Find Out More About Nurse Practitioners in Ontario

Find Out More About Nurse Practitioners in Ontario!

During our Information-Gathering process - re- Issues Impacting Health Care Services in Walden, the Walden-CAN Health Services Task Force learned more about Nurse Practitioners in Ontario:

If you are interested in discovering more about Nurse Practioners check out these websites:

1. The Training of Nurse Practitioners ...Primary Health Care Nurse Practioners (PHC NP)
3 pages at www.npao.org/phcnp.aspx

Nurse Practitioners' Association of Ontario
180 Dundas St.W, Suite 1410
PO Box 14
Toronto, ON M5G 1Z8
416-593-9779

2. The Role & Responsibilities of PHC NP
in a Community-Based Primary Health Care Practice-2000
15 page Report at www.npao.org

3. Nurse Practitioners' Association of Ontario Regions:
Map of Communities/Counties (NPAO Members)
2 pages at http://www.npao.org/regions.aspx

4. McGuinty Government Creating More Nurse Practioners:
News Release 2/8/2006
'Grow Your Own nurse Practitioner'
...New Initiative Will Improve Access To Care In many Rural And Northern Communities
2 pages at http://www.health.gov.on.ca/english/media/news_releases/archives/nr

You'll find much more , once you enter these sites or GOOGLE Nurse Practitioners in Ontario
Gwen, Sept.20/06

Possible Challenges for Walden-CAN HSTF-Health & Safety Issues in Walden, Vice-Chair, Jim Palys

Possible Challenges for Walden HSTF- expanded Role for Future:
Vice-Chair, Jim Palys

Health & Safety Issues in Walden:

I. Household hazard Waste Issue:
...The lack of proper disposal services/facilities for unused
or outdated household prescription drugs and other medications.

1. The City of Greater Sudbury currently utilises :
a. The Household Hazardous Waste Disposal Centre on Frobisher Street
b. The only depot that will accept unneeded prescription medication for disposal.

2. Some pharmacies :
a. Accept outdated or unused medications :
a. Provide the disposal at their own cost.

3. Many Residents of Walden need information & access:
a. Are unaware that these services exist
b. Or are unable to access the Disposal Centre in Sudbury.

4. The Toxic Taxi helps:
a. Will pick up these items on a call for service basis
b. Anywhere within the city.

5. Concerns re- Pollution :
a. There is a growing body of data that shows that prescription medications are working their way
into our water treatment facilities
b. In levels that are now detectable.

6. This may be a result of both:
a. Incomplete breakdown through metabolism within the consumer of the medication
b. Improper disposal through flushing into the wastewater system or disposal in the landfill.

Challenge:

1. Is there something the HSTF or another subgroup of the CAN can do to promote the proper
disposal of these medications?
2. Is there a role we can play?


Oxycontin is more than a problem of the large Cities!

1. Most of us have read recently about the problems associated with the abuse of certain prescription medications, most notably, Oxycontin.
2. The problems associated with Oxycontin are not only present in larger centres but in our community as well.
3. Most health and law enforcement experts believe this problem can be dealt with more efficiently from the community level.

Challenge:

1. Is there a role we can play re- Drug Abuse & Ocycontin?

2. Please see backgrounder from Sudbury’s Oxycontin Task Force
http://www.police.sudbury.on.ca/publications/OxyContin.pdf

If you have any ideas, suggestions or are interested in becoming involved in these Challenges, contact Jim Palys at jpalys@sympatico.ca

Walden-CAN - Health Services Task Force- 6 Month Report

Walden- CAN-Health Services Task Force- ‘ 6 Month Report’
…for June 13/06 W-CAN Meeting

I. Background:

In response to concerns expressed by residents of Walden re- the future of Primary Health Care Services in Walden, a Health Services Task Force of 8 people was established in Dec./06:

Richard Bois-Chair, Jim Palys-Vice-Chair, Gwen Doyle-Secretary, Members- Brent Battistelli, Darwin Brunne, Paul Doyle, Art Neufeld & Forbes Stoodley

II.Goals:

1. To gather ‘first-hand’ information - from KEY PLAYERS impacting primary health care services in Walden

2. To make detailed, regular Reports re- information gathered-to Walden-CAN & share with the public

3. To analyze the Facts & make Recommendations for Action to Walden-CAN & share with the public

III.Actions to Date:

1.From Jan. 12 – April 20/06 we held a series of Information-Gathering Meetings with KEY PLAYERS impacting primary health care services in Walden:

Our local Family Physicians- Dr. Bayly and Dr.Koop
A young Family Physician looking to establish a new practice in Sudbury,
Ray Hunt- Ministry of Health & Long Term Care
Catherine Matheson- City of Greater Sudbury
Dr. Chris McKibbon- lead Physician, City of Lakes- Family Health Team
Dr. Dave Morris- Dentist, one of future owners of LMC

It was a very steep learning curve!

IV. Detailed Reports include:

a.The instability of the status of primary health care at LMC:

Continued need for more Family Physicians
Need for continued retention support from the City of Greater Sudbury
Need for renovations at LMC
Need for new owners of site & new lease

b.Details from young Family Physician :

Outlining the realities of starting a new practice in Sudbury
Why not Walden?

c. Description of the Provincial Recruitment & Retention Grants for Family Physicians :
Relocating to an under serviced area in Sudbury- only 1 of 140 under serviced areas in Ontario!

d. Descriptions of the many funding ‘Models’- Family Physicians can choose to work in:
From Fee-For-Service to partially salaried- blended capitation to fully salaried.

e.Details re- the City’s ongoing policy re- Recruitment & Retention of Family Physicians for outlying areas:

The Mayor & Council’s Roundtable on Physician Recruitment & Retention
The Recruitment Program & activities
Partnership with SRH + NOM + Dr. McKibbon re- City of Lakes – 4 Family Health Teams

f. A description of City of Lakes- Family Health Team:

Funding model
Organizational model
TEAM possibilities
Process to date
Future Model for Under Serviced Areas in Ontario!

V.Analysis:

After all our Information-Gathering Meetings, the bottom line remained:

a. Walden Remains Under Serviced Regardless of Provincial & City Incentives :
Recruitment & retention grants/policies
City of Sudbury Recruitment Programs & hosting of visits by Family Medicine residents
The abundance of patients who need a Family Physician in the outlying areas of Sudbury
... the choice ultimately remains solely that of the Family Physician!

b. The Family Physician will make choices:
His/her professional interests- likes & dislikes- lifestyle choices & family situations will determine the choice of:
Funding ‘Model’ he/she chooses to work in
Location he/she chooses to live and/or work in

Note: the distance required to travel to & from SRH impacts Family Physicians with young families when considering working/living in outlying areas

c. Financial/other incentives which will help attract long-term commitment to outlying areas

VI. At our April 13/06 Meeting We Redefined our Role:

a. Advocacy: Community/Lively Medical Center
b. Liaison: City/SRH/Mayor & Council’s Roundtable/LMC
c. Inviting: ‘Marketing Walden’- developing/use Marketing Tools re- recruitment Family
Physicians/Business /Real Estate/Economic development/Tourism etc
d. Welcoming: Community really happy/excited to welcome newcomers

VI.Recommendations for Action to Walden-CAN:

1. ‘Fast-Track’ the development of ‘Marketing Tools’: to present our Community to
potential Candidates & their families; a ‘Welcoming Package’

2. Communicate what’s happening re- Health Services in Walden

3. Determine our Role in Assisting Mayor & Council’s Roundtable on Physician Recruitment &
Retention
4. Establish an ongoing Health Services Liaison Group
a. To work with Mayor & Council’s Roundtable
b. To keep current with health services issues in Walden

5. Investigate the Need for Establishing a Community Health & Safety Issues Sub-Committee
a. Integrating Pharmacists, Physicians, Nurses, Social Workers, Police, Lively DSS, other health care
providers etc
b. Investigate common health & safety issues Eg Drug Abuse

Announcements:

a. If all goes according to plan, the Lively Medical Centre will be under the ownership of Morris
Group- as of July 1st/06.
b.The City has agreed to provide additional Recruitment Funds to help entice new Family Physicians
to come & work @ LMC.
c. And the City also approved two more years of Retention Funds
for Dr. Peter Bayly & Dr. Gary Koop.

Good news for the stability of LMC & health services in Walden.

Walden - CAN Health Services Task Force Report & Recommendations for April 18 Meeting

Walden-CAN Health Services Task Force Report & Recommendations for April 18/06 Walden-CAN Meeting:
…as determined by HSTF at March 28/06 Meeting

Present: Richard Bois, Gwen Doyle, Brent Battistelli, Darwin Brunne, Paul Doyle, Art Neufeld, Forbes Stoodley
Absent: Jim Palys

I. Defining Our Role:

1. Advocacy: Community/Lively Medical Centre

2. Liaison: City/SRH/Mayor & Council’s Roundtable/LMC etc

3. Inviting: Marketing Walden- develop/use Marketing Tools
re- recruitment Family Physicians/Business/Real Estate/Economic development/Tourism etc
4. Welcoming: Community really happy/excited to welcome newcomers

II.Recommendations to Walden-CAN:

1. Fast-Track the Developments of Marketing Tools:

a. To present our Community to potential Candidates & their families
b. Welcoming Package

2. Communicate What is Happening re- Health services in Walden

3. Determine Our Role in Assisting Mayor & Council’s Roundtable
.on Physician Recruitment & Retention

4. Establish an ongoing Health Services Liaison Group:

a. To work with the Mayor & Council’s Roundtable re- Physician Recruitment & Retention
b. To keep current with health services issues in Walden

5. Investigate the Need for Establishing a Community Health & Safety Issues Sub-Committee:

a. Integrating Pharmacists, Physicians, Social Workers, Police, Lively DSS, other health care
providers etc
b. Eg Drug Abuse

III.Actions to be taken by HSTF:

1. To arrange for a Meeting with Dr. Morris & Dr. Michon; Dr. Bayly & Dr Koop :

a. Discover their new Vision for & status of the Lively Medical Center Site
b. Determine if & how we can help re- communication of their Vision

2. Arrange a Meeting with Co-Chairs: Councilor Doug Craig & Ms Jackie Thoms:

a. Determine what our Role could be to assist Mayor & Council’s Roundtable
on Physician Recruitment & Retention Process

3.Invite Dr. Carscadden to be a Resource for the Health Services Liaison Group

Walden-CAN- HSTF Report re- Feb.9/06 Information-Gathering Meeting with MOHLTC & City Staff

Walden-CAN-HSTF Report re-Feb.9/06 ‘Information-Gathering’ Meeting with MOHLTC & City Staff
re- Provincial & City Physician Recruitment & Retention Policies & Incentives
Present: Richard, Jim, Gwen, Darwin, Paul, Forbes, Art Absent: Brent
Guests:
Ray Hunt, Mgr, North & Family Health Team Implementation, MOHLTC
John Roininen, FHT Coord., MOHLTC
Catherine Matheson, General Mgr., Community Development, City of Greater Sudbury
Kim Rossi, Coord. Senior Services, City of Greater Sudbury

Ray Hunt: Commended volunteers of Walden-CAN for getting people together to the table to gather information help re-strategic planning; John Roininen is always available by phone re- questions
* Will answer your questions in the order in which they were submitted

Question: Explain in simple terms the Alternative Payment Models Family Physicians can choose from

a. Fee For Service: 100 different codes re- services
b. Family Health Networks: at least 5 FDs; paid as group; additional monies based on additional services; advisory services; electronic records, OMA supported Shadow Billing; not all FDs work equally- bonuses/penalties
c. Family Health Group: at least 3 FDs; each paid Fee For Services- capitated rate; some support provided; Telehealth; if nurse on call determines patient goes to ER; FDs on call; all patients are registered; share medical records
d. Community Contract: Capreol is special grand fathered situation; still supported by Province & City; monies approved Feb.8/06 Council mtg
e. All Models are voluntary: FDs choice; ¼ in Primary Care Models; most young FDs want to work in team approach; want better compensation package, more balance in life, less stress, less long hours
f. Province is trying to facilitate older FDs: showing them revenue advantages & comparing blended capititation to past Fee For Services billing; Still lack of trust of provincial gov’t by FDs

Question: Describe the 2 Recruitment Incentive Grants re- Under Serviced Areas

a. 18 Different Programs are provided…Two Incentive Grants for under serviced areas
b. Two @ $40,000 offered over 4 years @ $10,000 per year
c. One @ $40,000 to FDs relocating to under serviced area for 4 yrs; hospital privileges required;
@ $10,000 per yr
d. One @ $40,000 re Tuition to new grads. Relocating to under serviced areas for 4 yrs;
@ $10,000 per yr
e. An area is deemed under serviced based on Population + FDs required not on geography;
Look at all FDs – full-time, part-time, near retirement etc & estimate shortage
f. 140 under serviced areas in Ontario:
39 in Northern Ontario;
Sudbury is one of 39 under serviced areas
g. Sudbury is very effective at recruitment:
City Recruitment & Retention Policy + NOM + Chamber of Commerce + Mayor & Council’s Roundtable re- Recruitment & retention Of FDS are working well recruiting to Sudbury
h. The challenge is getting them to work in outlying areas

Note: Not all cities/communities offer Recruitment/Retention monies

Question: Explain the models Nurse Practitioners can choose to work in & how they are funded

a. NP can work in: hospitals, long-term facilities, Community & Public health Units
b. Same funding applies for under serviced areas or primary care NP positions
c. $100,000( $20,000 re- equipment/supplies) up to maximum of $110,000 per NP position
d. $80,000 salary & benefits
e. All NP positions are totally allocated:
109 NP = under serviced areas
111 NP = primary health care
f. Next generation FHTs will include NPs with funding as before

g. ‘Grow Your Own Nurses’- new program:
11 vacancies across province;
communities too north/rural
Have nurses who can train & be paid while training to be NP
... if they commit to 2 years working in same under serviced area


Question: Does the MOHLTC plan to re-allocate the 'Vacant' nurse Practitioner positions
in under serviced areas…to other under serviced areas where NP are living & looking for work?

a. MOHLTC cannot take away opportunity for small communities to recruit NPs
b. ‘Vacant’ NP positions will remain as is

Question: We would like clarification re- actual functioning of a Family health Team

a. What role do Family Physicians play in management of FHT?

Must use Family Health Network agreement
MOHLTC funds support staff·
Every FHT Team is different; all negotiated seperately
They determine how they want to be governed; hiring/firing/CAO/mgr etc·
Performance Reporting is required to be eligible

b. Who owns the facilities?

No preference re- who owns the site
Could be a municipal building

c. Do the FHT members sign a contract to participate for a given period of time?

They sign a contract
One is the ‘Lead’ physician in the FHN funding agreement·
Annual Performance Evaluation required

d. What happens when one or more Team members opt out or retire?·

In a Family Health Network (FHN) when FD opts out/retires, patients are not enrolled any more·
In an FHT patients are enrolled to the Team vs FD; therefore they are still enrolled to FHT·
OMA is concerned re- maintaining the link to FD & keep them with health services

e. Who is responsible for replacing/hiring Team members?·

The FHT is responsible
The FHT rules; operations etc are set out in their Charter·
Partnership between the MOHLTC + City + SRH

f. The ‘Alternative Payment Plan’ re- FHTs seems to be a stumbling block for some FDs…How flexible if the FHT payment model?·

One FHT might include all FDs in four FHT sites
The FHT in Walden might include five FDs·
Each FD paid by FHN
The FHN is legally a business or Medical Corporation of 20 FDs·
Board of Directors (probably all FDs) is set up to monitor activities·
FHN gets $$ from MOHLTC based on 20 FDs; representing X potential work as per submitted Plan·
FDs pay would be negotiated by all FDs in the FHN·
The Board dispenses monies based on each FDs Plan/Shadow Billing·
If FD falls short then monies may be withheld; depends on Board decision

Can FHT include multiple payment plans with the Team?·

Pay would depend on proposed services·
Shadow Billing is mandatory
It allows MOHLTC to monitor all activities of each FD·
The FHN gets an additional 10% for Shadow Billing·
Other health care providers in team are paid by MOHLTC as per guidelines·
FHT provides Liability protection for all employees- except FDs·
FDs Liabiity Ins. is provided by FHN

Catherine Matheson:
Post amalgamation the recent, big issues re- health services are the older FDs in the City
Staff has been addressing this issues- part of Recruitment & Retention Policy; have attended provincial competitions.
Mayor established the Roundtable to develop Strategic Plan to address these problems &
City continues to work with province specifically re- outlying areas of Sudbury

* See Semi-Annual Report, Dec.7/04 to Priorities Committee re-
“… New recruits, under serviced area designation, Mayor & Council’s Roundtable, Turnkey Clinics Update, Canadian Assoc. of Staff Physician Recruiters, LHIN & FHT proposal"

Question: We know that the City has a recruitment & retention policy to assist medical clinics in outlying areas, but we hear conflicting information about its use:
a.What is the City Policy re- use of funds for leasehold improvements?

In 2002 the outlying areas were facing difficulties re-primary care health services
* In April 12/02 Memo
Council approved $175,000 to Valley East to renovate municipal building; set up medical clinic; recruit FDs’ they needed a Group but they couldn’t recruit FDs;The money was set aside & will be used re- FHT·
Council approved $300,000 to be used by Nickel Centre to create new Medical Centre in Coniston; Contract signed with local FD; space for 2nd FD; no luck re- new FD·
Council approved $175,000 to Rayside-Balfour to renovate municipal building; set up new clinic;didn’t work; money set aside·

Walden didn’t have problem in 2002·
In 2004-09-16 City approved
$150,000 as one time expenditure towards the operation of the medical clinic in former Town of Walden…Purchase of service agreements @ $10,000 per physician.
In July ¼ - June 30/05”· City has approved
...an additional $5,000 per physician, Feb.8/06 – June/06

Onaping Falls & Capreol are Community Sponsored Clinics:
single FD on contract; grand fathered; City just approved continued support

b. How does a Fee For Service Medical Centre access the City Recruitment Signing Bonuses to recruit new FDs to outlying areas?·

Application to the City for approval of $25,000 Signing Bonus made after official cceptance by FD·
The City/SRH/Chamber of Commerce offer a Relocation Incentive·
Bottom line is physicians recruit physicians
City Incentives can’t persuade them to locate in outlying areas
That’s the job of FDs @ each clinic·
The NOM should help provide FDs; recruitment policy re- medical students focuses on those who grew up in the north.
50% of graduates from Northern Family Medicine Residency Program stay in north

Question: Describe the City Recruitment Process.

The Mayor & Council’s Roundtable on Physician Recruitment & Retention Strategic Plan 2005-2006:
Broad Objectives re- Physician Recruitment & Retention:

1. To research new approaches to providing improved accessibility & cost effective health care services
2. To ensure that Sudbury’s youth are aware of City’s health care sector opportunities, and that they feel
welcomed back to Sudbury even though they may have undertaken post graduate studies elsewhere
3. To ensure that the City of Greater Sudbury offers it medical community the best access to medical
Systems Information Technology
4. To provide ongoing support to Laurentian Universitys’ Northern School Of Medicine
5. To effectively send the message to International Medical Students that Sudbury is a diverse community
6. To showcase the community of Sudbury as welcoming, culturally diverse & growing

The same promotional approach is used to recruit FDs to the City & outlying areas:

1. Promoting community assessment visits sponsored by MOHLTC;
2. Hosting an evening in a city (eg. Ottawa) & inviting medical students, residents & allied health care
professionals native to Sudbury & their friends to Sudbury sponsored gathering
3. Attending a variety of conferences geared to family medicine practitioners
4. Providing information of the City of Sudbury website to allow physicians to find family medicine
practice opportunities; linked to MOMEC & PAIRO websites which are free;
5. Going to academic sites across Ont. & Canada & meeting medical students & residents off campus at
hosted City event.

Question: Has the City applied to the MOHLTC about reallocations of funding for ‘vacant’ NP positions for under serviced areas?·

In Nov./04 mayor & Council wrote MOHLTC, after being contacted by Marilyn Butcher on behalf of NPs; requesting reallocation of funding for ‘vacant’ NP positions·
The response was no.

The Ministry “…is committed to expanding employment opportunities for NPs across the province…the development of FHTs which will see the creation of interdisciplinary teams of health care providers. NP…an important component of FHT model…commitment to double the number of clinical educations spaces for NP by 2007/08”·

Other Questions asked in Part II:

How does Recruitment happen? Is there a package re- Walden at Recruitment Fairs?
Catherine Matheson:
Recruitment Fairs: every Sept.; 140 under serviced communities participate; only contact with them·
North East Medical Corp NOMAC; Jackie Thoms attends/organizes events·
Feb./06 Candidates coming to Sudbury for weekend tour·
Organize other special events: golfing, boating, BBQ as part of recruitment process·
Dr. Carscadden did lots of work recruiting potential candidates·
Any names of FDs are passed on to local FDs; FDs keep tabs on local students·
It’s up to FDs to recruit the candidates

Walden-Can is developing communication tools: website, community directory, newsletter etc.
You referred to Walden-CAN developing an Information package to help with recruitment, how should we proceed? Who do we contact? How can our community assist in recruitment process?

Kim Rossi: ·
Should send a letter to Mayor & Council’s Roundtable, explain your ideas & ask if a Walden ‘Information Package’ could be used as part of recruitment information·
Local businesses could get involved in a kind of ‘welcome wagon’ approach to young FDs & their families·
Might want to think about hosting an event for candidates.

What is the Status of the City of Lakes FHT?

Ray Hunt:

The FHT is proceeding slowly· Financial Plan should be approved March 30/06·
Pre-operational funds will get things started·
FHT to be set up in outlying area first- not Pioneer Manor first·
Providing support staff will make FHT attractive ·
No Interim Plan as yet

Question from Richard Bois:

Problem re-LMC & leasehold improvements; no lease can be signed until estate is settled- building sold or not;City has put monies into privately owned buildings; money has been spent to renovate & provide space for 2nd FDs in Coniston

What is City policy re- monies to fix privately owned buildings?

Catherine Matheson:

When examining the problems of recruiting FDs to outlying areas,
City had to make a decision·
Do we recruit to a building?
Or do we recruit to a new City of Lakes - Family Health Team?
The Council has decided it was better to recruit to a FHT with 4 Sites.

Post-Meeting discussion:

1. Working with the recruitment Team : Walden- can be one part of the process/welcome wagon
2. Our role is educating the public about what we’ve learned/what’s happening
3. The community could provide package for FDs: banks/businesses/groups provide services similar to the Chamber of Commerce; host an event
4. Until FHT is up & running – Bridge the Gap; at least 6 months to get FHT concept fleshed out
5. Get as much information as possible from Dr. McKibbon re- FHT; business plan; interim plans
6. Contact City re- idea of developing ‘Information Package’ …marketing Walden community to use in their Recruitment Process; website/community directory important tools7. Not a political pressure group

Next meeting: Feb.28/06 with Dr. Chris McKibbon, Chief of Staff, SRH, lead physician- City of Lakes –FHT

Report from Walden-CAN Health Services Task Force re- Jan 17/06 Meeting with Dr.Bayly & Dr.Koop

Report from Walden-CAN Health Services Task Force re- Jan.17/06 Meeting with Dr. Bayly & Dr. Koop
…for Walden-CAN Feb.7/06 Meeting
Present: Richard Bois, Gwen Doyle, Darwin Brunne, Paul Doyle, Art Neufled
Regrets: Jim Palys, Brent Battistelli, Forbes Stoodley
Guests: Dr. Koop & Dr.Bayly, Lively Medical Centre

1. Background information re- City’s Retention & Recruitment Policy re- Outlying Areas: by Dr.Koop

a. Copper Cliff Medical Clinic: when it closed ; FDs moved to Sudbury; little complaints from the community

b. Azilda Medical Clinic: privately owned building; 2 FDs went to City for Retention & Recruitment Funds; success story; in one year recruited Dr. McLean

c. Lively Medical Centre: 2004 went to City when Dr.Mitchell moved to Sudbury; asked City for Retention & Recruitment funding; thought we had new FD- one went to Ottawa- the other to Espanola

d. Coniston: Dr. Noel deTilly had small clinic; privately-owned building with extremely low rent; City suggested he move to 2 FD Clinic; privately-owned Apt. building; City paid for renovations; low rent; pays small % of lease; hires his own staff; no FD yet.

e. ‘Under Serviced Areas’ term applies to all of Sudbury:
Many opportunities to attract FDs in City core: walk-in clinics, hospitalist positions, teaching opportunities
Outlying areas still struggling to recruit FDs

2. Clarification re- LMC Request for Retention & Recruitment Funds from City, 2004:

a. When Dr.Mitchell left, looked at possibility of relocating eg Walden Plaza
b. Our landlord helped; only had to pay $17 per sq ft re- portion we used as 3 FD Clinic
c. City would not consider a Coniston –type scenario at that time
d. City provided $150,000 over 5 yrs
...in Retention & Recruitment Funds @ $30,000 per year (@ $10,000 per 3 FDs)
e. Our landlord would not pay for renovations without a lease
f. The $10,000 each just covered our overhead costs- NOT RENT!
- running costs, same telephone system etc
g. We have never seen the ‘Agreement’ as cited in City Council Minutes & posted on website

ACTION: HSTF needs clarification from the City re- $150,000 Retention & Recruitment Funds/Policy at Feb. mtg.

3. Status of the Nov.18/05 Letter to City from Dr. Koop:

a. Finding out if LMC is eligible for a one year $20,000 Signing Bonus
b. Requesting assurance that retention initiative will continue until new FDs recruited
c. No response to date * City Council must respond

4. Is a Fee For Service Clinic the only short-term solution for Walden?
...Until the City of Lakes – Walden FHT is up & running?

Comments by Richard Bois:

a. The City of Lakes –FHT will eventually be set up in a city-owned building with the ‘Alternate Payment Plan’ Model the only option; 2 –3 yrs?
b. The City has provided funds for Fee For Service Clinics, in privately-owned buildings in the past: Azilda, Coniston, LMC
c. If evicted from building, it seems the City should continue to offer support to LMC- after 41 yrs of service- offering space in Town offices; renovate; ask low rent etc – until the Walden-FHT becomes a reality

5. Would LMC relocate to the Town offices ...if given the option/support of the City?

Not against a move in itself...Already looked at this option with McTaggert, Catherine Matheson & architect
a. $300,000 in costs estimated by architect ( probably higher)
b.Talked about other services
c. Patients did not want to relocate at that time
d. Cheaper to renovate old building

Other comments:

a. If overheads & rent were not too high it would be attractive
b. If it were Fee For Service Clinic
c. A higher ‘Signing Bonus’ might help attract FDs to outlying areas
d. The Provincial Incentive Programs sounds good too; should find out more about it & how to access it
e. Community needs to think of other incentives to offer re-Walden

6. Status of LMC Proposal re- FHT & City of Lakes –FHT:

a. When LMC applied re- FHT it was not accepted; put together quickly; NP-based; didn’t have details re- ‘Payment Plans’
b. Nov/05 LMC applied to MHLTC for computer printout comparing our Annual Fee For Service payment with new FHT ‘Alternate Payment Plan’; still have received no information
c. Re-submitted our FHT proposal; turned down in 2nd round
d. City of Lakes – FHT proposal; still have not seen very much detail in writing
e. 3rd wave of proposals due Feb.15/06; smaller proposals by FDs & NPs not already part of an ‘Alternative Payment Plan’ Team

7. Nurse Practitioners’ Role in under serviced areas:

a. NP can be part of Fee For Service Practice…Provincial Grant is $30,000
b. In ‘Under Serviced Areas Models’... Provincial Grant is $100,000- $20,000 in equipment.
c. Provincial groundswell by FDs & NPs asking that these funds be made available to Fee For Service Practices
d. ONPA are lobbying the province to free up funding @ $100,000 re-‘vacant’ NP positions to those under serviced areas where there are NPs living & looking for work
...eg Sudbury

8. Sudbury’s Recruitment Team & LMC:

a. City & Catherine Matheson has always been helpful in the past; let LMC know if any new FD interested in coming to area
b. Concern re- the process used by City Recruitment Team; How are they helping LMC ?

ACTION: HSTF should ask for clarification of City Recruitment Policy @ Feb, mtg re any new FD coming to Sudbury/Walden?

9. What is the status @ LMC? What do you want?

a. If FHT model could be a Fee For Service model we’re interested; FDs + NPs
b. Best solution now is to recruit FD as soon as possible; other FDs later re- new patients

c. In the meantime:
Walk-in Clinics-Wed. (2 –7pm), Sudbury Family Doctors coming on trial basis
After Hours Clinics- Dr. Koop & Dr.Bayly alternating
Trying to get other Sudbury FDs to help
Hold things together until we can recruit new FDs

Actions for Health Services Task Force:

I. Find real status of City of Lakes –FHT:
What is the City’s role? Impact of FHT on LMC at Feb.Meeting

II. Find out status of City Grants:
Retention & Recruitment funds...Is the use of the Town offices an issue?
Clarify use of TAX money
Clear up confusion re- no money to renovate privately-owned buildings

III. Get 3rd Leasehold Funding
Keep LMC up & running until new FHT is reality

IV. Find out how we can help
re- Recruitment/Marketing Walden to new FDs

Report from Walden-CAN Health Services Task Force- Defining Our Role, for Jan.10 Meeting

Report from Walden CAN – Health Services Task Force- Defining Our Role…for Jan.10/06 W-CAN Meeting…

Summary Dec.13/05 Meeting of Walden CAN – Health services Task Force
7pm @ former Town of Walden offices
Present: Richard Bois-Chairman, Gwen Doyle-Secretary, Art Neufeld, Darwin Brunne, Brent Battistelli, Paul Doyle, Forbes Stoodley Absent , Jim Palys

I. Brief overview by Richard Bois:
a. Process of establishing the Walden Can
b. Issues identified by the participants @ community meetings: Nov.1, 15, 26 & 29/05

II. Overview of ‘Status of Primary Health Care Services in Walden’ :
...As we understand it – based on 2 ‘Unscheduled’ Community Health Services Meetings: Nov.1, 15 /05

a. Short-Term Issues facing Lively Medical Centre:

month-to-month lease; need for improvement to building; City policy to not pay funds towards privately-owned building; difficulty recruiting FD; our FDs Feb. proposal re- FHT – not approved by province

b. Long-term Proposal re- FHT @ Town offices as part of Dr. McKibbon’s ‘City of Lakes 4 FHTs’:
‘model’ approved by province; not seen the plan or time-line; payment plan is complex( totally different form other alternative payment plans);paperless office; FD( young & old) have problems with FHTs…why?

c. Letter sent by Dr. Koop to City( read by Terry Kett @ Nov.29/05 Walden CAN Mtg)
...Seeking clarification of City policy re- recruitment funds/signing bonuses re- Lively Medical Centre *Decision pending


d. Report to Council from Catherine Matheson, Mgr. Community Development:
re- Status of City of Lakes 4 FHTs:

... Highlighted the lack of progress in setting up the 4 FHTs because of need for approval @ provincial level·

a.Request for development grant to: hire a consultant for 1 month to prepare financial plan & hire a project manager for pre-operational stage…submitted Oct./05 * Waiting for approval·
b.Business Plan is pending- year 1 business plan & draft 2-5yrs·
c.Pre-operational Stage is pending- set up @ 4 sites in limbo

Many questions were raised: How much input from our FD? Why FD (young & old) don’t want to be part of FHT? Need more information re- FHT ‘model’ & how it impacts on health services in Walden now & in future? etc

III What is our Role? ... Working on behalf of the community re- their #1 concern – the status of health services in Walden

a. Short-Term Issues:

Gather ‘first-hand’ information from KEY PLAYERS:
... New FDs, our 2 FD, Dr. McKibbon, Ray Hunt @ Ministry of Health, Catherine Matheson etcb.

b. Long-Term Issues re- FHT @ Town offices:
Could be other possible sites
Issues are beyond our control re- where Doctors will work

* CONCERNS expressed by Committee:

1. We can gather information & become very educated but where will it go?
As a sub-committee of Walden CAN maybe after everything all we can do is educate the public so that they can make informed decisions about their options for future health care
2. We’ve (Walden) has followed the process @ the political level many times
…it’s like walking around a track…Plans never get done & this time there is no band aid solution 3. We hope the Walden CAN & Health Services Task Force can get the parties together …work @ improving communication between ALL PLAYERS.

III What first-hand information do we need & who do we want to meet & in what order? After much discussion it was decided to set up a series of meetings beginning first week of Jan./06:

IV.Some of possible questions to ask @ Jan. Meetings:
1. New Family Doctors:
What do they really want? Real needs? Concerns? What could be inducements? Drawbacks? Suggestions re- recruitments tactics. Why don’t want to be part of FHT? Why not Walden?

2. Dr. Koop & Dr. Bayly:
Status re- recruitment of FD? City’s response to Letter? After hours Clinics? Part-time Drs/NOM staff? Fact or fiction? Status of lease? Clarity City’s ‘bridging’ funds? What was your proposal re- FHTs? Why are you opposed to Dr. McKibbon’s FHT?

3. Dr. Chris McKibbon re- City of Lakes 4 FHTs:
What is your ‘model’ for Walden FHT? Funding plan…why don’t FDs seem to like it? How much input from our FDs? Interim plan re- Walden health services? Steps in process re- Walden FHT?

4. Ray Hunt, Senior Manager, North & Family Health Team Implementation, Ministry of Health & Long-Term Care:
What’s going to happen in Walden-short-term & long-term? Who decides what model is best for a community? When will approval re- City of Lakes request for ‘development grant’ be approved? What is role of NP in Walden FHT model?(pre-operational stage)How will community input be included?

5. Catherine Matheson, Community Development Manager- City of Sudbury: Recruitment Policy @ City/signing bonuses & funding policies re- Lively Medical Centre/Walden? How many of 30,000 people without FD live in Walden?Has City requested additional funding for more NP( re-allocation of ‘vacant’ NP positions)- as part of 4 FHTs? To work now in under serviced areas?

September Plans for this Blog!

September Plans for this Blog!

During September, I plan to post...

1. Walden-CAN Health Services Task Force - Reports :

a.Information-Gathering Meetings held with KEY Players
...impacting the future of health care services in Walden.

A young family physician- recently moved to Sudbury
Our local Family Physicians at the Lively Medical Centre
The Ministry of Health & Long-Term Care
City officials
The Lead Physician for the City of Lakes - Family Health Team.

b. Our HSTF Report & Recommendations to Walden-CAN at March 28/06 Meeting

c. Our 6 Month Report - What's Happened? What's in the Works? June 13/06

2. Websites where you can find more information about government intiatives re- health care in under serviced areas.

And I will start contacting...

Various health-related organizations in Walden & Sudbury :

For information re- meetings, workshops, conferences etc
Websites
Health issues/concerns impacting our community.

For suggestions or input, contact me at
gwen-paul.doyle@sympatico.ca

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