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Updated November 18, 2024

Process for After Hours Care Expression of Interest (EOI)

Divisions of family practice who are interested in joining the After Hours Care program are invited to complete a short expression of interest (EOI) form by January 31, 2025 that will inform planning of the future expansion of the program throughout BC.

We anticipate a phased approach to onboarding divisions that takes into account the number of attached patients in the division PCN(s), family physician interest, community need, division capacity to support family physician user onboarding, and staffing considerations.

To support you in communicating with your members about the After Hours Care program and the EOI process, we’ve developed a slide deck and FAQ. We will host a webinar on December 10, 2024, to answer any questions you may have.

In the summer of 2022 during the Doctors of BC Future of Primary Care engagement, family physicians identified being on call 24/7 as one of the top three burdens for longitudinal family physicians. In response, FPSC, together with HealthLink BC, developed the After Hours Care (AHC) program to provide attached patients with access to after hours virtual care for urgent medical concerns and to relieve family physicians of the burden of being on call.

The After Hours Care pilot launched September 19, 2023. We’re now planning for a provincial expansion anticipated for 2025/26, subject to available funding, and we’re excited to launch the EOI call to divisions to help inform the expansion process.

Next steps:

1. Join an optional webinar for the Divisions of Family Practice on December 10^th, 2024 from 5:00 – 6:30 PM about the After Hours Care program and the EOI process where we will answer your administrative questions. Please click here to register for the webinar.
2. Complete the EOI form by January 31, 2025, to be considered for onboarding in the first phases.

We look forward to expanding the AHC program provincially to provide access for attached patients to after hours care, reduce visits to emergency, and most importantly, reduce the burden faced by longitudinal family practices.

Please direct questions to the FPSC Provincial Initiatives team at AHCP@doctorsofbc.ca.

Updated November 19, 2024

Evaluation: After Hours Care reduces ER visits, improves access

BC’s After Hours Care program is making a difference for people and physicians, by connecting people to the care they need when their family physician is not available and removing a top burden experienced by physicians.

The After Hours Care program saw 584 family physicians and nurse practitioners sign up to use the program with their patients in its first year. 

The numbers represent an estimated 597,000 patients who now have a family doctor across the five regions included in the program pilot: Greater Victoria, Langley, Shuswap North Okanagan, South Okanagan Similkameen, and the Thompson Region.  

“Colleagues who do call shifts, and longitudinal physicians, consider this a win-win project,” says Dr Sarah Chritchley, family physician with the Victoria Division of Family Practice. 

Read more here.
Download an infographic about the pilot evaluation here.

If you have questions about the service, are interested in joining, or have questions about the physician group contract, please reach out to AHCP@doctorsofbc.ca.

Updated November 18, 2024

Table of contents: 

• Who can use the service
• Expectations for using the service
• Communications toolkit
• Sign up to use After Hours Care with your patients

Who can use the service

• Longitudinal family physicians who are members of the following divisions of family practice and longitudinal nurse practitioners who are within the geographic boundaries of the following divisions of family practice can sign up to use the after hours service with their patients:
  • Langley Division of Family Practice
  • Shuswap North Okanagan Division of Family Practice
  • South Okanagan Similkameen Division of Family Practice
  • South Island Division of Family Practice
  • Thompson Region Division of Family Practice
  • Victoria Division of Family Practice
     
• You may register to use the service with your patients without committing to working any shifts.

Expectations for using the service

• Rapid access appointments are an extension of your office when your clinic is closed. We ask that you set aside 2-5 rapid access appointments each week so that you can fit in any suggested follow-ups. Rapid access to appointments are based on the encounter a family doctor working the service had with your patient.
• The After Hours Care program only operates from 5:00 p.m.—9:00 a.m. weekdays, and 24 hours on weekends and holidays; in order to be compliant with the CPSBC practice standard, you must still arrange coverage for any time your practice is closed on weekdays between 9:00 a.m.—5:00 p.m.
• The After Hours Care program is not meant to serve as a replacement for a locum or other alternative arrangements when you are on vacation or absent due to illness or for another reason. It is, however, entirely appropriate for your locum to use the After Hours Care program to cover your practice during the program’s service hours, provided you have signed up to use the service with your patients.

Communications toolkit

We've developed materials for family practices to share with patients to support you in communicating about the After Hours Care program.

These materials include:

• Poster to help patients choose the right health service.
• General poster about After Hours Care with direction for patients to call their family practice clinic.
• Clinic messaging templates and scripts including:
• Emails to patients
• Information to add to clinic email signature blocks
• Clinic voicemails
• Information to add to clinic websites

Sign up to use After Hours Care with your patients

Sign up now to have your patients receive care through After Hours Care when your practice is closed evenings, nights, weekends and holidays. Please ensure all family physicians and/or nurse practitioners in your clinic sign up to use the program. To simplify patient communications, please ask all family physicians and nurse practitioners in your clinic to sign up for After Hours Care. If you have any questions, please contact AHCP@doctorsofbc.ca.
 

Updated November 18, 2024

Table of contents: 

• What it is
• Principles
• Scope
• How it compares to other services
• Testimonials
• Hours of service

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:

1. 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.
2. To support longitudinal FPs and NPs to better meet their professional obligations to their patients after hours. 
3. 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:

1. 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.
2. 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.
3. 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.
   

Updated November 18, 2024

Table of contents: 

• After Hours Care reduces ER visits, improves access.
• After Hours Care program is evolving.
• After Hours Care program pilot: The first three months.
• Shuswap North Okanagan Division to join the After Hours Care program pilot.
• Pilot program helps lift burden of after hours care.
• Communications toolkit for family practices to use with patients.
• Do you have questions about the After Hours Care service?

After Hours Care reduces ER visits, improves access

BC’s After Hours Care program is making a difference for people and physicians, by connecting people to the care they need when their family physician is not available and removing a top burden experienced by physicians. 

The After Hours Care program saw 584 family physicians and nurse practitioners sign up to use the program with their patients in its first year. The numbers represent an estimated 597,000 patients who now have a family doctor across the five regions included in the pilot. Read more about the evaluation, and download an infographic about the pilot evaluation.

After Hours Care program is evolving

FPSC is pleased to announce that the After Hours Care program pilot, initially set to end March 19, 2024, is transitioning to an ongoing program and expanding to a new region, providing certainty to participating family physicians, nurse practitioners, and their patients.

On January 22, 2024, the Shuswap North Okanagan Division of Family Practice joined the After Hours Care program to help test the expansion process and address the current access to after hours care challenges in Vernon. Conversations are underway between Doctors of BC and the BC Ministry of Health about plans to expand the program further throughout the province. Read more.

After Hours Care program pilot: The first three months

As of December 12, approximately 70% of family doctors and nurse practitioners in communities participating in the After Hours Care program pilot have signed up to use the service with their patients, serving a combined population of 370,000 attached patients. In addition, more than 90 physicians have signed up to staff the service, more than half of whom have so far staffed one or more shifts. Read more.

Shushwap North Okanagan Division to join the After Hours Care program pilot

The Shuswap North Okanagan Division of Family Practice will soon be added to the After Hours Care program pilot. The pilot, which started in September 2023 as a six-month endeavour through the partnership of the Family Practice Services Committee (FPSC) and HealthLink BC, is currently planned to start expanding across the province in April 2024. Read more.

Pilot program helps lift burden of after hours care

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. Read more.

Communications toolkit for family practices to use with patients

We've developed materials for family practices to share with patients to support you in communicating about the After Hours Care program. You can download materials from this page: fpscbc.ca/after-hours-care/using-the-service/toolkit. 

Do you have questions about the After Hours Care service?

Contact: ahcp@doctorsofbc.ca.Click here to sign up

The Divisions of Family Practice initiative helps family physicians in BC communities to work together to enhance their practice and address gaps in patient care.

Divisions of Family Practice are affiliations of family physicians with common health care goals and/or in the same geographic area of BC.

This initiative was designed to increase family physicians’ influence on health care delivery or policy and provide personal and professional support for physicians. It gives physicians a stronger collective voice and more impact in their community while helping them work together to improve their clinical practices, offer comprehensive patient services, and influence health service decision-making in their community.

To achieve their goals, Divisions of Family Practice work in partnership with their health authority, the FPSC, and the Ministry of Health Services (MOHS). Together they are responsible for identifying the gaps that exist in patient care in a Division’s community and for developing solutions to their own particular issues.
 
For more information, email divisions@doctorsofbc.ca.

Meeting summaries can now be found on the JCC website.