04/22/2014 07:13 EDT | Updated 06/22/2014 05:59 EDT

Vancouver clinic changes may leave patients without doctors, says report

An external review commissioned by Vancouver Coastal Health says the authority's plans to change services at a number of health clinics could leave vulnerable patients without doctors.

The report — obtained by the CBC — questions a decision to consolidate services for at-risk patients from five clinics around the city to the Raven Song Community Health Centre.

Coastal Health says the move is intended to better serve the five per cent of patients who are most in need. But the review, written in December 2013, says many of those who don't meet that criteria still need complex care.

"It is widely recognized that few private practices are accepting new patients and virtually none currently have the additional resources, staff and expertise to manage patients with complex and intertwined health and social needs," says the external review.

"We agree that expecting private practices to absorb and maintain potentially unstable and high-needs patients without additional support is unrealistic."

The review was penned by Providence Healthcare's Dr. Garey Mazowita and Vicki Farrally of Praxis Management. 

Coastal Health operates the Pine, Evergreen, Pacific Spirit and South Community Clinics and provides funding to the Mid-Main clinic for primary care. 

The doctors are salaried, as opposed to fee-for-service, and are supposed to work alongside nurse practitioners and clinical pharmacists to provide interdisciplinary care to at-risk patients, such as new immigrants, marginalized youth, the mentally ill and the frail elderly.

The health authority claims the clinics are increasingly serving low-risk patients who would be better served by fee-for-service practitioners.

In contrast, the review says the clinics believe they are "serving high-needs patients who otherwise would go without primary care or use more expensive services such as emergency departments."

Quality of care questioned

The controversy comes just months after B.C.'s Auditor General released a report questioning the quality of care British Columbians received in exchange for the $3.6 billion they paid to doctors in 2011/2012.

That report noted the fee-for-service system "restricts physicians from working in interdisciplinary teams, which have been shown to improve patient satisfaction, access and equity."

The external review makes the same point.

"The optics appear contrary to the government's current integration and interdisciplinary care agendas," the review says.

"The optics of undertaking significant change to the handful of interdisciplinary clinics already serving primarily marginalized high-needs populations and their redirection to largely inaccessible private practice may be difficult to address."

Vancouver Coastal Health's medical director of primary care, Dr. David Hall, says the health authority factored the concerns raised in the external review into its plans.

"There is a caution in the external review about ensuring that we do provide care for everybody who's already connected to us," said Hall.

"We will do our best to ensure that clients continue to have a family doctor through this change.

"We're moving slowly to make sure that happens and we have provisions to continue to provide care for everybody that's currently getting service from us."

Patients have been told the changes will take effect in October.