The need for primary care has never been more critical. Knowing that, the leads at Langley City Family Practice saw an opportunity to enhance their clinic—and they seized it.
Team-based primary care is a model of health care delivery where various professionals work together to support a patient’s needs and address complex issues. In addition to physicians, these teams may include nurses and nurse practitioners, social workers, physical therapists, occupational therapists, midwives, counsellors, pharmacists and dietitians. When an interprofessional team collaborates, patients see the person who is most appropriate for their needs, resulting in shorter wait times and increased access to care. One clinic leading the way in this model is Langley City Family Practice (LCFP).
The clinic has an impressive team of six (soon to be seven) full-time family doctors. While doctors are essential, what makes LCFP even stronger is their team of nurses and administrators. Having such an extensive team means that clients receive care as efficiently as possible, and no one gets lost in the mix.
The Team-Based Primary Care Learning Centres (TPCLC) Project
Team-based care is the future of family practice. The UBC Department of Family Practice (the Department) is conducting a three-year project on team-based primary care learning with funding support from the Ministry of Health. The project aims to prepare family medicine residents in the province’s primary care network (PCN) model. The Department is engaging clinics to see how feasible it is to train residents in a team-based primary care setting and supporting them in figuring out how to make the most of their teams for themselves, their residents and their patients. We work alongside the participating preceptors as they teach learners and residents in the family practice setting.
As team-based primary care gains popularity, full-service family practices like LCFP are at the forefront. All of the doctors at this clinic teach to varying degrees. Dedicating and allocating time each week to providing direct observation (DO) is important—and with the TPCLC project (which requires a minimum amount of direct DO), it doesn’t make a negative financial impact on the clinic.
The Team at Langley City Family Practice
With demands on doctors being intensely strained, LCFP has figured out how to maintain a thriving family practice that delivers high-quality care to patients and exceptional learning to residents. They provide a comprehensive range of services, spanning from assisting with surgeries, addressing various physical conditions like lumps and bumps, and offering obstetrics and women’s health care, to delivering long-term care, inpatient treatment and mental health support. By functioning as a TPCLC, they can problem solve using individual contributions based on each team member’s expertise.
Dr. Jeff Plante has been at Langley City Family Practice for 12 years. Prior to engaging with UBC and the Ministry of Health for the project, Jeff had already been teaching for eight years. His philosophy on the family practice community is that “physicians either work where they trained or where they grew up.” With that in mind, he strives to ensure that the clinic is somewhere that residents want to stay.
“This model is what I wish they had when I went through [residency].”
Clinic partner Dr. Suhani Thakore has been at the practice for two years. In this time, she has made a big impact. She says that during her residency in Langley, she was drawn in by the team-based approach. It is on a level she says she hasn’t seen in any other community. Here, it is “more like partnership care” where everyone in the clinic, such as registered nurses and room runners, provides parallel support to patients. Suhani appreciates getting advice from colleagues who have decades of experience, or who have recently graduated and have the most up-to-date knowledge. To her, this is a huge benefit. Part of her desire to join the TPCLC project is to get further experience teaching residents. While she hadn’t previously done any teaching, she loves providing this kind of direct observation, noting, “this model is what I wish they had when I went through [residency].”
Dr. Genevieve Leduc-Robert is wrapping up her time as a resident and will return to the LCFP as a full-time physician. Like many family physicians, she likes engaging with a variety of cases, getting to know patients, and seeing families change and grow. Working in a team-based setting, Genevieve “can focus on [her] role as a physician.” This also allows her to receive direct feedback, and prevents her from feeling isolated. For her, “it’s a good way to see where you’re at in your training, see how you’ve grown, and get specific feedback.”
Dr. Anita Wong has been a physician for 31 years—and a locum for 28 of them. She spends about 70% of her time at Langley City Family Practice, filling in as needed, and helping to provide continuity of care for patients when the doctors are away. The way she sees it, making connections with the community helps to ensure that people receive the longitudinal care they deserve. Her perception of the state of health care is that “people have been exceptionally stressed, but the doctors here are proactive.”
The nurses at LCFP spend their days seeing babies for immunizations, doing mini mental exams, ear flushes, allergy shots, physicals and even making phone calls to deliver test results. They work hand in hand with the doctors who make space for them to be experts in their own areas. RN Erynn Phillips appreciates that “there’s a huge level of respect for everyone – we recognize individual roles and expertise.” In addition, “breaking up tasks better serves patients. Less falls through the cracks. And for us, there is a reduced risk of burnout” says LPN Emily Gardiner.
The clinic functions as well as it does thanks to the team of medical office administrators, including an office manager Natalie Nandan, room navigator Chelsea Sielucki, and referral manager Cynthia Heudes. Together, they ensure that patients don’t slip through the cracks and that the clinic stays as organized and efficient as possible. Having a team of MOAs ensures that things run as smoothly as possible for the team and their patients. With this structure, residents also get the opportunity to learn about the business side of family medicine, like writing and submitting referrals and how to write prescriptions. The day-to-day of a family practice clinic is varied. When you need to expect the unexpected, it helps to have a group of people who are ready to step up and engage as needed. As Dr. Leduc-Robert put it, “you hear about lots of paperwork and forms and new things being put on family doctors, but when you have MOAs and nurses who can take on parts that fit their roles, you can focus on diagnosis and management.”
“You hear about lots of paperwork and forms and new things being put on family doctors, but when you have MOAs and nurses who can take on parts that fit their roles, you can focus on diagnosis and management.”
The clinic often has multiple learners at different stages, so residents can see the progress they have made since they started. Through ensuring resident involvement, everyone can learn from each other, and the doctors can also stay up to date on the latest in education. Dr. Wong notes that teaching keeps her “on her toes” and helps ensure that she stays current on the latest in family medicine.
A Functional Environment
All of the doctors, including the residents, share a communal office space. With this unique setup, they can share ideas, collaborate on cases, ask questions, and build a sense of trust and connection to one another that strengthens their team culture. The team is also able to use the money from the project to develop the infrastructure to facilitate residents in the office. They can support each other if a patient needs to be seen urgently, have discussions, and check in on outstanding questions with MOAs and nurses.
Due to the extensive range of cases and ongoing monitoring required, there is a need for thorough checks and diligent follow-up. Having a shared office space makes it accessible and expedient to receive answers and support. It also ensures that residents feel like welcome members of the team. Dr. Leduc-Robert pointed out that, “it’s a safe space. Including the residents, we feel like we’re part of the group.”
“[I]t’s a safe space. Including the residents, we feel like we’re part of the group.”
Patient Benefits
So what does this all mean for patients? It means same-day care. It means less time spent waiting. It means that people see the most appropriate provider for the concern they have at any given time. Team-based primary care creates access because patients get to see whoever has the most applicable skills for their needs. It also means that there is an increased capacity to see their doctors when most appropriate. With RNs, LPNs, MOAs, and residents, they can work to scope to allow everyone to do what they are comfortable with and are trained specifically to do. Ultimately, as Dr Wong put it:
“People who have longitudinal care do so much better. I’ve heard a lot of patients at the clinic say they are grateful to have a doctor, particularly in this office…Patients and demands are more complex, and the demands on physicians’ time is increasing … and collaborative clinics are the only way you can sustain longitudinal care.”
Lifelong Learning and the Future of Family Practice
What sets this clinic apart is the magnitude of what is being done. Team-based primary care ensures that patients are taken care of, doctors aren’t burning out, and residents are getting the direct observation they deserve to become the best family physicians they can be in an interprofessional model of care. Take it from Dr. Thakore:
“You are never alone. We want to impart that on our residents, too. Medicine is lifelong learning, the only way you can get through that and not feel overwhelmed is [by] having other people go through the same thing with you. The biggest thing about team-based learning and clinics is always feeling supported. As a recent grad, the biggest joy of teaching is learning from residents. The moment you hit on something that both teacher and resident have no idea is going on, it becomes an open forum … It’s a great space for learners. The ultimate teaching point of team-based care is recognizing you will never know everything about medicine, but that’s okay.“
Langley City Family Practice strives to do the best for their patients. It shows. Their main goal is patient care, and with that, comes an excellent teaching environment. With the future of family practice planted in team-based care, LCFP is leading the way.