Introductions FACILITATOR : Lynne Dupuis, Senior partner at DOYON+DUPUIS Julie Lemieux President of the Board of Directors Stéphane Méthot Board of Directors Angèle Lemieux Board of Directors Lise Raymond Board of Directors Michel Raymond Interim Executive Director - he is the one who obtained the FRNPLC in 2009 and has been with the organization since its inception Nicolle Plante-Dupuis - New Executive Director Special Thanks to our distinguished guests Terry Tilleczek, Senior Director, Policy and Health System Planning NELHIN Monique Lapalme French Language Services Coordinator, North East Local Health Integration Network Michel Mayer Executive Director of the Sudbury East Community Health Centre Claude Bouffard Mayor of the Municipality of French River Councilors of the Municipality of French River Anita Bourgeois - Assistant to MPP John Vanthof 1
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In the late 1990 s, the communities of Sudbury-East were home to two family physicians, one operating from Noëlville and one operating from St-Charles. As both of them indicated that they would be retiring in the next few years, the Sudbury-East area was actively looking for solutions to meet the growing healthcare needs of its aging population. Due to the need to increase access to primary care in the area, in 1999, two nurse practitioners (Lise et Michel) took root in the Sudbury East area in order to establish a nursing station under the supervision of the Centre de santé communautaire de Sudbury. Recognizing the extent to which primary health care services were needed and the imminent departure upon retirement of the only physicians established in the region, these two individuals discussed with the community the possibility of establishing a new Community Health Centre (CHC) in the area. During the 90s, the francophone community of the area took action and submitted a first request regarding the acquisition of a CHC in Sudbury East. This request was not successful. A second request was sent in 2001; once again, the proposal didn t generate the desired response. During these years, there were 2 nurse practitioners who were working out of small offices located in St Charles and Noelvile. In 2003, the request was revisited and was once again submitted. Unfortunately, the request was not successful under the first wave of CHC implementations in the province. In early 2005, anticipating the creation of a number of Family Health Teams (FHT) in the province, the request was once more reviewed in order to meet the criteria of this type of clinic. While examining this request, the Ministry of Health realized that the region s need for a CHC was greater than that of a FHT; in 2005, after a fifth request, it was finally announced that Sudbury East would receive the funding required for the establishment of a CHC in 2007. Waiting lists quickly became a problem for the newly created CHC. In 2009, nurse practitioners of the area with a group of residents from Sudbury East again began to lobby the government to increase primary care services. The FRNPLC project was approved in 2009 as it was part of the second wave of the Ministry of Health initiative to establish Nurse Practitioner-Led Clinics throughout the province. The FRNPLC had been lobbying the government for a distinct site as it became obvious that the SECHC could not 3
service certain areas of Sudbury East with the funding and staffing allocation it had received. The FRNPLC was to focus its services on the outlying areas of Sudbury East, which are the towns of Alban, Pickerel River, Monetville, Markstay-Warren and Dokis. Initially, the FRNPLC proposed to set up offices in Alban and Warren. The Warren site was to share offices, staffing and costs with the SECHC. This initiative was turned down as the Nursing Secretariat Team did not approve having two distinct funded groups work out of the same space and building. The FRNPLC was established as a separate and self-governed entity and reverted to only opening one office in Alban. Consequently, due to local pressures in the Markstay-Warren municipality, the LHIN granted limited funding to the SECHC to operations at a third site in Warren. Also worth noting, is that both family physicians retired in 2007 and 2008 and no family physicians opted to establish their practices in the region since. The SECHC has been in operation for ten years and the FRNPLC has been in operation for five years. Both organizations are experiencing challenges at different and similar levels. Both organizations have collaborated closely from the beginning to ensure the needs of the clients (Patient Centered Approach) are front and foremost. We will review tonight the main challenges faced by both organizations. Since 2007, the Ministry of Health and Long-Term Care has opened 25 NPLCs in the province since the first one opened its doors in Sudbury. There are currently 74 Community Health Centres (CHCs) in Ontario. 3
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It is important to note that both organizations focus on improving and being pro-active in health service delivery for the local communities. 5
These are the services offered in both organizations. The orange represents human resources located in both the FRNPLC and the SECHC. The circles in blue are services only available at the CHC and the purple represents the services at the FRNPLC. The only services that require funding approval are the chiropractic services which are renewed with the MOHLTC twice a year. A new contract has been negotiated and a new chiropractor will be starting to offer services at the NPLC in April 2017 with approval until October. Should the MOHLTC decide not to approve the funding reallocation, then this service will discontinue regardless of what happens with the integration. 6
At the community meeting held on February 22 nd, 2017, Theresa Agnew from the Nurse Practitioner s Association of Ontario provided a presentation as to the role of their organization. The Vision of the NPAO is to transform health care for Ontarians through Nurse Practitioner innovations. The Nurse Practitioners Association of Ontario is the professional voice for Nurse Practitioners in Ontario. The mission is to ensure accessible high quality care for all. We are very happy to have the NPAO represent Nurse Practitioner s in the province and locally, however they do not represent other health care professionals working in multi-disciplinary teams such as the FRNPLC. These would be our registered nurses, social workers, health promoters etc. The NPAO has worked hard at raising the visibility of the role of the NP by promoting the role through media interviews. They also lobbied elected officials and the leaders of other disciplines to create an awareness of the real contribution that nursing could make in the health care system. 7
The French River Nurse Practitioner-Led Clinic Nurse and the Sudbury Est Community Health Centre are both members of the Association of Ontario Health Centres. The Association of Ontario Health Centre s represent 107 community-governed primary health care organizations in Ontario. Membership includes 74 Community Health Centres (CHCs), 10 Aboriginal Health Access Centres (AHACs), 10 Community Family Health Teams (CFHTs) and 13 Nurse Practitioner-Led Clinics (NPLCs). The AOHC and its members believe good health begins in homes, in our schools, in our workplace, and in the communities where we live. Our goal is therefore to work towards a complete state of wellbeing for individuals, families and entire communities 8
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Patients First was a key element in the government s commitment to transform the health care system into one that puts patient s first. LINKS: Patient Care Groups (Price-Baker Report, May 2015): http://www.health.gov.on.ca/en/common/ministry/publications/reports/primary_care/primary_care_price_report. pdf Patients First : Ontario s Action Plan for Health Care (February 2015) : http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_patientsfirst.pdf Patients First : A Proposal to Strengthen Patient-Centered Health Care in Ontario (December 2015): http://www.health.gov.on.ca/en/news/bulletin/2015/docs/discussion_paper_20151217.pdf 10
In 2013 the North East Local Health Integration Network (NELHIN) published the Integrated Health Service Plan for 2013-2016. This plan aligned with the provincial governments Patient s first Action Plan for Health Care which identifies three focus areas: (1) Keeping Ontario Healthy; (2) Faster Access and a Stronger Link to Family Health Care and (3) Right Care, Right Time, Right Place. When the Price-Baker report and the Patient s First report were initially released, the Ministry of Health and Long Term care and the LHINs initiated discussions that looked at a design that regrouped primary care services with local hospitals. These discussions have changed and the concept of primary care groups is evolving In 2015, the three documents listed above where published and looked at supporting health system transformation. The publication Strengthening Access, Performance and Accountability was a discussion paper that looked at Sub- LHIN geographic breakdowns. In this first discussion paper, Sudbury East was included in the Greater Sudbury Sub- LHIN region. In April 2016, these Sub-regions were revisited by the NELHIN and Sudbury East was identified as a separate sub-region. The concept of sub-regions is continually evolving. The identification of these sub-lhin areas initiated the exploration of integration of primary care in Sudbury East. The First Business plan regarding an integrated model of care was developed and submitted in December 2015. This first step was to explore if there was an appetite at the Ministry of Health and Long Term Care (MOHLTC) and NELHIN level to even consider this type of innovative project. In February 2016, the Proposal A New Model of Health Care for the Sudbury East region was submitted to both the MOHLTC and the NELHIN. The MOHLTC agreed with the concept being proposed. The proposal was presented to the Sudbury East Municipality Association (SEMA) in the winter of 2016. As we have seen throughout the development of primary care services in the area, a project such as this one requires planning and time while being mindful of provincial priorities and political opportunities. 11
The design of a new model of care is a process with many steps involved. Community members are key people in the design of health services. However prior to engaging community members it is important to know that the project is supported by the decision makers. We have recently received the support of the MOHLTC to continue down this path. The most recent business plan requires additional changes and will include feedback from this session. Once these are made, the document will be posted on the NPLC and CHC websites. 12
GOVERNANCE The FRNPLC was established as a Nurse Practitioner membership model requiring 51% Nurse Practitioner representation. All directors currently reside within the French River area. The SECHC is a community based Board of Directors with membership from all 3 municipalities. The proposed model would create an opportunity for a community based board with increased representatives from the French River area. In the process of integration, discussions would be needed between both boards to identify how they move forward. PATIENT CARE Increase current patient numbers to achieve MOHLTC requirements for funding Currently we have received very positive responses from the residents of the French River regarding the services they receive (97-100% patient satisfaction regarding access, involvement and time spent with provider). Both the FRNPLC and SECHC have adopted Advanced Access protocols from Health Quality Ontario to increase our ability to offer same or next day appointments for urgent care to divert patients from the ER. We will continue to value access to care and quality above all. RESOURCES Opportunities for health care providers to consult with one another is vital in retention and reduced burnout rates of staff. Increased access to other providers in all sites would assist in ensuring continuity of care during absences such as vacation leaves, vacancies or sick leaves Multi-disciplinary teams lead to better health outcomes for their patients. Better use of resources: human and financial INFORMATION Ability to share health information electronically with other agencies such as hospitals, Home Care Providers and Seniors Support Program would be improved to gain faster access to other professionals. As a larger agency, we can advocate for all residents of Sudbury East. 13
REPORTING One submission of financial reports which is much more time efficient in the areas of : payroll, audits, as well as yearly and quarterly report submissions. DATA COLLECTION Ability to properly capture data to report to the MOHLTC/NELHIN and to inform future projects, programs and service. Currently the FRNPLC does not have the ability to capture all data electronically and some of this is done through a paper/pen method. Whereas, the SECHC has the ability to capture more data and information through their electronic medical record. Properly reporting data is required when applying for increased funding and maintaining current services. Our COMMON GOAL is to increase access to patient centered primary care and continue offering high quality health services in our local communities 13
The FRNPLC and SECHC have both been developed through a similar approach to patient care. Both agencies primary care teams are Nurse Practitioner-led. For our clients, it would be business as usual - no loss of services. We want to expand and enhance health services for all residents of Sudbury East using an equitable approach Our agencies are looking to be pro-active and plan for health care in Sudbury East in a way that is most beneficial to patients so they can continue to access services closer to home. Integration would not negatively impact clients but rather lead to building on existing services to increase opportunities to build a sustainable and long term primary care hub for this area. We are currently accepting new clients who do not have another primary care provider (NP or Family Doctor). 14
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Process of integration We requested an extension from the NELHIN in order to make modifications to the business plan draft based on community feedback (such as this session and feedback to be provided in the following month). Once preliminary updates have been made, the business plan will be posted to www.frenchrivernplc.ca for review and consultation from the public. 16
How can you have a voice in these changes? Staying informed Make it a priority to be well informed on the changes and key messages, as to not share misinformation. When we have information, it will be shared via: Information sessions Social media (Facebook) Website Newsletter Community televisions. If you are concerned, or have specific questions send an email to news.bulletins@frenchrivernplc.ca. 17