'Worth fighting for': Group Health CEO addresses 'gut-wrenching' call to cut patients

The Group Health Centre’s model is successful and worth fighting for despite the impending de-rostering of more than 10,000 patients, says its president and CEO, but she says immediate efforts will be focused on slowing the bleed to prevent 6,000 additional people from losing their primary care provider.

This week, GHC president and CEO Lil Silvano and communications manager Giordan Zin sat down with SooToday for an in-depth interview about the circumstances that led to the current primary care crisis in Sault Ste. Marie, and the future of the organization.

Silvano said the decision announced in January to de-roster 10,176 Group Health Centre patients was "unfortunate," but said it was done under the guidelines of the College of Physicians and Surgeons of Ontario.

"These are our family, these are our friends, our neighbours, our employees, right? They no longer have access to care,” she said. “The magnitude is huge.”

Zin noted all of the patients on the list to be de-rostered were at one time attached to a primary care provider, but some have spent years without a permanent one while the GHC was seeking replacements.

For years, the Group Health Centre has insulated the Sault from experiencing the full impact of fewer family physicians entering the profession than were retiring or leaving, said Zin. 

"Like in other communities, when physicians retired, the de-rostering was pretty much a common occurrence,” said Zin. "The Group Health Centre, with the collaborative team model, for a long time people would be like: 'Oh there's a new a new physician coming in. They'll assume the roster.”

The years-long shortage of primary care providers signing up to practice at GHC came to a head when some 2,823 patients over seven years were the first wave to be de-rostered, followed by the announcement in January that 10,000 more would no longer be members as of May 31.

“The decision was gut-wrenching, we struggled with it for a long time,” Zin said.

With only a few short months of notice, thousands of Sault residents received a letter informing them they would no longer be patients of the GHC as of that date.

Silvano, who took over as president and CEO of the Group Health Centre in November 2022, said she walked into an organization facing a "perfect storm" in terms of the shortfall of physicians and other issues.

"I don't think anyone could have fathomed this to happen 60 years ago or even 10 years ago,” she said of the de-rostering.

Zin noted most of the senior management team and most of the current GHC board members are relatively new to the organization.

"We've got a phenomenal team in place and they're all brand new,” he said. ”It's just unfortunate that, as soon as they arrive, this crisis is here and we're kind of hampered.”

Previous to her current role, Silvano served as Sault Area Hospital’s vice-president and chief financial officer. 

After she started, Silvano took a closer look at the money coming into the GHC from the province. She noticed the five-year provincial funding agreement for specialist support at the centre had never increased since the deal was signed in 2012 under the previous Liberal government. 

Every year, including after the election of the Ontario PC government in 2018, the agreement kept getting rolled over with no increases, even though the cost of providing those services has steadily increased.

A boost to that funding over time was is the spirit of the original agreement, said Silvano, and in a January letter sent to the ministry and MPP Ross Romano, she asked for $4.7 million in a one-time retroactive payment and $500,000 in ongoing funding.

Silvano said she couldn’t see any evidence that the previous management at GHC had ever requested an increase in specialist funding from the Ministry of Health.

That specialist funding is separate from the de-rostering announcement, she noted, and if it had increased in the past it would not have saved the 10,176 people from being de-rostered.

Almost $11 million in outstanding funding requests were included in the letter to Romano. $3 million of it was tied to funding an expression of interest for Expanding and Enhancing Interprofessional Primary Care Team. Silvano said the GHC recently learned it was denied funding for that request.

The denial of that funding will set the organization back in its efforts to retain the 6,000 patients at risk of being de-rostered.

“That one would definitely have assisted us in terms of more retention of our physicians by supporting them in a different way with their existing roster,” she said.

Interviewed on Tuesday, Romano told SooToday his number one priority is finding a solution for the 10,176 de-rostered patients before the May 31 deadline.

Romano has set up a task force to address the needs of people in Sault Ste. Marie about to find themselves without a primary care provider. It includes administrators and medical staff from many groups including GHC, Superior Family Health Team, Sault Community Health Centre, Sault Area Hospital, among many others.

"The Group Health Centre is a huge part of primary care in the city of Sault Ste. Marie and District of Algoma and I think that we have to stay optimistic about coming up with a solution,” Romano said. “I think we have to assume at this point in time that we're going to need all hands on deck and that's that's the certainly the approach that I'd like to take.”

Romano said he does not accept that there is no solution for the thousands of people about to lose their primary care provider in Sault Ste. Marie.

”It's very clearly outlined [in the letter] that there was nothing that could be done and no amount of funding was gonna change that position,” said Romano of the GHC’s de-rostering decision. “Right now, the only priority is making sure that 10,176 patients do not lose services and that we have a type of primary care for them in place.”

On Wednesday, NDP leader Marit Stiles was in Sault Ste. Marie to meet with GHC management, local community leaders and people affected by the loss of their primary care providers.

Zin said  GHC is especially hopeful the ministry will approve one of the other funding requests in the letter: $1.6 million over two years to enable five nurses to train and become nurse practitioners.

The program would cover the cost of the training and in return the fully trained nurse practitioners would agree to stay on at GHC for five or eight years after they graduate.

Each of the fully trained nurse practitioners would be able to take on a roster of 1,000 GHC patients — 5,000 in total.

”This isn't an overnight solution, but we see nurse practitioners as a part of the comprehensive health care team that we have here at the Group Health Centre,” said Zin. ”We're still going to have physicians, we’re still going to have specialists and primary care providers and we see the nurse practitioners fitting in with that.”

Asked if de-rostered patients would get priority if the GHC were eventually able to grow again and take on new patients, Zin said that’s not likely. Instead, patients without a provider would sign on to the ministry’s Health Care Connect web site with the hopes of eventually being paired with a provider.

“Everyone pulls from the same list,” said Zin. “Our ultimate goal is to grow. If we had our way we'd recall everyone and all the people from that list. We'd love to provide care for the entire community.”

In the meantime, some physicians still practicing at GHC have deferred their retirements.

"Most of them are doing it on their own accord,” Silvano said. “They want to be able to transition their patients to another primary care provider, right? So they find it hard to leave.”

Zin noted his own GHC physician has twice deferred retirement.

"I'm fully expecting that I'll be in the next bunch to go,” said Zin. “But he deserves a retirement, he's put a whole career in and, you know, he's sticking around because he feels an obligation and responsibility.”

Silvano said the GHC model is still successful and the organization is still responsible for some 50,000 patients, even after the de-rostering.

”I think what we're seeing here is what's happening across the province. There's just not enough people practicing primary care or family based primary care,” she said. ”Can we grow again? Right now I would say our focus is on retention.”

"We definitely have the ministry's ear," she added. "We are talking to them a lot and they get it. It is definitely worth fighting for."