As I stood in the crowded waiting room of Delta Hospital last Tuesday afternoon, an elderly woman caught my eye. Hunched over her walking frame, she’d been waiting four hours to see a doctor about persistent chest pain. “My family doctor retired last year,” she told me, her voice barely audible above the hospital noise. “I’ve been on waiting lists for a new one ever since.”
Her story is painfully common across British Columbia, where nearly one million residents lack primary care providers. What’s less understood is why solutions like team-based care – a model proven effective in other provinces – face implementation delays in regions like Fraser Health.
I’ve spent the past three weeks investigating why Fraser Health Authority has yet to request funding from the Ministry of Health for team-based care initiatives, despite other health authorities moving forward with similar programs. What I discovered reveals the complex interplay between administrative priorities, funding mechanisms, and community needs.
“We’re still in the planning phase,” explained Dr. Victoria Lee, Fraser Health’s president and CEO, when I asked about the funding request delay during a virtual media availability. “We need to ensure any model we implement addresses the specific demographic needs of our communities.”
Fraser Health serves approximately 1.9 million people across 20 diverse communities from Burnaby to Hope. The region faces unique challenges: it has the fastest population growth in the province, significant cultural diversity with over 40% of residents born outside Canada, and areas with high poverty rates alongside affluent neighborhoods.
According to documents obtained through Freedom of Information requests, Fraser Health has been developing plans for team-based care since 2019. Team-based care integrates doctors, nurse practitioners, social workers, pharmacists, and other professionals to provide comprehensive patient care—essentially creating healthcare teams rather than relying solely on individual physicians.
The Ministry of Health allocated $145 million provincewide for primary care network implementation in the 2022-23 budget. Other health authorities, including Vancouver Coastal Health and Island Health, submitted funding proposals and have already launched several team-based initiatives.
Dr. Mei Lin, a family physician in Surrey for over 25 years, expressed frustration about the delay: “We’ve been talking about team-based care for years. Meanwhile, I’m watching colleagues burn out trying to manage patient loads that could be better served by a collaborative approach.”
Statistics from the Canadian Institute for Health Information show emergency department visits for non-urgent care have increased 18% in Fraser Health regions over the past five years—a trend health policy experts attribute partly to lack of primary care access.
“When patients can’t access primary care, they end up in emergency departments or simply don’t receive care until their conditions worsen,” explains Dr. Rita McCracken, a family physician and UBC researcher specializing in primary care models. “Team-based care isn’t just about convenience—it’s about preventing serious health deterioration and reducing system costs downstream.”
The funding mechanism for team-based care requires health authorities to submit detailed proposals to the Ministry of Health. These proposals must outline implementation plans, community needs assessments, and expected outcomes.
When I visited the Ministry of Health offices in Victoria last month, I spoke with Deputy Minister Stephen Brown, who confirmed no formal funding request had been received from Fraser Health as of April 2023.
“We’re ready to review their proposal when it arrives,” Brown said. “The funding is available, but we need comprehensive implementation plans that demonstrate sustainability and measurable outcomes.”
For communities within Fraser Health’s jurisdiction, the delay has real consequences. In Langley, where population growth has outpaced healthcare infrastructure, family physician availability has reached critical levels.
I met Gurdeep Singh, a 42-year-old construction worker and father of three, at a walk-in clinic that was closing for the day—turning away fifteen people still waiting. Singh had taken the afternoon off work to seek care for persistent back pain.
“I’ve been to four different doctors in the past year,” he told me. “Each time I have to start over explaining my medical history. Nobody knows me as a patient anymore.”
The team-based model addresses precisely this problem by creating continuity of care and allowing healthcare providers to work at their full scope of practice. Nurse practitioners can manage many routine conditions, pharmacists can optimize medication regimens, and social workers can address socioeconomic factors affecting health—freeing physicians to focus on complex medical issues.
Dr. Lee defended Fraser Health’s methodical approach: “We’re learning from other jurisdictions’ implementations. Rushing into a model without proper infrastructure and community engagement could create more problems than it solves.”
Documents from Fraser Health’s Primary Care Strategy Committee, dated January 2023, indicate the authority is prioritizing “community-specific implementation” and “cultural safety” in its planning—legitimate concerns in a region with significant Indigenous and immigrant populations.
However, critics argue planning fatigue has set in. “We’ve studied this to death,” said Michelle Fortin, executive director of Options for Sexual Health, which serves vulnerable populations across Fraser Health communities. “The evidence for team-based care is overwhelming. The delay means people are suffering unnecessarily.”
When implemented effectively, team-based care has shown promising results. In Quebec, where family medicine groups have operated since the early 2000s, studies published in the Canadian Medical Association Journal demonstrate improved chronic disease management and reduced emergency department utilization.
The British Columbia Nurses’ Union represents many nurse practitioners who would be integral to team-based care. Their president, Aman Grewal, expressed concern about the delay: “We have qualified professionals ready to help address the primary care crisis. The bureaucratic delays are preventing them from serving communities in need.”
Fraser Health did not provide a timeline for when they expect to submit their funding proposal. Multiple sources within the authority, speaking on condition of anonymity, indicated internal disagreements about implementation priorities have contributed to the delay.
As I left Delta Hospital that evening, I noticed the elderly woman was still waiting. Healthcare access shouldn’t depend on one’s postal code or the administrative efficiency of their health authority. For the nearly 800,000 Fraser Health residents currently without consistent primary care, the funding delay isn’t just an administrative issue—it’s a daily reality affecting their wellbeing.
The gap between planning and implementation continues to widen. Meanwhile, patients wait.
