Prima Health Annual Report 2024

Message from the Board

Primary care in Kootenay Boundary and our province is under immense strain, with 20% of the population lacking a family doctor or nurse practitioner. Prima Health, a not-for-profit cooperative, was created to address this crisis by pioneering community-led clinics that reduce administrative burdens on practitioners, improve team-based care, and ensure sustainable operations. As a responsive and innovative solution, Prima brings highly skilled professionals to support and stabilize clinics while meeting the evolving needs of both practitioners and patients.

Over the last three years, Prima has grown significantly, with three clinics already operational and a new one set to open in 2025. Prima Health is committed to expanding access, optimizing care delivery, and fostering collaboration among stakeholders. By leveraging community partnerships and advocating for systemic change, Prima Health aims to transform primary care in the region into a model of equity, sustainability, and resilience. We are proud of Prima’s accomplishments and remain dedicated to realizing a truly regional vision of networked clinics and accessible primary care for everyone in Kootenay Boundary.

Pat Dooley (Chair), Dr. Ellen Smart (Vice-Chair), Dr. Tobias Gelber, Kris Salikin, Linda Sawchenko

Why Prima?

The primary care landscape in Kootenay Boundary is under  stress, with a complex web of challenges for both practitioners and patients. The strain is amplified by the fact that 20% of the population, or approximately 17,000 in the region do not have a family doctor or nurse practitioner. These “unattached” patients often find themselves with limited options. Walk-in clinics, once a  reliable resource for many, are disappearing due to insufficient funding models. As a result, unattached patients must turn to alternatives like corporate healthcare platforms or crowded Emergency Departments (EDs) to meet their needs. EDs are busier than ever, and temporary closures are in our region are starting to occur. Forecasts paint an even more challenging picture, with provider shortages expected to worsen by 2027 as demand continues to grow.

Physician-owned clinics, often viewed as the backbone of community care, are struggling under mounting pressures. High staff turnover, tight operational margins, administrative burdens and burnout are endemic. Clinic spaces are frequently too small to accommodate growing teams or train medical learners. Physicians report that the time and effort required to manage team recruitment, technology, finances, and operations are often unpaid labor, and take away from hours that could otherwise be spent with patients. Team-based care, although important, is insufficient to meet current and rising demand. The traditional private practice model is becoming less appealing to new graduates, making recruitment harder as older physicians retire. Meanwhile, the surge in corporately owned and operated clinics, such as those seen in Richmond, BC—where one-third of clinics lack physician governance—is resulting more expensive care and threatens continuity of care and the focus on social determinants of health.

For patients, the impact is deeply personal. Those without a family doctor or nurse practitioner struggle to access timely care, face long wait times for appointments, and experience a lack of continuity in their healthcare. Many are forced to rely on Emergency Departments, even for non-urgent issues, due to the lack of accessible alternatives. This situation undermines health equity and the stability of the entire system.

These systemic stresses ripple outward, impacting the broader community. The instability of healthcare provision becomes a barrier to economic development, leaving communities grappling with both unmet medical needs and reduced attractiveness for prospective businesses and  residents.

Because of these challenges, there is a growing passion for community clinic models, with practitioners and communities envisioning a better way forward. Without immediate action to stabilize healthcare delivery and support innovative care models, the situation will only worsen, threatening the well-being of both patients and practitioners. The time for change is now, and it must address the system as a whole—bridging gaps, reducing burdens, and ensuring care that is both accessible and sustainable.

What is Prima? 

In 2021, the KB Division of Family Practice established Prima Health, a not-for-profit independent cooperative with a clear and ambitious mandate: to reimagine primary healthcare delivery in the Kootenay Boundary region. Governed by a five-member board of directors, Prima Health is designed to provide management services to clinics, operate innovative community-led clinics, and foster collaborative approaches to healthcare alongside other stakeholders.

Prima Vision

Prima Health has developed a bold vision for how primary care can better serve communities. Prima’s Regional Service Plan, with six proposed clinics, outlines a sustainable model centered on efficiency, team-based care, and community governance. Though initially aiming for provincial funding, Prima is now leveraging community partnerships and opening unfunded clinics to meet the urgent need for care.

The six proposed Community-Led Clinics (CLCs) aim to reduce administrative and financial burdens on physicians, enabling them to focus on patient care. By shifting ownership and operational responsibility to the community, these clinics lower costs and support sustainable team-based care.

Prima Health in Action

Prima Health operates two primary care clinics and a screening clinic, while providing financial and human resource support to three additional clinics. A new clinic is set to open in January 2025. These efforts are driven by a commitment to:

• Increasing the time physicians and nurse practitioners can dedicate to direct patient care.
• Enhancing team-based care to distribute workload and meet rising demand.
• Attracting and retaining both Canadian and international healthcare providers through well designed spaces that enable collaboration and efficiency.

The Cornerstones of Prima Health

1. Capital Investment
   A significant challenge facing clinics is the lack of space. Many operate in facilities too small  to accommodate current teams, let alone future recruits or medical learners. Prima Health proposes to address this by investing in expanded clinic infrastructure, fostering economies of scale, improving workflows, and easing the transition for retiring physicians by removing the burden of clinic ownership.
2. Enhanced Team-Based Care
   Prima Health is committed to optimizing team-based care, which research shows improves patient outcomes and increases efficiency. By aiming to improve the ratio of team members to physicians and nurse practitioners, Prima clinics ensure patients receive the right care at the right time, relieving the strain on physicians and creating a more collaborative healthcare environment.
3. Operational Investment
   With high operational costs and frequent staff turnover, clinics often struggle to maintain stability. Prima Health seeks to increase funding for operational overhead, ensuring clinics can retain skilled staff and enabling practitioners to focus on patient care rather than administrative tasks.
4. Community Participation
   Sustainable primary care is a shared responsibility. Prima Health’s model relies on community members to actively participate in clinic governance, financial investment, and advocacy, fostering a sense of shared ownership. This approach not only strengthens clinics but also makes healthcare providers feel valued and supported within their communities.
5. Networked Clinics
   Prima Health emphasizes the benefits of a networked clinic model. For practitioners, it means opportunities for mentorship, shared learning, and coverage. For administrative staff, it creates a community of support and innovation. A centralized backbone organization brings economies of scale and unified resources, enhancing efficiency across the system.
6. A Regional Approach
   Prima Health recognizes the unique challenges of both rural and urban communities. Their model seeks to address inequities by ensuring funding and infrastructure improvements benefit underserved populations across the region. By prioritizing collaboration over competition, Prima Health strives to meet the needs of all British Columbians, particularly those in marginalized or remote areas. 

A Call to Action

Prima Health’s work is driven by a deep belief in the power of community and collaboration to transform primary care. The challenges are significant, but the opportunities are immense. By building a network of community-led clinics, Prima Health is setting the stage for a future where healthcare is not only accessible but also adaptable, equitable, and sustainable. The success of this vision will require continued investment, partnerships, and a shared commitment to better care for everyone in the Kootenay Boundary region.

What Prima did this year

This past year, Prima Health and the Kootenay Boundary Division of Family Practice have been working closely together to continue work on designing and implementing a vision for a future for primary care clinics that is equitable, sustainable, and resilient, with space for new practitioners, reduced administrative burden and robust team-based care. Prima Health continues to advocate for a full complement of community clinics in our region as outlined in our Regional Service Plan submitted to government in the fall of 2023. 

Prima Health continues to manage the KBHealthOnline.ca, a nurse practitioner-led  primary care clinic, and in this past year successfully opened, KBScreen.ca, a screening clinic for unattached patients , transitioned the Beaver Valley Clinic to community-led operations under Prima Health in October of this year. Additionally, three clinics in the Boundary region have signed agreements for financial and HR management support from Prima.

KB Division and Prima Health also worked with the Lower Columbia Community Health Centre Network Society who received approval in September for the Lower Columbia Community Health Centre in Trail (Read all about it!).

What is Prima going to do next year?

As Prima Health looks to the future, its commitment to transforming primary care through community-based clinics remains unwavering. By focusing on reducing administrative burdens, improving recruitment, and building sustainable care models, Prima Health aims to address the region’s pressing healthcare challenges. Key priorities for the coming years include: 

• Launching KB Access: Scheduled to open in January 2025, this episodic care clinic will provide essential services to unattached patients, addressing a critical gap in access to care.
• Supporting Existing Clinics: Prima Health will continue to alleviate the administrative burden on physicians and nurse practitioners in its current clinics, optimizing team-based care and ensuring efficient operations.
• Engaging Stakeholders: Efforts will focus on increasing awareness of the value and necessity of Prima Health community clinics among regional and provincial stakeholders, including local businesses, non-profits, and municipal and regional governments.
• Advocating for Funding: Prima Health will persist in championing the infrastructure and operational support needed to bring the Prima Regional Service Plan to fruition.
• Listening to Healthcare Providers: Regular engagement with local physicians and nurse practitioners will remain a cornerstone, ensuring their needs inform ongoing improvements to the Prima Regional Service Plan.

Through these initiatives, Prima Health continues to lead the way in creating accessible, efficient, and sustainable primary care solutions for the Kootenay Boundary region.