Thirty-six came for this first ever evening gathering of ASK Salt Spring to welcome MLA Rob Botterell and discuss healthcare needs in our community.After our Acknowledgement, we began by giving each participant a chance to introduce themselves. A common theme in these self-introductions was concern about not having a doctor, interest in a team approach to healthcare on Salt Spring, and frustration that things appeared to be changing too slowly. 

After introductions around the circle, Rob shared his delight at being the very last car to get onto the early morning ferry to Salt Spring. He shared his appreciation for ferry staff who asked two cars to shift slightly to make room for his car, a very tight fit. Rob also expressed his delight that so many had come to share their insights concerning healthcare with him, acknowledging later in the gathering how grounded – as well as not shy – were Salt Springers, consistently confident to express their opinions! 

Rob began our conversation by referring to the Accord between the Greens and NDP (https://news.gov.bc.ca/releases/2024PREM0075-001656), covering a number of important initiatives but targeting the expansion of community health centres as a top priority. While he had envisioned their immediate expansion, he now hopes that the first step in the process – an expedited review of our healthcare system – will provide a roadmap for this expansion when it is released this December. 

This healthcare-focused ASK Salt Spring is one of many steps in Rob’s process of thoroughly understanding our healthcare needs so that he can more effectively address them. He expects that his advocacy will focus on getting access to a primary care physician for all as well as filling gaps in our healthcare services. While he wants change to happen quickly rather than getting mired in “never never” plans, he warned us that change does take time. Recognizing that our healthcare service will not change overnight, he has high hopes for significant progress in 2026. 

Reminding us that while it is his job to address our needs, it is our job to make sure that he is clear about those needs. Asking us to think flexibly and creatively to explore solutions, we began our lively conversation about concerns with our current healthcare system and options for change. 

While comments from participants covered a wide range of issues, some themes soon emerged: 

1. Are we requiring doctors to fit into an outdated model? It is estimated according to 2021 census figures that there are 3,460 Salt Springers without a primary care doctor. (It may be helpful to update this estimate.) Is this simply due to a shortage of doctors? Should our focus be upon expanding the capacity of our provincial medical schools? While training more doctors in BC is always a good plan, there seemed to be consensus that the issue is more complicated. Currently, doctors choosing Salt Spring must fit into the old (some believe outdated) model in which they must set up their own practice, shouldering the enormous initial setup costs as well as daunting ongoing operational expenses. These doctors often find themselves spending far more of their time and energy with business and administrative tasks rather than patient care. Many younger doctors do not want to work in this old model, attracted, instead, to the model of a team of health professionals working together. While hope is on the horizon, right now Salt Spring cannot offer doctors this team-based option. 
2. Attracting a doctor to one’s community requires certain amenities, with housing at the top of the list. It was suggested that Salt Spring is not doing all it can to attract interested doctors. When homes come on the market, should they be purchased as an extra enticement? How well are we doing identifying doctors who seek the lifestyle Salt Spring offers? Do we have a strategy and a team to close the deal with interested doctors by lauding the joys of island life and enticing them to share this lifestyle? A participant spoke of her recent joy successfully recruiting a doctor and his family, a huge time commitment with great benefits. Most seemed to agree that, with a recruiting strategy and a team, we could do better attracting interested doctors. 
3. Can we get more Nurse Practitioners on Salt Spring? It was generally agreed that the potential of nurse practitioners is not fully realized here. It was theorized that this is partially due to the shortage of preceptors for them(https://www.dal.ca/faculty/health/practice-education/for-students/what-is-a-preceptor-.html). While doctors in private practice may not have the time for such mentoring, would a team of professionals working together be more able to offer this needed training and experience? 
4. Some commented that our current single point of entry was inadequate, suggesting a more holistic approach. Some spoke of the value of access to other healthcare professionals in the same location. They mentioned the value of a team of healthcare professionals, bringing together many expertises including social workers, mental health workers, physical therapists, and pharmacists to address our health needs. Others mentioned the importance of being able to discuss multiple, connected health issues at a single appointment rather than the current limit of one issue per visit. Especially important to seniors with numerous connected issues and various medications, it was theorized that great progress could be made if health were approached from a holistic perspective rather than our single point of entry system 

As our conversation progressed, it became evident that many in the room were deeply interested in the team concept of health care and that it was time to define some models of this holistic approach. We learned that there are many successful clinic models in Canada and that many fall into one of two categories: 

1. A Community Health Centre (https://bcachc.org/about-chcs/) is a community-driven not-for-profit or cooperative organization that offers healthcare services and programs through a collaborative team approach. There are many examples of successful Community Health Centres, most notably and nearby on Pender and Gabriola Islands. It was noted that the Gabriola Community Health Centre was built by 150 determined local volunteers (https://gabriolamed.ca/). 
2. A Primary Care Network ( https://fpscbc.ca/what-we-do/system-change/primary-care-networks) is a partnership of physicians, nurse practitioners, nurses, and other health care providers to offer a team approach. Provision can be made for community partners.  

For many, the distinction between Community Health Centres (CHC) and Primary Care Networks (PCN) appears to be minimal with community involvement foundational for the success of both. For some, the initial impetus differs as Primary Care Networks are often physician-driven. But, for most in the room, this distinction diminished with the great news that a number of our physicians in the South Island Division of Family Practice have been working diligently to create a PCN for Salt Spring. And, their efforts are bearing fruit as 11 full time equivalent healthcare workers have been allocated to Salt Spring’s PCN – Thank you!

Very good news indeed, we learned that there is still much to do to make Salt Spring’s PCN a reality, especially finding or creating office space for these 11 new health care workers and securing housing for them. Participants asked: “How can I help?” “Can I donate money?” “When can we learn more?” The response was: “Please give us a bit more time and stay tuned for an exciting announcement in the very near future – maybe, mused Rob, a wonderful Christmas present for Salt Spring?”  

With that enticing promise, we turned our attention to addressing Rob’s need to identify gaps in our healthcare services. While time did not allow for the creation of a comprehensive list of missing Salt Spring healthcare services, participants identified the following service gaps for: 

• Youth;
• Sexual Health Intervention;
• Neurodiverse Needs;
• Children. . . .there are neither pediatricians nor children’s physical therapists on Salt Spring;
• Preventative Medicine and Nutrition; 
• Electrocardiograms, MRIs, and Dialysis Equipment and Services;
• Elder Support, Especially Concerning Abuse; 
• Long Term Care Facilities;

Our time together over for this gathering, it was clear that participants could have continued listing missing healthcare services. Instead, they bid an appreciative “Farewell” to Rob, thanking him for his eagerness to ask us, willingness to listen, commitment to be our advocate, tenacity to find solutions to the myriad of healthcare concerns, and optimism that we can revitalize an outdated primary care model to a community-responsive approach that works for all. (Thank-you, Rob!)  

Just in case you are interested. . . .This report has been written by Gayle Baker, founder of ASK Salt Spring, currently also a Salt Spring Local Community Commissioner. It has been reviewed and edited by Rob.