Virtual walk-in clinics undermine primary care
Despite efforts by the BC government to increase access to primary care, new developments risk making it even harder to find a doctor.
BC 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, however, 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.
BC is one of the only provinces that allows doctors to bill government for virtual phone or video visits without restrictions.
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’s 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 UK-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 BC 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.
How?
Walk-in clinics—virtual or otherwise—erode the personal relationship and do not provide effective primary care.
Telus, for example, pays doctors a guaranteed amount per hour regardless of whether they consult with patients via the app or not. This is different from the dominant fee-for-service payment model whereby family doctors are only paid based on the volume of services provided, and is increasingly attractive to a number of doctors who are looking for a predictable income and don’t want to a run a business by billing fee-for-service. However, in attracting doctors to work for the Telus Babylon health app, we are left with fewer doctors to provide relationship-based primary care and patients have 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 where they can be paid a predictable salary. Community Health Centres offer this advantage by providing family doctors with the kind of workplaces they increasingly expect while also giving patients a higher quality continuity of care.
Rather than allowing disruptions from companies like Telus that undermine effective primary care, the BC government should follow other provinces and restrict the use of virtual care to doctors who provide on-going care at approved clinics.
Topics: Health care
