Minister Christian Dubé, among all the measures and work put in place since your arrival at the Ministry of Health, we must highlight a notable success: the implementation of the Front Line Access Counter, the GAP. At our medical clinic, approximately 12,000 places were offered. This success depends, mainly, on honest and effective collaboration between the ministry and family doctors.
Let us also remember that the GAP is an idea of family doctors and that its implementation was under the responsibility of the Ministry of Health. Initially, in 2022, the objective was 500,000 meeting places annually for all of Quebec. Today, we are around 950,000 places offered.
However, instead of celebrating this success, your negotiators unilaterally announced the end of the agreements that allowed the implementation of the GAP. For our clinic alone, there are 12,000 appointments that your ministry will take away from the citizens of Saint-Jean-sur-Richelieu and the surrounding area.
An essential package
Each patient registered collectively at the clinic with this GAP agreement comes with an annual fee of $120. This amount is distributed by the clinic manager to the doctors in proportion to their participation and is used in part to pay the salaries of other health professionals, administrative staff and the costs of equipment and premises. Also, this is an amount that remunerates doctors for supervising the implementation of collective registrations and monitoring the results and examinations that these doctors will receive for the current year.
With the law on attendance implemented years ago by Minister Barrette, a large proportion of family medicine groups (GMF) in Quebec closed their doors to patients without a family doctor registered in their establishments. The reason was simple: this law financially punishes doctors who do not see their patients.
The arrival of the GAP allowed our clinic — and others — to open walk-in slots to orphan patients. In a region without a network clinic, the GAP became the only door open to patients without a family doctor to avoid emergencies.
Our clinic was able to hire two nursing assistants, allowing for a second triage at the clinic and the provision of services such as taking vital signs or taking blood. We also hired a new receptionist and medical secretary to handle the influx of new patients. All this thanks to the $120 package paid to doctors, but transferred in part to the clinic. Likewise, two doctors decided to come and lend a hand to our project of opening at GAP.
The majority of patients seen by this system had access to comprehensive care and medical monitoring for their chronic condition — or to an urgent consultation for an urgent problem — while waiting for their turn at the access window to a family doctor, the GAMF.
A suppression with disastrous effects
We knew the agreement was for two years. However, it was agreed that we needed to find a new approach to patient and remuneration management with the upcoming framework agreement. We understand that issues at the ministry may have delayed discussions. And we were prepared to continue with the current GAP terms until the new framework agreement was in place.
The department’s unilateral decision not to offer a “bridge”, that is to say to at least maintain the current agreement until a new agreement is signed, will have catastrophic effects.
For us, it will be impossible to keep two nursing assistants. We will also lose the help of three doctors at GAP. The rest of the team will return to their regular practice, with their registered patients, to avoid threats of penalties. The medical secretary and the receptionist will therefore also have to leave us if a solution is not found quickly.
Concretely, there will be no other appointments offered at GAP by our clinic: that’s 12,000 appointments lost. And you should know that this step back will scold many professionals: rebuilding what took two years to build is far from being a credible possibility, even if the financing conditions of the GAP were to return in a few months.
Mr. Dubé, this is a call for the urgency of the situation. We are all extremely sad and frustrated for the patients. May 31st is coming: keep what’s working well in place… while there’s still time to save it. And while there is still time to find a lasting solution.