Alberta government report finds inappropriate spending in Primary Care Networks

— Keith Gerein, Postmedia

Inappropriate spending, questionable compensation for administrators and slow progress on developing interdisciplinary care are among the problems highlighted in a new government report on Alberta’s Primary Care Networks.

“The main finding in the analysis of the review was that there is a great deal of variability in both service and financial practices across the sampled PCNs,” says the report released Monday. “There is little evidence that (PCNs) assess community health needs in a methodical manner to match their programs with community needs, allocate resources for priority areas and evaluate to ensure results are aligned with objectives.”

Since being created in 2005, PCNs have become the province’s predominate vehicle for delivering primary care, with about 80 per cent of Albertans now enrolled in one of the province’s 42 networks.

In basic terms, PCNs are groupings of privately owned doctors’ offices that work together to care for patients. Under the current funding formula, the government provides $62 a year to a PCN for each patient in its roster — money that is supposed to be used to hire other health professionals, such as therapists, nutritionists, pharmacists and nurses, who are shared around the network.

The idea is that patients will receive better care if they have access to a team of health professionals that can help prevent disease, manage chronic conditions and keep track of their interactions with other parts of the health system, such as hospitals and diagnostic testing.

However, there have been concerns raised in recent years that some PCNs have not been making wise use of all the money they have received and have been too slow to improve their services.

The new review backs up many of these worries, prompting the government to warn that changes are coming.

The government said Monday it has already imposed clearer financial guidelines on PCNs, while additional new rules in the areas of governance accountability, financial accountability, service responsibilities and team-based care will be announced in the coming months.

As well, consultations are to be held that will focus on expanding after-hours care and shifting to a new funding model that promotes better team-based care.

“This review showed primary care networks are delivering patient-focused health care in most cases, but it also showed there are some inconsistencies,” Health Minister Sarah Hoffman said in a written statement.

In conducting the review, the government picked a sample of 13 PCNs from different areas and looked at their financial practices and service delivery. Also included was the PCN program management office run by the Alberta Medical Association, which was created to provide operational and business support.

In particular, the review found:

• Wide disparities in how PCNs reported relationships with AHS, “with the majority reporting that their governance representatives changed too frequently and often were not at the right level within AHS to make decisions.”

• The program management office has failed to provide consistent support for the PCNs to standardize services.

• Instances where PCN administrators have received compensation above guidelines, and instances where the appropriateness of spending on compensation for doctors was unclear.

• Instances where PCNs used public dollars on inappropriate expenditures that were inappropriate.

• The primary care initiative policy manual is out of date and does not reflect modern day operations.

• The pace of development of effective inter-disciplinary teams has been slow, and PCNs still use too many physicians as opposed to non-physicians to deliver care.

Last year, the government cut funding to PCNs, ordering them to use some of their accumulated surpluses to make up the difference. Full funding was restored in the latest budget to $233 million.

Since their inception, the province has spent more than $1 billion on PCNs.

A report from the province’s auditor general in 2014 criticized PCNs, the government and Alberta Health Services for failing to show enough urgency on the primary care file, particularly for people with chronic illnesses who would be the biggest beneficiaries of having regular access to a team of health professionals.