Despite efforts by the B.C. government to increase access to primary health care, new developments risk making it even harder to find a doctor.
B.C. is one of the only provinces that allows doctors to bill government for virtual phone or video visits without restrictions. This may make it more convenient to see your regular doctor, but a number of corporations have identified a lucrative business opportunity to operate virtual walk-in clinics.
Primary care is intended to be our first point of contact with the health care system where we see a regular practitioner or team over the course of our life.
A conclusive body of research tells us that primary care can improve health outcomes, reduce costs to the public system, and social inequities if it is comprehensive, coordinated, community-oriented, and continuous over time.
Primary care works best when there is a long-term relationship between the patient and a team of family doctors, nurse practitioners and other providers. They know our medical history and can more effectively support our health and make referrals to specialized services based on their knowledge of us as a patient. This ongoing relationship is the cornerstone of high-quality primary care.
Walk-in clinics — virtual or otherwise — erode the personal relationship and do not provide effective primary care. We need policies that make it easier to find a regular primary care provider and get timely and convenient access to continuous care, including same-day appointments and virtual visit options with our usual provider. Virtual care can be a useful tool when it supports care between patients and their regular providers.
In March, Telus unveiled its Babylon health app, which allows patients to consult a doctor through a smartphone app. This is a partnership with the U.K.-based Babylon corporation. In England, the app has undermined primary care services, and raised significant quality of care concerns.
The problem with this model of care is that it encourages one-off consultations with doctors that a patient has never seen before. It may be an attractive alternative to waiting in a walk-in clinic down the street, but it further entrenches a problematic model of episodic care.
As B.C. embarks on primary care reforms intended to improve access to regular primary care providers, these virtual walk-in clinics have the potential to undermine the government’s efforts.
Telus, for example, pays doctors a guaranteed amount per hour regardless of whether they consult with patients via the app or not. This is attractive to doctors who are looking for a predictable income and don’t want to a run a business, which is required under the dominant fee-for-service payment model. This leaves fewer doctors to provide relationship-based primary care and less access to this more effective form of care.
What should be done instead?
We need to provide family doctors with opportunities to work in team-based primary care models — like Community Health Centres — where they can focus on practicing medicine, rather than running a business. This is consistent with the kind of workplaces that many family doctors increasingly expect.
Rather than allowing disruptions from companies that undermine effective primary care, the B.C. government should follow other provinces and restrict the use of virtual care to doctors who provide ongoing care at approved clinics.
Rita McCracken is a family doctor and assistant professor at the University of B.C.’s Department of Family Practice; Andrew Longhurst is a research associate with the Canadian Centre for Policy Alternatives; Ruth Lavergne is assistant professor in Simon Fraser University’s Faculty of Health Sciences; and Damien Contandriopoulos is a professor in the University of Victoria’s School of Nursing.