Updated on: July 21, 2022
When the Victoria Primary Care Network (PCN) was announced one year ago, it represented a huge step in primary care transformation for people living in Victoria, Saanich and Oak Bay.
PCNs link together family physicians in a local area with other health care professionals – nurse practitioners, nurses, mental health clinicians, social workers and others – to provide patients with access to a comprehensive range of team-based primary care services.
The Victoria Primary Care Network is a collaboration between the Victoria Division of Family Practice, Indigenous community partners, patient partners, Island Health and key community organizations that deliver primary care in Victoria.
Victoria PCN achievements in the first phase of the four year plan include:
- Six new family physicians and one registered nurse for existing clinics in Tillicum, Quadra, Shelbourne, Gordon Head and Fairfield
- Two longitudinal case manager nurses to care for patients aged 65 and older with complex health needs, helping them to remain at home and out of hospital when possible
- Four Mental Health and Substance Use (MHSU) clinicians
- Four clinical pharmacists
- An enhancement to the existing primary care clinic at the Victoria Native Friendship Centre including an additional physician and nurse practitioner, and an Indigenous Wellness Leader
- Low Barrier Mobile Outreach team comprised of a roster of physicians, registered nurses, and two outreach workers, as well as 4.4 FTE registered nurses providing addiction medicine at BC Housing sheltering sites
- Memory Care Service team comprised of a registered nurse, occupational therapist and social worker. The service is operational two days per week.
- Opening of Luther Court Society’s Community Health Centre
- Island Sexual Health transitioned to a Community Health Centre celebrating its first anniversary
In addition, the Downtown Victoria Urgent and Primary Care Centre (DVUPCC), announced at the same time as the Victoria PCN, is a key service being provided within the primary care network. Currently staffed by a dedicated team of physicians, nurses, social workers, MHSU clinicians, and medical office assistants, the DVUPCC is the largest in British Columbia. It offers both urgent care and longitudinal care to thousands of patients, many of whom have complex health conditions and are unhoused or have sought refuge from other countries. Since opening in July 2021, the team at DVUPCC has received more than 34,000 patient visits.
“The demand for service has been incredible. Some days we get several hundred calls from people seeking care,” says Dr. Paul Sawchuk, DVUPCC site medical lead and one of the physicians working at the clinic. “We recently provided nursing and physicians appointments to 185 people in one day. We are so proud of that accomplishment, but we are always thinking ‘how do we do more?’ How can our team see even more people?”
“Our team is so passionate about the work so it is very easy to lead them in the provision of equitable and culturally safe team based care,” says DVUPCC manager, Elizabeth McGrath. “One of the pillars of team based care is trust and Dr. Sawchuk and I, as team leaders, have been working hard to build trust within our team. Trust is always built slowly but we are making good progress.”
When Dr. Sawchuk moved to Victoria from Winnipeg, he didn’t know anyone on the DVUPCC team and most of the team didn’t know one another. Over the past year, the team has become more cohesive, often socializing after hours during pizza nights and staff softball games. The camaraderie has helped to foster strong connections at the clinic.
“The biggest thing team based care does is improve the quality of service for high needs patients. There are many conditions and issues that I am not an expert in where I look to fellow team members for support,” Dr. Sawchuk says. “If someone has financial difficulties and needs a prescription, our social workers can help them navigate that. If someone is experiencing a mental health issue, our MHSU workers can assist. I don’t know how we could care for the people we do without working as a team.”
The site is located on the traditional territory of the Lekwungen speaking people of the Esquimalt and Songhees First Nations, and DVUPCC staff are committed to the learning journey of truth and reconciliation. They also work closely with community partners like Our Place and local immigrant and refugee organizations to ensure that vulnerable people get the care and support that they need. When patients face language challenges, the team accesses translation services through the Provincial Health Services Authority (PHSA).
“We serve very diverse populations - people with complex and acute medical issues who come from all segments of our society,” says Dr. Sawchuk. “It’s a genuine team effort with everyone trying to move the patient along and figure out how best to help them.”
One component of the DVUPCC model that has proven to be helpful is that physicians are on time-based contracts, rather than being compensated through fee for service. This allows providers to spend more time with patients, many of whom speak little or no English and have experienced some form of trauma.
“When you are speaking through an interpreter with a refugee and they are telling you about their pain, rushing that conversation isn’t helpful or appropriate. It is important to take the time to try to listen as fully as we can,” says Dr. Sawchuk. “When someone shares those parts of their life, we have a dedicated team of skilled people who are listening and thinking about how to connect the patient to services and resources.”
“We are fortunate to have nurses on our team who have more practice with a trauma informed lens so when it comes to some of these complex cases, we lean on them to help guide us and steer us to make sure we are providing the appropriate care,” says McGrath. “In addition, our staff is thirsty for knowledge and have been taking courses that will allow for more independent nursing appointments.”
The practice will continue to grow over time as more primary care practitioners are hired, and the team-based model is attracting a number of highly skilled professionals, including semi-retired physicians. After Dr. James Houston retired from his busy downtown Victoria family practice, he began working in urgent care at the DVUPCC 2-3 days per month.
“The model at DVUPCC is very flexible. It’s an ideal fit for people who want to keep their skills up but don’t want to commit full time,” he says. “Team based care really is the way to do it. It’s a bit of an adjustment for those of us who are used to doing everything on our own, but it’s a very supportive place to work.”
“I was showing a new grad around recently and told him that I honestly believe this is the best job in Victoria and one of the best jobs in the country,” says Dr. Sawchuk. “Island Health has done a good job in supporting us so it’s been a team effort outside of the building, too. We are appreciative because it helps our team feel seen, recognized and supported in difficult times.”
The Downtown Victoria UPCC is open 8 a.m. – 8 p.m., seven days a week.