The Coast Mountain Primary Care Network (PCN) is a diverse and vibrant region encompassing the communities of Tahltan, Dease Lake Stikine, Stewart, Nass Valley, Kitsumkalum, Kitselas, Terrace, Thornhill, and Lakelse Lake. The geography encompasses over 30,000 square kilometres and covers some of the most remote and complex landscapes in British Columbia, from Terrace to the Yukon and Alaskan borders.
The Coast Mountain Primary Care Network is the result of a collaborative effort following years of planning and engagement with partners including First Nations Health Authority, Kitselas Health, Kitsumkalum Health, Nisga’a Valley Health Authority, Northern Health Authority, the Pacific Northwest Division of Family Practice, and Tahltan Health.
The Coast Mountain PCN region has a catchment of approximately 27,461 patients. This population is expected to increase to more than 30,000 by 2026.
Coast Mountain PCN patients experience significant challenges to accessing primary care as they reside in geographically remote, rural, and weather impacted communities. These considerations are important in the context of designing the Primary Care Network.
The Tahltan people have occupied their territories around the upper reaches of the Stikine River in what is now northwestern British Columbia since time immemorial.
Lack of publicly funded access to allied health care providers is impacting on the long-term status of patients in the TAHLTAN STIKINE region.
Tahltan community members have indicated their highest priority is to ensure access to a local Pharmacist for the Dease Lake Health Centre, as well as to provide primary care community dispensing and patient consultation supports. A 1.0 FTE pharmacist recruited through the Coast Mountain Primary Care Network will help to stabilize this support.
Through a PCN early draw, a 1.0 FTE Family Physician has been recruited. A remaining 0.20 FTE of Family Practice support will be further implemented to enhance attachment. Through the Primary Care Network, allied health care providers including: Psychologist, Traditional Wellness Advisor/Navigator, Physiotherapist, Occupational Therapist, Speech Language Pathologist, Kinesiologist and Dietitian (0.5 FTE each) will bolster primary care within Telegraph Creek, Dease Lake, and Iskut.
Nisga’a Valley Health Authority’s planned PCN supports will further strengthen the established Nisga’a Valley Health Authority team by providing 1.8 new Family Physicians who will work collaboratively with the existing NASS VALLEY Family Physicians and Nurse Practitioners to attach patients who are currently without a primary care provider.
New Psychologist, Occupational Therapy, Dietitian, and Kinesiologist supports will allow for the development and operationalization of in-community, culturally safe access to these health professionals, as well as enabling lifestyle supports (CHANGE BC) for type 2 diabetes and metabolic syndrome patients.
A critical support needed within the Nisga’a Valley primary care network plan is the redevelopment of infrastructure in terms of clinic space. One of the existing clinics is located in a flood and tsunami zone, and needs to be rebuilt in a safer location. Other clinics will require baseline renovations to allow for team-based care and effective patient access and utilization. This service plan provides a cost estimate for Nisga’a Valley Health Authority capital costs, and respectfully recognizes the funding for these developments will be determined through government-to-government discissions between Nisga’a Valley Health Authority and the BC Government.
A high priority for Stewart is family practice: nursing outreach to vulnerable patients within the community. Currently, this service does not exist and will be a welcome priority for Stewart.
The request will be for a 0.5 FTE registered nurse with a special interest in family practice home visits. In addition to this, Stewart will be part of the rotation of Allied Healthcare Providers who will provide support to the Tahltan Stikine region, enabling patient access to a broad range of family practice focused primary care supports.
The contemporary community of Kitsumkalum draws on its ancient Tsimshian culture for values. The meaning of Kitsumkalum refers to the ripples in the water as it runs over the rocks, while another description refers to the “People of the plateau”.
Kitsumkalum’s priorities are for family physicians who are able to provide care within the community, taking time to establish relationships that are culturally safe, and providing optimal care for individuals who have not traditionally had success with maintaining longitudinal primary care.
Recruitment of 1.7 FTE family physicians will build attachment and address long-standing continuity challenges. Kitsumkalum will recruit Allied Healthcare Providers, including: Traditional Wellness Advisor, Dietitian, Kinesiologist, Occupational Therapist and Physiotherapist (0.4 FTE each).
Kitselas Traditional Territory stretches from the Pacific Ocean on British Columbia’s North Coast, about 200 kilometres inland, to the Skeena River Valley. The Kitselas Territory is comprised of several reservations. The majority of their people live on two reserves close to the City of Terrace: Gitaus and Kulspai. The Kitselas First Nation is known as Gitselasu, The People of the Canyon.
Kitselas has indicated having local family physicians who are able to provide culturally safe care within the community is a priority. Recruitment of 1.5 FTE family physicians will provide culturally safe care and outreach to each of Kitselas’s communities establishing trust and providing longitudinal primary care to unattached patients.
Kitselas will develop a Primary Care Network team of Providers, including: Traditional Wellness Advisor, Dietitian, Kinesiologist, Occupational Therapist and Physiotherapist (0.4 FTE each).
Within the Coast Mountain and Pacific Northwest region, Terrace functions as the regional centre for primary care and acute care supports, serving the population of Terrace as well as the rural surrounding areas. The Coast Mountain PCN will provide care for thousands of patients who reside in the some of the most isolated communities in the province. Our communities are heavily impacted by challenging weather, travel, supply and staffing complexities, as well as patient access challenges in terms of geography and connectivity.
Family physicians in Terrace provide multiple services to the community and surrounding areas in addition to their community-based practices. These include in-patient care at Mills Memorial Hospital, staffing a busy Emergency room, regional psychiatric ward assists, maternity care (including C-sections), surgical procedures, surgical assists for visiting specialists, anesthesia, oncology, opioid agonist therapy, long term care, sexual health clinic (OPT clinic), and palliative care (including MAiD).
Despite providing all of the community supports listed above, panel sizes are generally as large or larger than urban counterparts. In addition, due to a lack of allied health support and access, largely due to recruitment issues with multiple vacant positions, family physicians are spending a significant amount of time providing care to patients that would best be delivered by other practitioners, including counselling/mental health services, injury rehabilitation, chronic disease management, medication reviews, disability applications, etc. By optimizing patient access and flow through the PCN this would also open up space in current practices to take on more patients.