Updated November 18, 2024
Table of contents:
What it is
After Hours Care is a program developed by Doctors of BC and the Ministry of Health (through the Family Practice Services Committee) with HealthLink BC that provides care to patients when family practices are closed evenings, nights, weekends and holidays.
The purpose of the After Hours Care program is:
- To provide access to after hours virtual care for attached patients in community with urgent or semi-urgent health concerns as an extension of the longitudinal family physician (FP)/ nurse practitioner (NP) service.
- Out of scope: Providing support for those residing or currently in facilities and/or unattached patients.
- To support longitudinal FPs and NPs to better meet their professional obligations to their patients after hours.
- To support Primary Care Networks (PCNs) to meet core policy attributes with respect to urgent, same-day access and extended hours of service.
The patient journey
This image shows the patient journey through After Hours Care and the team members involved along the way.
- Patients call their family practice clinic to connect with the After Hours Care service.
- A navigator answers their call, determines the type of assistance the patient is looking for and routes the call appropriately. For example:
- Administrative issues will be asked to call back when the clinic reopens.
- Issues or medication-specific questions will be connected with a pharmacist.
- Issues regarding symptoms will be connected with a trained registered nurse to be triaged.
- General medical questions will likely be handled entirely by nursing while obvious emergencies will be directed to call 911 or head to the nearest emergency department.
- Urgent non life-threatening issues are transferred to a clinical program support team member, who will set up a chart and arrange for an after hours physician to call back the patient.
- Once the encounter with the after hours physician is complete, an encounter note will be sent to the patient’s community family physician or nurse practitioner.
- If semi-urgent follow-up is recommended, then the clinical program support will reach out to the clinic the next day to confirm receipt of the encounter note and stress the need for a rapid access appointment.
Guiding principles
The full set of guiding principles can be found here.
Scope
The principles of the After Hours Care program identify a number of items as out of scope:
- Calls from unattached patients (i.e. those who do not have a longitudinal FP or NP; attending the same walk in clinic is insufficient).
- Calls from patients in facilities (e.g. inpatients, long-term care, emergency department, hospice, addictions recovery).
- Administrative issues and health care system navigation.
- Sick notes and forms as these are non-urgent and most appropriately done by the FP/NP who knows the patient.
- Mental health crisis intervention, however, it is not unreasonable for an After Hours Care physician to speak with the patient to ensure there isn’t an underlying issue that can be managed by the service.
- Prescription renewals unless it is clinically deemed to require an urgent prescription. This is the most challenging area as a prescription renewal may be considered urgent depending on upcoming holidays, travel, type of medication and other issues. In this case, a series of questions is asked of the patient before the call is connected to a physician—the purpose of this service is not to be a prescription refill service.
How it compares to other services
How the After Hours Care program differs from HEiDi service at 8-1-1:
While the After Hours Care program is similar to HEiDi (HealthLink BC Emergency iDoctor-in-assistance) at 8-1-1, the two services are not the same:
- The structure is different.
- The HEiDi service takes 811 calls from all patients triaged by nurses at HealthLink BC and provides virtual care and advice from 9:00 a.m.—11:00 p.m. daily.
- During the pilot, the After Hours Care program is limited to calls only from attached patients. The program operates from 5:00 p.m.—9:00 a.m. weekdays, and 24-hours on weekends and statutory holidays.
- Family physicians and nurse practitioners who sign up to use FPSC's After Hours Care program with their patients also agree to quickly see their patients who’ve called the program and are deemed to need semi-urgent follow up.
- The breadth of services is different.
- Consistent with the requirements of the College of Physicians and Surgeons of BC, FPSC's After Hours Care program will manage critical labs, etc., for physicians and nurse practitioners using the program with their patients.
- In addition to providing advice to patients, FPSC's After Hours Care program can also (if appropriate) prescribe, refer, etc., and follow up on these.
- Longitudinal focus is different.
- FPSC's After Hours Care program serves as a comprehensive extension of the patient's longitudinal family physician or nurse practitioner. For some issues, this nuance might not be evident, but for others, understanding longitudinal practice and/or community services allows more effective advice and follow up recommendations. Regardless, the community physician or nurse practitioner receives a timely encounter note for each call to FPSC's After Hours Care program.
How the After Hours Care program differs from virtual care clinics:
- The service is not a virtual care provider. As physicians staffing the service will have access to CareConnect and PharmaNet, they will have some insight into the longitudinal record. However, they won’t have access to the comprehensive patient record in the clinic EMR (electronic medical record).
- The After Hours Care program will reconnect patients to their longitudinal family physician or nurse practitioner for any necessary follow up in order to close the loop to longitudinal care.
- When urgent, telephone handoff will take place between the service and the community family physician or nurse practitioner.
Testimonials
Dr Sienna Bourdon:
My experience with the After Hours Care program has been excellent. Encounter notes are comprehensive, labs when ordered are very appropriate and help move things along, and most importantly, the physicians who my patients speak to are usually able to definitively manage the issue, saving an appointment in my schedule for others.
Dr Sienna Bourdon is a family physician and Medical Director of the Shoreline Medical Clinic, Brentwood Bay, Victoria. This comment was provided in July 2024.
Dr Sarah Chritchley:
As a director of a call group, the After Hours Care program has been a great relief. Gone are the many hours of work running the call group, scrambling when someone forgets their shift, communication with the call service, collecting call dues not to mention the time being on call. Also, getting reliable documentation of calls sent from the After Hours team has been fantastic. Colleagues who do call shifts and longitudinal family physicians consider this a win-win project. I strongly support it continuing and being offered across the province.
Dr Sarah Chritchley is a family physician with the Victoria Division of Family Practice. This comment was provided in May 2024.
Dr Kevin Hill:
Over the past 15 months, I have been actively involved in providing services for the HEiDi and CAT-e arms of HealthLinkBC, commonly known as the 811 and COVID antiviral services respectively. The After Hours Care program is being closely modelled on these. Those services, offer flexible scheduling with short shifts, allowing this this work to fit around other commitments. The system also allows for extending working hours by taking consecutive shifts.
There is a degree of choice regarding shift selection and the number of shifts required per month, as well as the option to take leave when needed. Additionally, there is a realistic chance of being able to swap a shift in the event of a clash with other work. Before starting, I received comprehensive training, for which I was compensated.
The Virtual Consult Service colleagues (who function as virtual medical office assistants) are supportive and well-informed about local services, fostering a positive and helpful atmosphere in our primary communication channel – a group chat. The patients are triaged before physician reviews, and the charts are prepared in advance. The Electronic Health Record (EHR) system is user-friendly, and technical support is readily available and responsive – I've never had to wait more than a few minutes for assistance.
A central online repository houses a range of documents providing information and updates related to the work. Additionally, we have access to provincial health records and can easily share information with patients and pharmacies.
Patients have responded very positively to the services, appreciating the ability to receive medical advice, especially during the current climate. For example: HEiDi virtual physicians, while working with 811 nurses, were able to divert approximately 7 out of 10 patients away from visiting Emergency Departments, with 1 in 3 being able to manage their urgent problems at home without visiting any other doctors, and 1 in 3 being able to follow up with their family doctors within the next 7 days. I anticipate that the After Hours Care program service will do the same in responding to the patients with their urgent issues, supporting them to avoid visiting emergency departments, and following up with their own family doctors safely.
Dr. Kevin Hill is a family physician with the South Okanagan Similkameen Division of Family Practice. This comment was provided in September 2023.
Hours of service
The After Hours Care program is available:
- Monday to Friday from 5:00 p.m.—9:00 a.m.
- 24-hours on weekends and statutory holidays (see the full list here).
- The service also operates 24 hours on Easter Sunday, Easter Monday and Boxing Day.