participating Family Physician
must register their intent to participate in A GP for Me with their local division, even if he/she
is not a member of that local division. This will assist the local division to understand how
many doctors in their area are prepared to support Attachment initiative efforts. Division
contacts are available online at www.divisionsbc.ca.

For the In-Patient Care initiative, some local divisions may choose to administer the fee
codes. There will be another administrative mechanism in place for those divisions that
choose not to administer the codes. Details confirming which divisions will administer In-
Patient care fee codes will be available closer to April 1, so please check back for further
information closer to that date.

5. Do I need to be a member of my local division to qualify for the attachment fees?
No, the Attachment initiative fee codes will be available to all family doctors providing
longitudinal care and that comply with the three criteria for the Attachment initiative:

• You are providing full-service family practice services to your patients, and will
  continue to do so for the duration of that calendar year;
• You are confirming your doctor-patient relationship with your existing patients
  through a standardized conversation or ‘compact’. Se Q6 for details.
• You have contacted your local division of family practice to share your contact
  information and to indicate your desire to participate in the community-level
  Attachment initiative as you are able. See Q20 and Q21 for more details.

For physicians that have hybrid practices with both longitudinal patients and walk-in patients,
A GP for Me fee codes can be billed only for those patients for whom the physician has
accepted Most Responsible Physician (MRP) responsibility for their community-based care.

6. What is meant by my needing to ‘confirm your doctor-patient relationship with
your existing patients’ in Q4?
Doctors and patients participated in the drafting of an informal doctor-patient conversation
(sometimes referred to as a ‘Compact’) that is being used to confirm patient attachment as
part of the A GP for Me initiative.

The three prototype Attachment communities helped develop wording for this doctor-patient
conversation and, more recently, focus groups were held to test the language of the compact.
Here is the resulting wording:

As your family doctor, my practice team and I will:

• Provide you with the best care that we can
• Coordinate any specialty care that you need
• Offer you timely access to care within the best of our ability
• Maintain an ongoing record of your health
• Keep you up-to-date on any changes to the services offered at our office
• Communicate with you honestly and openly to address your health care needs.

As my patient, I ask that you:

• Seek your health care from me and my team whenever possible
• Identify me as your doctor if you have to visit an emergency facility or other health care
  provider, so they can provide me with information about your treatment for your
  medical record
• Communicate with me honestly and openly so that we can best address your health
  care needs.

You do not need to call in your patients to discuss this or mail information individually.
Materials have been created that provide this information to patients; you may choose to use
these materials in your office and offer them to your patients. You can see the materials at
bcma.org; click on News and it will direct you to the appropriate section. You can also contact
Hayley Gordon with the provincial Divisions team at hgordon@bcma.bc.ca to order paper
copies for distribution in your office.

7. Isn’t attachment just another term for capitation?
No. Capitation is a method of payment and the Attachment initiative in BC does not change the
payment method for a physician.

Also, this is not a restricted rostering. Participation is entirely voluntary for both patients and
physicians. Doctors and patients will each still be able to choose to work with one another, and
either may decide to opt out of their doctor-patient relationship at their discretion.

8. What are the criteria for billing the new attachment fees?
Any family physician wishing to participate in the Attachment initiative may do so by submitting
an MSP “Attachment Participation” code of a zero-sum amount at the beginning of each
calendar year. In doing so, you will be verifying that you:

• Are providing full-service family practice services to your patients, and will continue to
  do so for the duration of that calendar year;
• Are confirming your doctor-patient relationship with your existing patients either in
  person or by providing information about the physician-patient primary care
  relationship. (supporting communications materials will be provided to all doctors); and
• Have contacted your local division of family practice to share your contact information
  and to indicate your desire to participate in the community-level Attachment initiative as
  you are able.

9. What proof will the Ministry require that doctors are confirming their relationships
with existing patients?
Through the MSP “Attachment Participation” code (see Q7).

10. Are we expected to take on new patients?
No, participation in the Attachment initiative is voluntary. If you choose to participate you will
not be forced to take on patients that you do not want; the commitment states you must
participate at the community level “as you are able”.

However, the program is designed to help create capacity within the existing system:

• The telephone visits available through the Attachment initiative suite of fee codes have
  been shown in other jurisdictions to increase efficiency and therefore practice capacity;
• The new Attachment incentives related to patients with complex, chronic conditions are
  designed to support you if you do choose to take on these individuals; and
• The three Attachment prototype communities have demonstrated that community-level
  planning through local divisions has created capacity.

So, you may find that participation in the Attachment initiative does create capacity in your
practice, enabling you to take on more patients if you wish.

11. Are we expected to work longer hours?
No; is it not the GPSC’s intention to ask doctors to work harder or to put in extra hours. We
expect that practice capacity will be enhanced through the practice-level and community-level
supports included in the Attachment program.

All aspects of this program are optional. We are recognizing and supporting doctors who are
already providing longitudinal care, help those who want to strengthen relationships with
existing patients and increase practice efficiency, and provide compensation to those who are
willing to take on new patients, including those with more complex care needs.

12. How will these programs help doctors?
Through A GP for Me, family physicians will be provided with both practice-level and
community-level supports. New fees will improve practice efficiencies through telephone
‘visits’, and family physicians will be better compensated and supported for the time required to
provide longitudinal care to more complex patients.

Community-level efficiencies can be developed by co-operation through local divisions, again
increasing the capacity of primary care in the community in which you work.

Family doctors will also have opportunities for input – through Divisions of Family Practice –
into primary care planning at the community level, aimed at coordinating and, if needed,
enhancing access to services.

Finally, family doctors will be positioned at the centre of primary care delivery, and awareness
of their important role will be built through focused communication and enhanced patient
relationships.

13. How will this initiative help patients?
Patients who already have a family doctor will have new options for accessing care, through
things like telephone fees at the practice level and enhanced access to services at the
community level. They will also have better continuity of care by a GP when they are in
hospital.

Over time, patients who are currently without a family doctor will also benefit. Work by
Divisions will both increase local primary care capacity and introduce means of finding doctors
for patients who are looking for one.

14. How do you know this program will be successful?
Over the last three years, A GP for Me has been prototyped in three communities: Cowichan
Valley, Prince George and White Rock-South Surrey. Approximately 300 family physicians
participated in that phase through their local division of family practice, and they were
successful in finding doctors for about 9,000 people who did not previously have one. In one
community, there is currently no wait time if a resident is looking for a family doctor. The approaches that were tried in these three communities will be helpful input to doctors in other
parts of BC as they develop their own local plans.

15. Were any doctors consulted in the development of these programs?
Doctors have been integral to shaping and growing both the Attachment and In-Patient Care
initiatives. Nearly 400 family physicians in BC have contributed thus far. Family physicians have
been involved in every step of this process:

• As members of the GPSC shaping the high-level framework of both initiatives,
• As members of both the BC Medical Association and the Society of General Practitioner
  boards of directors, reviewing and approving the work of the GPSC,
• As members of the provincial attachment working group from the prototype communities
  that met monthly to discuss learnings and projects at the community planning level, and
• As members of the prototype communities, working to test and implement community-level
  plans in their practices. Approximately 300 physicians tested and implemented the
  prototype plans across three communities.
• As well, approximately 150 doctors have been involved through their local division of
  family practice in shaping the In-Patient Care initiative.

In addition, doctors and patients have been consulted over the last several years through
workshops to establish a definition for patient attachment and outline the responsibilities of
both physicians and patients in this acknowledged relationship. Finally, many divisions across
the province have been addressing various elements of attachment through their CSCs, such as
collecting and analyzing data from practices, the community, facilities and the province to
better understand the number of unattached patients and the priority areas for improving the
health of vulnerable populations.

16. Will we be allowed to drop patients from our practice, or are we committed to
them forever by the attachment program?
Doctors will still be able to drop patients from their practice, as long as they adhere to the
College of Physicians and Surgeons of BC policies.

17. How many people in BC need a family doctor?
Provincial data shows that about 176,000 people in BC are looking for a family doctor. There
are more people than this who do not have a regular doctor, but not everyone is interested in
having one.

18. I had heard there was going to be an attachment fee for each confirmed patient in
a doctor’s practice. Has this changed?
This idea was discussed but discarded. Doctors did not feel that the fee would help make it
more feasible for them to take on new patients and the administrative burden was too onerous.
As well, patients indicated that they felt their doctor was already attached to them; a formal
conversation could be odd and sometimes confusing. The revised approach provides new fees
and other supports to doctors for the longitudinal care they are already providing, and was
developed as a direct result of physician feedback.

19. I provide longitudinal care but my practice is already full. So a new doctor can
access these new fees and reap economic benefits, as can doctors that haven’t
previously been providing longitudinal care. Why can’t I?
Several of the new fees being introduced as part of the Attachment initiative are aimed at
rewarding longitudinal care that is already being provided by family doctors. These include fees
for telephone consultations and an expanded scope of complex care fees for your existing
patients. We believe that these new fee codes make it possible for physicians to work in more
flexible ways that traditional fee codes don’t, such as accurately compensating you for the time
required for caring for complex patients, or enabling patients to talk to you on the phone for
matters that don’t require an in-person visit. New guidelines regarding patients who qualify for
complex care billing codes enables doctors to include more patients in this billing category as
well.

You do not need to take on new patients to benefit. However, if these other measures help you
increase efficiency in your practice and you choose to take on new patients at some point in the
future, you will also have access to the new patient fees.

20. I’m a member of a local division but I don’t want to participate in this initiative.
How do I know that the division won’t move ahead in doing this work even though I
don’t want to?
Participation by divisions is voluntary. Each Division is an independent non-profit society, and a
decision by the Division to move forward with participation in either the Attachment or the In-hospital initiatives would need to be made by the Division’s members. Division boards are encouraged to solicit feedback from their members and we encourage you to communicate your thoughts to your division leadership. If the majority of a division’s membership supports the division taking on attachment strategies such as community planning, the division may move ahead in participating in attachment activities.

If your Division does decided to participate in the Attachment initiative, your own participation
is still voluntary. You may choose not to participate in any of the ‘A GP for Me’ activities; if you
do not, however, you are not entitled to bill any of the attachment fees.

If you do choose to bill the Attachment initiative fees, you must be willing to participate in the
community planning work that your division undertakes. The degree that you participate in the
planning is up to you. The division may request your participation in activities such as:

• Where able, attend planning meetings or consultations;
• Participate in testing out new ideas with your colleagues such as new scheduling
  techniques, practice support, or surveys; or
• If interested, provide clinical support to new programs in the community – and be fairly
  compensated for your efforts.

The three prototype communities’ learnings provide good examples of the kinds of activities
your community may undertake, and that you would be asked to consider participating in.

21. I want to participate, but I don’t have a local division that is participating. What
can I do?
While over 95% of Family Physicians now have access to a local division, there are still some
communities that do not have one. If you do not have a local division, you should consult your
local colleagues to see if there is interest in participating. If there is, contact us through
www.divisionsbc.ca to indicate your interest and you will receive assistance in establishing
either a division or an alternate process if forming a full division is not feasible.

If you do have a local division, but the division has decided not to proceed at this time with ‘A
GP for Me’, you are entitled to submit the Attachment participation code as long as you meet all
requirements, and then also to access the Attachment fees. We would also encourage you to
make your voice known to your local division, and encourage your local colleagues to
participate as well.

22. Are health authorities involved in this attachment work?
Health authorities can offer resources and support that can make a real difference in care
offered to patients in your community. Note that both the attachment work and In-Patient care
are initiatives of the GPSC for physicians to improve primary care. Both initiatives will be
physician-led work in communities where doctors and divisions decide to take on this work. It
is up to local divisions to involve health authorities in the attachment community-level work at
their Collaborative Service Committees when and if it is appropriate.

There are great opportunities for divisions to harness the positive work that health authorities
are pursuing in the areas of primary health care improvement. Divisions can work with their
local health authority and other important partners through their CSC to make a difference for
local patients. The three prototype communities’ learnings provide good examples of the
effectiveness of these partnerships.

23. Does the College of Physicians and Surgeons support the telephone fee code?
The College of Physicians and Surgeons has not voiced any problems with telephone fee codes.
For details on what is expected for documentation when giving advice over the phone, contact
the Canadian Medical Protective Association.

24. How does the unattached complex high needs patient attachment fee work?
The unattached complex high needs patient attachment fee is billable once per patient. If the
fee is billed in the same year by a second family physician it will be rejected, unless there is a
note that says the patient has moved communities and is again unattached. The fee is not
billable when patients transfer from one family physician to another within the same
community.

Also, these patients must be referred to a family physician; for more details refer to the fee
description.

25. Are there any fee codes that relate to physicians attending to patients in a
residential facility?
There are several codes that can be used when attending to patients in a residential facility.
The unattached complex/high needs patient attachment fee can be used for frail unattached
patients admitted for long-term care. The attachment patient conference fee code is billable on
patients in the community or any facility, including long-term care.

26. If a participating family physician accepts only some patients and not all patients
required, will there be repercussions from the College of Physicians and Surgeons?
The College of Physicians and Surgeons recognizes the clinical life of a family physician is
complex; there are many reasons, both professional and personal, for being able to take on a
patient at some points and not others.

27. Do I have to register with a Division of Family Practice to access the new fee
codes through the A GP for Me initiative?
Yes. For more details please see Q4 and Q5 above.

28. What if only half of my patients are eligible for the new fee codes? Do I only
register those who are eligible or all of my patients?
Registration for participation in ‘A GP for Me’ is done by physician, not by patient. For family
physicians, a single, zero-sum participation code must be submitted each calendar year to
access the fee codes for that year. Patients do not need to be registered. See Q4 above.

For physicians that have hybrid practices with both longitudinal patients and walk-in patients,
A GP for Me fee codes can be billed only for those patients for whom the physician has
accepted Most Responsible Physician (MRP) responsibility for their community-based care.

29. How does A GP for Me and the associated fee codes work with EMRs?
The fee codes themselves are independent of being on an EMR or not. The fee codes will need
to be entered into your EMR if you are using one. Software products vary; some allow you to
enter new fee codes, some do not. If in doubt, contact your software vendor.

The MSP Teleplan system will be accepting the new fees as of April 1, 2013.

30. Which of the Attachment incentives, if any, can a locum bill when working in an Attachment participating practice?
There needs to be a discussion between the host FP and the locum as to the provision of any service that is covered by any GPSC incentive regardless of whether the host FP is participating in the Attachment initiative. Many GPSC incentives are for services or care that goes beyond the individual visit. For example, both Complex Care incentives include a planning visit and pre-payment for time, intensity, and complexity in the coming year, not just for the duration of the locum. 

Since the host FP is responsible for the follow-up management of the care incented through the initiatives, it must be agreed that it would be appropriate for the service to be provided by the locum. There are also implications to how the provision of these services and the resulting billing of the incentive fees will be treated in the locum agreement for fee splitting/payment. The host FP and locum must come to an agreement on this issue prior to any GPSC incentives being billed on behalf of services provided by locums (see SGP locum checklist).   

1. G14071 – GP Locum Attachment Participation Code
   Since locums have no longitudinal practice of their own, they do not need to bill the G14070 Attachment participation code.  However, in order to facilitate the billing for services provided by the locum covering in an Attachment participating practice, the GPSC has developed the GP Locum Attachment Participation Code G14071, which will remove the need to submit any e-notes when billing any of the Attachment incentive fee codes.  Fee item G14071 is effective April 1, 2013 and may be submitted to MSP commencing May 30, 2013. The G14071 fee code should be submitted annually at the beginning of the calendar year, or prior to providing the first locum coverage for an FP participating in the Attachment initiative.

2. G14074 – Complex/High-needs Unattached Patient Attachment Fee
   If the host FP is agreeable to the locum seeing a new patient to provide a review of past history and discuss the needs of the patient in planning for care into the future, then this service is billable with fee code G14074 for the provision of this intake service by the locum, provided G14071 GP Locum Attachment Participation Code has been submitted earlier in the same calendar year.

3. G14075 – Attachment Patient Complex Care Fee – Frailty Level 6 or 7
   If the host FP is agreeable to the locum seeing a patient eligible for the Attachment Complex Care incentive to provide the planning visit as per fee description, then this service is billable with fee code G14075 for the provision of this service by the locum, provided G14071 GP Locum Attachment Participation Code has been submitted earlier in the same calendar year.

4. G14076 – Attachment Patient Telephone Fee
   Locum physicians are eligible to have the G14076 billed for telephone calls provided to patients when covering for an Attachment participating host FP.  Each locum will still have the same 500 telephone call fees per calendar year available, provided G14071 GP Locum Attachment Participation Code has been submitted earlier in the same calendar year.
   Note: An electronic note “Dr. A covering/locuming for Dr. B pract #XXXXX” is still required in order to bill G14076 – GP Telephone/e-mail follow-up management fees for patients on whom the host FP has been paid one of the portal planning related fees: 14033, 14043, 14053, 14063, or 14075.

5. G14077 – Attachment Patient Conference Fee
   Locum physicians are eligible to have the G14077 billed for conferencing with allied health professionals when covering for an Attachment participating host FP, provided G14071 GP Locum Attachment Participation Code has been submitted earlier in the same calendar year.
   

Back to the FAQ.

Printable PDF version of the FAQ.