“It was the Wild West,” according to one policy-maker involved in the creation of Alberta’s Primary Care Networks (PCNs) almost two decades ago.
PCNs — groups of family physicians working with other health-care professionals such as nurses, dieticians, pharmacists and social workers to identify and address the greatest primary care needs in communities across the province — have changed the nature of primary care in Alberta.
The 18-year history of PCNs — a unique, made-in-Alberta approach to improve and better co-ordinate patient access to primary health care — is detailed in a recent paper published in BMC Family Practice.
“Alberta’s frontier spirit supported the creation and then growth of the PCNs in a very specific way,“ says Dr. Myles Leslie, PhD, lead author and member of the O’Brien Institute for Public Health at the Cumming School of Medicine (CSM).
From preliminary meetings on living room floors to governance structures drafted on cafeteria napkins, the launch of Alberta’s PCNs is a study in primary health-care reform through frontier-town, grassroots initiatives.
“Without the Alberta ‘get things done’ mentality, and its value for independence and local solutions for local problems, this primary care transformation may never have happened,” says Leslie, associate director of research at The School of Public Policy at UCalgary and assistant professor in the Department of Community Health Sciences at CSM.
The province’s 41 PCNs, comprised of 3,800 family physicians and more than 1,400 other health-care practitioners, operate as joint ventures between physicians and Alberta Health Services (AHS). This concept is gaining traction both within Canada and worldwide, says Leslie, as it’s seen as a way to achieve better care, better health outcomes, better provider experiences and better value for money.
“Our PCNs have made high-level aspirations to improve population health, disease prevention and service delivery integration while contributing to bending the cost curve as they move care upstream from hospitals,” he says.
Alberta’s primary health-care transformation
In 2000, the federal government created an $800-million Primary Health Care Transition Fund to accelerate primary health-care reform and integration across the country.
In 2003, Alberta’s PCNs were created through an agreement between the Alberta Medical Association (AMA), the Ministry of Health and the regional health authorities that would eventually be merged into AHS.
Leslie and his co-authors conducted interviews with stakeholders who were there at the beginning, drawing out a history of groundbreaking primary care reform.
“It was so small-town. We would sit on some guy’s living room carpet — two of us, with one person from the AMA — starting to sort of draft this [idea]. You know, go through this process. That’s literally how it started,” said an unnamed physician quoted in the paper.
Another stakeholder said: “It was truly a grassroots movement. Very quickly, we got to a place where there’s a bunch of us that recognized there’s a real opportunity here, and we have to saddle this horse and ride it properly.”
Leslie refers to the early years of the PCNs as the Frontier Era, but change was coming.
In 2012, Alberta’s auditor general delivered a report directly questioning the value that the province was receiving for its ongoing investment in the PCNs.
“The report ushered in a new era for the PCNs. It signalled the end of the Frontier Era and a new focus on accountability,” says Leslie.
Preventive medicine, integration with other elements of the health system, clinical quality improvement and the delivery of care by teams that include non-physicians — all hallmarks of excellent primary health care — became their focus, says Leslie.
Despite the challenges, the PCNs’ ability to survive and expand not just locally, but across an entire province, is remarkable, he adds.
And their key role in the province’s response to the COVID-19 crisis — distributing personal protective equipment and patient handling protocols to family doctors — indicates their ongoing importance.
“The story of Alberta’s PCNs is a story of people, time and culture — of a diverse group of people coming together to create sustained change over time,” says Leslie.
“The continuing willingness of the different stakeholders to work at understanding and aligning one another’s cultures to achieve the transformation toward primary health care has been central to the PCNs’ survival and success.”