Notes re- Nov.15/05, 'Unscheduled'Community Meeting re- Status of Medical Services in Walden

Notes re- Nov.15/05, ‘Unscheduled’ Community Meeting
re- Status of Medical Services in Walden
Chair: Paul Doyle
Speakers: Terry Kett, Dr.Koop & Dr. Bayly
Audience: Those people from CAN Meeting who wished to remain

Councilor, Terry Kett gave a brief summary of his earlier comments re- importance of concept of Family Health Team for Walden:

a. Nov.4 Meeting with Dr.McKibbon, Kim Rossi(from City) & our 3 Doctors
b. 2 main aspects…Financial & Advantages to the Community of FHT
c. It’s to the financial advantage of Drs to be a part of FHT
d. Other Doctors from NOM will help…500 patients from Drs’ Roster
e. Nurse Practitioners would be paid by the Province
f. City has already invested $2 Million in Town offices…would pay $250,000 to renovate that building
g. No money will be spent on private building ie the Lively Medical Center
h. There is a positive role for a ‘Community Advisory Committee’
i. There was a Nov. 14 Meeting with repr. From the Ministry, Dr. McKibbon & our 3 Doctors. We (Terry & Eldon) were not invited. How did it go?

Update by Dr. Koop re- Status of Health services in Walden & FHT:

1. Appreciate being invited - as a Doctor & a citizen of Walden...interested in the process of establishing a Community Action Network…identifying the issues facing Walden.I would act as a resource – not a member

.a. The main issue facing us is what’s happening to the family health services.
b. CAN is a process we should use re- the Family Health Team in Walden
c. I strongly advise a Walden Community Health Advisory Board

2. Background re- Family Health Team in Walden:

a. Family Health Teams in Ont. were initiated in April/04
b. Lively Medical Centre found out late & submitted a proposal in Feb./05…we were turned down
c. Dr. McKibbon’s proposal was put in at the last minute too…his was accepted
d. Perhaps ours was turned down because ‘it’ could be part of the larger- ‘City of Lakes FHT’…we don’t know.
e. They (the province) seem to want more Doctors in a FHTf. We lacked ‘community involvement’ but there was not time to get it before our proposal was submitted

3. We need a Community Advisory TEAM in Walden now:

a. We need a Community TEAM in Walden …to work with the Doctors & FHT
b. Community involvement is needed in the governance ‘model’ of FHT
c. We should set up a Community Advisory Board as soon as possible re- family health care in Walden
d. In Sudbury they might use a governance structure involving the hospital & University(Medical School)
e. Could there be a ‘Walden Community Health Advisory Board’ under the umbrella of a broader FHT? We need to find out.

4. We need an Interim Solution re- Lively Medical Center now:

a. We are looking at a ‘Walk-In’ style Clinic @ the Center until we find a Doctor or Nurse Practitioners to maintain health care services
b. We need to keep up with the issues as they unfold & keep everyone up to date re- what’s happening

Update by Dr.Bayly :
We wouldn’t have had any trouble after Dr.Carscadden’s retirement but we lost the Doctor who was coming at the last minute.

1.Since the Nov. 1 Meeting we have had 2 long meetings :
a. They gave us a tremendous amount of Ministry of Health information re- FHT.
b. We had long cell phone conversation re- FHT ‘model’
c. It ( FHT) is a very nebulous concept …not much in writing
d. Of existing FHTs in Ont…each one is working differently

2. We are working to help Dr. Carscadden’s patients…helping them find new family Dr.
3. We are looking at Interim/Alternative solutions @ the Medical Center…Other Doctors to help out re- After Hours Clinics
4. Things are happening re- FHT…The Clinic is looking into options…nothing is firmed yet
5. Other Meetings are planned
6. Don’t jump to conclusions because of incomplete facts or information
7. Ray Hunt, Senior Manager @ Ministry of Health & Long-Term Care offices in Sudbury, said not to keep writing letters now…they are trying to solve the problems

Question & Answer Session:

Question: What do we do now? After Dr. Carscadden retires or those who have no Doctor & will need prescriptions renewed …have multiple illnesses?

Dr. Koop:
The best option is the After Hours Clinics- here or @ the 4 Corners

a. We are trying to get help @ Lively Medical Center…Doctors to come & fill in
b. We need to look after ‘short-term’ solutions
c. We were 6 of us @ Clinic & now we’re down to

It’s getting harder to recruit Family Drs…

a. There have been cut-backs in #of spots @ Medical Schools
b.Most young Doctors don’t want Family Medicine as a specialty.
b Family Doctors don’t necessarily want to be a part of FHT

Question: What happened at last nights meeting with representatives from Ministry & Dr. McKibbon?

Dr.Koop:
We looked at the financial info. …Family Doctors VS FHT Fee Billings

a. The FHT billing process is very complicated…not simple
b. The existing Family Health Networks ‘model’ (FHN) is 100% salaried
c. The Family Doctors ‘model’ is Fee for Services
d. The Family Health ‘model’ (FHT) is totally different from either…’partially salaried’ – 60% salary + 40% ‘other’ ways * there is lots of red tape

NOTE: FHN Doctors whose proposals to become FHTs were approved in April/05
…6 months later have not been able to solve problems in the ‘new funding model’

Question: What about funding for Nurse Practitioners at the Medical center?

Dr.Koop:
It has been said that there is no funding for Nurse Practitioners unless we are part of the FHT

a. This is may not be the case if there is strong local input.
b. They are salaried employees…fully subscribed by the provincial government.
c. They can work in a privately owned building.
d. We need interim provincial funding re- NP

Dr. Bayly:comments added to clear up misconceptions

a. Our recent meetings have cleared up the misconception going around that if we become part of the FHT there will be Doctors coming to help us.
b. There is no evidence of other Doctors coming to help us if we become part of FHT…it’s just not happening!
c. Nurse Practitioners could help us …free up Doctors’ time & enable them to see patients with multiple problems
d. NP could provide health services in Walden now

Terry Kett adds his comments in response to Dr. Koop & Dr. Bayly:

a. Thursday night I spoke to Dr. Strasser, NOM, re- the relationship with FHT…how did he see NOM fitting in?
b. He feels FHTs will make smaller practices possible and therefore be more attractive to Doctors & grads.

c. I appreciate our Doctors efforts looking at short-term but we have to get on the band wagon now if Walden is to grow. I don’t care if it takes 3 years to complete changes to the Town office building…we need to be part of the FHT and get Interim funding now!

Question: Marilyn Butcher, a Nurse Practitioner, from Lively is here tonight. Perhaps she could tell us something about the funding of NP in under serviced areas ?

Marilyn Butcher RN(EC) Nurse Practitioner:

1. NP are funded by the Provincial Government in many ‘models’…community health center, clinics, family practices, home health agencies
Go to http://www.npao.org/ or pick up one of our brochures

2. In 2003 117 NP Positions were created . 30 Proposals went in from Sudbury area alone-
Sudbury Manitoulin received 4 NP positions.

3. At present there are 40+ ‘Vacant NP Positions’ not being utilized…the funding is sitting there in various funds at MOHLTC, ie Underserviced Area Program, Interdisciplinary Practitioner Program, etc (there are other funding envelopes as well)

4. 26 of these ‘Vacant NP Positions’ are within the Interdisciplinary Practitioner program funds and were allocated to specific ‘under serviced communities’…which have been unable to hire NP
…the funding lies dormant

5. NPs are presently lobbying the gov’t to ask for reallocation of this funding…to permit NP to be hired to work in ‘other’ under serviced communities which have NP living there & ready to work.
We have 3 NP living in Walden ready to go and 3 more in Sudbury.

6. Sudbury is designated as Medically under serviced. You can find this info on MOHLTC web site
http://www.health.gov.on.ca/English/program/uap/listsof_areas/gp_ladau.pdf

7. This funding is totally separate from FHT funding. It’s under ‘interdisciplinary Funding’ re- under serviced areas.

Question: What is the Role of NP?

Marilyn Butcher:

a. The NP is a registered nurse with advanced university education who work in partnership with doctors, nurses & other health care professionals
b. We can have our own practice…patients of all ages
c. Can perform physical check-ups, write prescriptions, order diagnostic tests, make referrals to family doctors, specialists etc
Eg. We had a practice with 2 NP & a Family Dr. who worked with us 3 hours per day
d. We can be paid by the Agency (eg. VON), who funds NPs from their global budgets or from funds given to them for NPs by the Ministry of Health

Question: Is Walden designated as a ‘Under Serviced Area’?

Terry Kett:

a. We are an Under Serviced Area and the quick way, on a temporary basis to get NP funding is to become part of the FHT
b. Re- persuading the Ministry of Health to reallocate NP funding for Interim use @ Medical Center. I don’t see it happening. It is difficult to get changes @ Provincial Level…they don’t like to change their policies.
c. We should set up an Advisory Task Force with CAN to deal with Interim Health Services problems: work together, set up a strategy & announce our PLAN

Question: Why can’t we (CAN) work at 3 different health service issues at the same time? Our Doctors now + FHT in Walden + NP Funding

Terry Kett: It’s possible. I don’t see why not. But we need CAN set up first.

Question: Maybe we would be better to focus on “the bird in the hand” we have now…the Clinic has been here 41 years…we should keep the existing practice going now! We (CAN) should write letters to a very specific person re- providing NP funding for Walden now?

Marilyn Butcher:

a. The Nurse Practitioners Association of Ont. has already had initial discussions this week re- the reallocation of ‘Vacant NP Positions’.
b. No promises were made.
c. We need pressure from other communities
d.We need to address the NP problem as a Group (CAN) not individual letters

Question to Dr. Koop: What do you think about the NP funding possibilities?

Dr.Koop:
a. We were told this week that the funding re- NP was frozen!
b. CAN could decide to make an inquiry – on behalf of the community- to see if NP funding is available

Dr. Koop outlined the challenges facing Lively Medical Center now:

a. We are month to month tenants @ the Medical center…no lease can be signed
b. Something needs to be done now
c. It is very difficult to recruit Doctors if the building isn’t fixed up
d. The question re- money to fix up the clinic until the FHT is set up . They say it can’t be done. Maybe a test for our community is to get it done!
e. I would be happy to be a guest or to act in an advisory capacity re- Walden Community Health Advisory Board…to work to fill the gap
f. We need a Community Health Advisory Committee in Walden…working with us (Doctors)
g. Our population (in Walden) is getting older
h. Our patients are getting older with multiple conditions to treat/manage
i. Many families have no Doctors
j. We need 10 Doctors not 2 Doctors

Question: What about Valley East? Do they have the same problems?

Dr.Koop:
a. For years the Valley has had it worse than Walden. Not enough Doctors.
b. Now we’re as bad off as they are.

Question: Where are the 4 FHTs in Sudbury going to be set up?

Dr. Koop:
a. Pioneer Manor b. Valley East @ the Town offices c. Rayside Balfour @ the Town offices
d. Walden @ the Town offices

Question: Perhaps we should contact the Chairmen of the other CANs to find out what’s happening re- their FHT?
Terry Kett: That could be addressed at the CAN meeting.

Dr.Koop: I’ve heard there are 6 new Doctors in Sudbury starting soon. Doctors are needed in Walden now!

The Doctors & Terry Kett will keep us informed re- developments.


Checked & revisions/corrections made by Terry Kett, Dr.Koop, Dr. Bayly & Marilyn ButcherNov.18/05
Notes taken by Gwen Doyle,Nov.15/05