The collaborative care model obviously is very in vogue today, and you hear about the PCR, primary care reform, basically everywhere you go in the health care sector.
The collaboration in the military is nothing new. It's been in existence for much longer than it existed in the civilian system. When I entered the military practice in 1985 I was actually quite surprised at how much collaboration was already in place and how much leveraging of services was already in practice. We were using nurse practitioners before the term was known. We were using pharmacists much more than giving drugs in the civilian sector. We were using physios much more robustly. That collaboration diminished during the nineties during the budget cuts, when we were closing a lot of bases and our services.
When we came back to rejuvenation in the year 2000 through the Rx2000 program, we really re-entrenched the collaborative model through what we call PCR, the primary care reform initiative. This is primary care but it's not limited to primary care. What we're talking about is continuative care whereby you have.... It's a form of capitation where members are rostered to a care delivery unit. In that unit there are physicians, military and civilian. There are nurse practitioners, physician assistants. There are medical technicians. With that core, they look after a group of people. Then we have as primary care providers physiotherapists, where a member can simply access.... If you have an ankle injury over a sports weekend, you don't have to go see a doctor to get a referral. You just go see the physiotherapist and have them look at it. If there are issues that he or she wants looked at, then they refer them back.
If you have some issues about certain self-medication, for example, again you don't have to go see a doctor. You can just go down to our pharmacy. We're one-stop shopping. They can do all of that. If you have some family issues, you can go see a social worker for family issues directly.
That is the core to which then we have secondary and tertiary care. In all of our bases, there are mental health components. Some of the larger bases have a much larger centre, where the core of the primary care is part of the mental health care team so that the communication between the primary care and the mental health is smooth. The mental health itself is not stovepiped. That is a team of psychologists, psychiatrists, mental health nurses, and social workers and pastoral counsellors who work together to look at that patient. If it's a complex one we have case conferences, and that involves not just mental health but there's the primary care team that goes into it.
That kind of stuff actually does play havoc a little bit with so-called efficiency. It takes a lot of people to look after holistically. I don't really want to get down to efficiency in that regard, but rather it is a very effective way to holistically look after the patient who's in the middle and you have the whole team.