Pilot program helps lift burden of after hours care

Dec 20, 2023

A pilot program that provides after hours care for attached patients of family physicians and nurse practitioners in the Langley, South Island, South Okanagan Similkameen, Thompson Region, and Victoria Divisions of Family Practice is already showing results. 

The six-month pilot, a partnership between the Family Practice Services Committee (FPSC) and HealthLink BC and five divisions of family practice, was developed to reduce the challenges that family physicians face in providing patients with care outside regular office hours. 

After hours care was one of the top burdens family doctors identified during Doctors of BC’s primary care engagement in summer 2022. The new program meets the College of Physicians and Surgeons of BC’s Practice Standard for Care Coverage Outside Regular Office Hours.

Dr Jennifer Begin, of the Ponderosa Primary Care Centre in Penticton, says the pilot is working, particularly in the South Okanagan Similkameen where they have received a high number of calls since the program launched in September. 

“With the closing of one of our local walk-in clinics and limited access to UPCC (Urgent and Primary Care Centre) providers, it is rewarding to see the ability to reduce the demand on our ER from those we are able to manage with urgent phone calls,” Dr Begin says. 

Family physicians in the pilot regions can sign up to work the after hours service and receive compensation for their time, paid hourly through a physician group contract with the BC Ministry of Health. Dr Begin says the program is also helping with recruitment in South Okanagan Similkameen, “as this has taken some of the pressure off individual 24/7 requirements,” allowing physicians to take on a longitudinal panel.

As of December 7, 84 family physicians have signed up to staff the service, while 356 family physicians and nurse practitioners have also signed contracts to use the service with their attached patients – about 70% of those across the pilot regions.

Assuming the pilot is successful and continues, “we would anticipate further attachment in South Okanagan Similkameen as a result,” Dr Begin says.

In January, the Shuswap North Okanagan Division of Family Practice will be added in a test run of the After Hours Care program’s expansion process, set to begin in April. Shuswap North Okanagan was selected in part due to its size of 40,000 attached patients (not too many that would overwhelm existing capacity while not too few so as to make an insignificant impact), and because Vernon recently saw its last walk-in clinic close—making it a priority community in the eyes of the Ministry.

Adding one more division will allow staff to learn how to effectively bring new communities into the program while establishing workflows to meet the needs of many more attached patients, physicians, and nurse practitioners joining the After Hours Care program. The provincial expansion will likely be a phased approach to maintain patient and staff ratios. The After Hours Care program currently covers 366,000 patients, which represents 70% of attached patients in the Langley, South Island, South Okanagan Similkameen, Thompson Region, and Victoria Divisions of Family Practice. 

The pilot is meant to extend, not replace, a patient’s family doctor or nurse practitioner. Its focus is on handling urgent issues that can’t wait until the medical office reopens, along with calls about critical labs and other results. 

During the pilot, crisis and counselling care is out of scope, as well as most prescriptions and notes (unless the physician deems it necessary — such as a prescription for antibiotics). The service accepts calls from individual patients in the community but not those from facilities such as long-term or in-patient care.

To reach the after hours service, patients in the pilot regions whose family doctor or nurse practitioner have signed up, follow their clinic’s existing process for accessing care after hours and are connected to the After Hours Care program. The service runs weekdays from 5:00 p.m. to 9:00 a.m. and 24 hours on weekends and statutory holidays. 

What happens when patients call the After Hours Care program:

  • A care team member assesses the patient’s health concern and when appropriate, a family doctor calls back. 
  • Patients with emergencies are directed to the ER or 9-1-1.
  • Patients with administrative or non-urgent concerns are asked to call their clinic when it reopens.
  • Staff from the service send an encounter note to the patient’s family doctor or nurse practitioner the following morning.
  • If semi-urgent follow-up is needed, the next morning an after hours physician does a phone call hand-over to the patient’s family doctor or nurse practitioner.

The pilot will be evaluated along elements of the quintuple aim. Learnings from a successful pilot will guide expansion across the province and how to support unattached patients in accessing care after hours. 

For more information, visit fpscbc.ca/after-hours-care.