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A fight best held in public

On paper, there’s room for Alberta’s 40 Primary Care Networks and the 140 family care clinics proposed by the province to work side-by-side.

On paper, there’s room for Alberta’s 40 Primary Care Networks and the 140 family care clinics proposed by the province to work side-by-side.

But so far, there’s only been a series of disagreements reported in the province’s papers on how this should be funded and managed — which is as it should be.

The public airing of grievances from PCN supporters on its own has been informative for many thousands of Albertans whose only understanding of primary or family health care can be found in a hospital emergency ward. Not to mention the illumination provided by auditor general Merwyn Saher, who says there’s no mechanism in place to determine how much value Albertans are getting for the $170 million a year they are putting into the PCN network.

Perhaps it’s uncomfortable for Premier Alison Redford, Health Minister Fred Horne, Alberta Medical Association president Linda Slocombe and others to read the back-and-forth of negotiations reported publicly. But for the public, this is a good outcome. We’ve had too much of secret meetings, and deals announced for which we have few details, and even less ability to understand the costs.

If Alberta is going to have a fight over health care, let us have this fight in public.

University of Alberta professor John Church recently told reporters that the time has come for Redford to “fish or cut bait.” “And the premier is willing to cut bait,” he said.

That means upon the expiry last week of a temporary agreement between doctors and the government, there’s a whole new agreement to be made. So far, it’s reported that the province has proposed removing the language related to PCN from the agreement and killing a task force that was to study the system.

You can read this as a proposal to end Primary Care Network, as some doctors fear — but so far, this is only on paper.

Right now, there are 40 PCNs scattered over the province and they get $62 for every Albertan in their region — even those Albertans who don’t even know a PCN exists in their area, much less how to contact one. Primary Care Networks are run by doctors and other health professionals. They co-ordinate individuals’ care and can refer patients to other providers, plus provide advice on wellness and healthy living to the community.

They are for-profit entities, run under the authority of the doctors. Since they started about a decade ago, doctors report greater efficiencies, allowing physicians to carry higher patient loads, which means doctors who were not accepting new patients in the past are accepting new patients now.

We simply know this as better access, for which $62 a year seems like a pretty good deal.

The proposed family care centres would stay open late and accept walk-ins. You may not see a doctor — you may not need to. Other practitioners would have authority to take a look at you and perhaps give you a shot you may need, or other minor things we now associate only with doctors. The clinic would be paid on a for-service basis.

For families that cannot find a family physician, or for entire towns that don’t have one, this also looks like a pretty good deal. Employing greater numbers of nurse practitioners to do more of this team-approach health care appears to work in Europe, for instance.

In the meantime, the AMA and the province have no agreement on pay and working conditions. Which should seem pretty obvious to the readers of newspapers.

This is the system working in public. It’s our money on the table, and we can trust the participants to have our interests at heart.

Of course, the actual negotiations should be private, but the issues need to be debated at length, in public. That’s what paper is for.

Greg Neiman is an Advocate editor.