The General Practice Services Committee (GPSC) was established in 2002 as a joint committee of the BC Medical Association (BCMA) and the Ministry of Health.

The committee’s mandate is to strengthen community-level patient care in British Columbia by addressing the challenges faced by BC’s full-service family physicians. A strong system of primary care is seen as key to the sustainability of our public health system.

In support of the province’s family physicians, the GPSC developed a two-pronged strategy involving financial incentives and practice support. Funding of $800 million was committed in support of this strategy for a six year period to address the following priority areas:

• chronic disease management
• maternity care
• care of the frail and elderly, and patients requiring end-of-life care
• patients with complex care needs
• prevention
• mental health
• recruitment and retention of full-service family practitioners
• multidisciplinary care between general practitioners and health care providers.

Financial Incentives

Financial incentives for physicians are provided under the Full-Service Family Practice (FSFP) Incentive Program. The program is designed to adjust fees for general practitioners (GPs) to promote guideline-based care in such areas as chronic disease management (e.g. for patients with diabetes, congestive heart failure, etc.), maternity care, and care for the frail and elderly.

Significant achievements of the FSFP in 2009 include:

• Chronic disease management (CDM): Financial incentives ensured that hundreds of thousands of BC patients with diabetes, congestive heart failure, and hypertension received care based on the latest clinical guidelines for those conditions.
• Mental health: Under a community mental health initiative, a fee is available to GPs who develop a comprehensive mental health plan for patients. In 2009, 1,829 participating GPs developed mental health plans for 49,697 patients. GPs are also paid a follow-up fee for consulting with these patients about their care plans up to five times a year by phone or email.
• Patients with complex care needs: An incentive payment is available to GPs who develop and monitor care plans for patients with two or more of the following conditions: diabetes, chronic kidney disease, cerebo-vascular disease, coronary artery disease, and chronic respiratory disease.  In 2009, 2,550 GPs billed this fee for managing care plans for 108,145 patients with complex health needs. GPs are also paid a follow-up fee for consulting with these patients about their care plans up to four times a year by phone or email.

Practice Support

Although financial incentives are a vital component of the GPSC strategy, experience in other jurisdictions has shown that incentives alone do not lead to broader system change.  For this reason, the GPSC developed the Practice Support Program (PSP) which offers family physicians and their medical office assistants (MOAs) practical, evidence-based strategies and tools to enhance the efficiency of their practices and to support improved patient care.

The PSP is available to all GPs and their MOAs throughout the province. The program provides training modules on chronic disease management, patient self-management, advanced access scheduling, group patient visits, and mental health care.

Each PSP training module involves three half-day group learning sessions, followed by an action period of six to eight weeks during which module participants try out what they’ve learned.  During these action periods, participants are supported by visits from previously trained GPs and MOAs who can answer questions and provide helpful suggestions based on their experience.

Significant achievements of the PSP in 2009:

• As of March 31, 2009, about one-third of all GPs in the province and their MOAs had participated in one or more of the program’s training modules.
• GPs who completed the advanced access module decreased their average patient wait time for regular appointments by 3.3 days.
• 89 percent of GPs who completed the chronic disease management module said it enabled them to deliver better patient care.
• 91 percent of GPs who completed the group medical visits module felt group visits increased patient satisfaction with their care.

Divisions of Family Practice

In 2009, the GPSC introduced Divisions of Family Practice – affiliations of family physicians (FPs) -- who share common health care goals and/or who practice in the same region of the province. The intent of Divisions is to increase the professional satisfaction of FPs and help them acquire a stronger collective voice in their communities in order to influence health service decision-making. Divisions also help FPs to identify gaps in patient care within their communities, and to develop solutions to address those and other local health service issues. 

Further developments

The GPSC continues to develop new initiatives to support enhanced practices for GPs across the province and improved care for patients.

Recent initiatives include a new financial incentive and training module to support enhanced end-of-life care for patients who are dying. Another new incentive is planned to promote more GP participation in decisions about the discharge of complex patients from hospital back into the community. A further initiative to support the expansion of multidisciplinary care involving GPs and other health care providers is also being developed.