After decades of strife, we've entered a golden era of cooperation between doctors and government

I wrote my first "Health Care is in Crisis" story in 1981 as a cub reporter. I was to write at least two or three, if not a dozen, such stories every year thereafter as a health reporter for the next two and a half decades.

While the details varied, the essential elements tended to fall into one of two narratives lines: 1)Doctors railing against stingy, short-sighted government, warning patients will be harmed. Or 2)Government blaming greedy doctors for fostering unsustainable system, warning patients will be harmed.

I grew so tired of that constant, divisive narrative — that incessant wrangling and finger pointing that always used patients as pawns — that I left health care coverage for awhile for the more pleasant pastures of running a lifestyle magazine.

But in the interim these last six or seven years, unbeknownst to many, a dramatic shift has occurred in the BC health care narrative. In fact, a new collaborative culture between government and the medical profession has been emerging that is creating positive health care change. And moreover, patients are no longer the unwitting pawns in a battle for dominance, but the winners in a cooperative conversation that aims to put their needs first.

"It really is a new era," says Dr. Bill Cavers, new president of the Doctors of BC (formerly called the BC Medical Association.) Cavers, a Victoria-based GP since the early 1980s, has lived through previous decades of doctors vs government animosity and has been at the vanguard of the new culture of collaboration.

Others agrees that the culture has changed from animosity to cooperation: "There has been a really palpable change," notes Dr. Ron Collins, a Kelowna anesthesiologist. In the past Collins avoided the rough and tumble of health care change because of its acrimony and divisiveness, but with the new cooperative culture he has become much more involved, now working to improve physician engagement in contributing to better patient outcomes, particularly in surgery. "There is the realization now that there is no ‘dark side’, no good guys and bad guys, we are all on the same side."

Much of the credit for this new era of cooperation belongs to the creation of four collaborative joint committees of doctors and government. These joint committees are the first of their kind in Canada, but their story has not yet been widely told either inside or outside of the province. The committees are:

1) The General Practice Services Committee (GPSC), which deals with issues of primary care through family doctors offices;

2) The Specialist Services Committee (SSC), which is aimed at improvements to the specialist care system.

3) The Shared Care Committee (SCC), which aims to help integrate GPs, specialists and other allied health professionals.

4.) The Joint Standing Committee on Rural Issues which deals with health care issues in BC's hinterlands.

Each committee consists of four appointed doctors, primarily from the Doctors of BC, and four Ministry of Health officials, with doctor and government reps as two co-chairs. All decisions are made by consensus. Health Authority representatives and patients are invited to partake of the discussions as guests. The committees now also have significant administrative and executive support for their increasing number of programs and activities.

For the sake of full disclosure, I should state clearly that I am now working as a consultant for two of the four committees (SSC and SCC) and worked in the past for the GPSC. In fact, I joined them because I was impressed by their refreshing cooperative mandate and ground-breaking activities, by their ability to put aside more than three decades of fighting to find common ground. I decided that, rather than stand on the side as a reporter critiquing their actions, I would jump in and offer my skills to help them achieve positive change in health care. Part of my role is to tell more people about what they are doing and why -- hence this blog post. So here are some interesting tidbits to know:

All of the committees are funded out of the Physician Master Agreement, the envelope of money in the BC health system that goes to doctors' compensation. In the past it mostly went to the fee-for-service payments and therefore directly to doctors' incomes. Now a portion of the money earmarked for doctors' pay is going to these committees and their programs in a way to "fund change." The annual amount for all three committees and their many programs in 2014 is now around $400 million. BC's annual health budget is now $17 billion so this represents just about 2.4% of the annual health spending in the province. In the scheme of things, it is a small investment to try some new things in new ways, but nevertheless $400 million a year can buy an awful lot of positive change.

Rather than fighting over what is good for government or good for doctors, the committees found if they focused on what is best for patients they could find common ground. Asking the question, "how do patients benefit from this change?" has depoliticized the whole process.

The General Practice Services Committee, (www.gpscbc.ca,) was the first to be formed in 2002/3. It is focused on supporting GPs in the province to provide full service family practice — the cradle to grave care of a good family doctor. Tactics included special payments for maternity care, or to manage complex chronic diseases, and other financial incentives to take on more time-consuming patient issues; training programs to enhance their clinical skills and job satisfaction, and even training to promote more efficient offices. About 50% of BC doctors are GPs, and the GPSC has the biggest budget of the three committees (now about $200 million annually.) One of the GPSC's most successful creations is the Practice Support Program, which develops modules for training and pays doctors and their office staff to attend the programs which includes everything from how to schedule patient appointments so less patients are waiting, to chronic disease management, to difficult issues like end of life care or youth mental health care. Practice support is now being offered to specialists, too. http://www.gpscbc.ca/practice-support-program

The success of the GPSC spurred the creation of the other two committees. The Specialist Services Committee, SSC (www.sscbc.ca) was formed in 2006 and its role is to foster improvements and close the gaps for patient care in the specialist care (acute care) system. It is funding a number of physician-led quality and innovative projects such as Collin's project to improve patient outcomes from surgery. Other funded, physician-led projects include a redesign of BC hip fracture care, a prostate cancer support program, youth-to-adult transition protocols, telemedicine consultations, training in new techniques like hand-held ultrasound, and the creation of a special province-wide program of inherited heart arrhythmias. The SSC has a new round of funding for more quality innovation projects led by specialist physicians that will be announced later this year.

The Shared Care Committee (www.bcma.org/partners-patients) was also formed in 2006, and while it works closely with the General Practice Services Committee and the Specialist Services Committee it is a distinct group with its own mandate and projects to address the care provided by both family physicians and specialist physicians. Its aim is to improve the patient journey and integration of the system. Patient safety, quality, prescription drug issues and allied health care integration are all part of its mandate. One of its biggest and most important programs that it is funding is a collaborative project to improve the access to and integration of child and youth mental health care.

The final committee, the Joint Standing Committee on Rural issues, is primarily focusing on issues of physician recruitment retention and health care education and provision in the less populated regions of BC, as well as travel issues for patients living in those regions who need to access more specialized care in the Lower Mainlaind, Okanagan, or Southern Vancouver Island. www.health.gov.bc.ca/pcb/rural_jsc.html

While health care will always demand innovation and effective funding, there is evidence that BC is making good progress. The rate of growth in health care spending is slowing down significantly. After years of frightening 7 to 9 per cent annual increases in budget, the annual hike is down to a respectable, almost sustainable 2.6 per cent. BC has some of the best health care indicators in the country such as the best cancer survival rates, lowest maternal mortality rates and longest life spans. We have the lowest per capital spending on health care but have the best avoidable mortality rate for treatable causes of any province or territory in Canada, as well as the lowest hospitalization rate for conditions that are best handled outside of hospitals in primary care. These indicators show that while there is always room for improvement, our health system in BC is working relatively well compared to other provinces.

While this blog post just skims the surface of these committees and their activities, it does show, that at least for now, that the culture of health care has been changing for the better in BC.

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