Report to Council: West Shore Municipal Approaches to Supporting Access to Primary Care

PURPOSE

The purpose of this report is to brief Council on actions being taken by neighbouring West Shore municipalities to support resident access to primary care, to outline known challenges and emerging models, and to present a range of options for Council’s consideration. This report is intended to increase Council’s exposure to relevant information and policy approaches and does not recommend a specific course of action at this time.

BACKGROUND AND CONTEXT

Access to primary care has become one of the most frequently raised issues I hear from residents across the West Shore. Available data indicates that there are over 2,000 residents in View Royal who are currently unattached to a primary care provider. I have also been advised that there are significant limitations in the attachment data, including under-reporting and outdated registries, and it is broadly assumed that the actual number of unattached residents is higher.

Primary care delivery is not a municipal responsibility. Physicians, clinics, and hospitals are funded and regulated by senior levels of government. That said, municipalities increasingly face resident expectations to play a facilitative role where land use, zoning, amenities, partnerships, or convening authority can help reduce barriers to access.

While municipalities can assist with land use and space, physician supply and the availability of suitable, affordable, and operationally viable clinic space continue to be the principal constraints on expanding access to primary care. In many cases, workforce availability remains the dominant limiting factor even where clinic space has been secured.

I also wish to note that residents of View Royal, along with residents of all Capital Regional District municipalities, pay regional taxes collected by the CRD that support hospital infrastructure and related health services. While hospitals and primary care are distinct components of the health system, this reinforces the public interest in ensuring the broader system functions effectively and responsively.

LEGISLATIVE CONTEXT

The Community Charter affirms municipalities as an order of government responsible for the well-being of their communities. Section 7 of the Charter provides broad authority for municipalities to act in relation to the health, safety, and protection of persons and property, where such actions fall within municipal jurisdiction.

The Local Government Act authorizes municipalities to regulate land use and development, including zoning, density, and amenity contributions. It also enables partnerships, leasing arrangements, and other tools where they serve a public purpose consistent with adopted plans and bylaws.

While neither statute assigns responsibility for health care delivery to municipalities, both provide authority for supportive and enabling actions that may contribute to community well-being, including improved access to primary care.

REGIONAL COORDINATION AND HEALTH SYSTEM ENGAGEMENT

I am participating with other West Shore Mayors in quarterly meetings with representatives from Provincial Health, Island Health, and primary care providers, including family physicians and licensed practical nurses. These meetings are focused on identifying and advancing practical actions to increase primary care capacity in the region, improving coordination between municipalities and the health system, and reducing barriers to clinic establishment and staffing.

Through these discussions, it has been consistently emphasized that municipal actions are most effective when aligned with Island Health recruitment, credentialing, and operational support. It has also been recognized that no single municipality can address access issues in isolation, given shared patient populations and regional workforce dynamics.

I have also been advised through these engagements that there remains significant interest from American physicians and nurses in relocating to British Columbia, including the West Shore. While interest levels are high, challenges related to licensing, credential recognition, immigration pathways, and system onboarding continue to limit the speed at which this interest can translate into additional primary care capacity. Addressing these barriers remains an active topic in regional and provincial discussions.

OVERVIEW OF WEST SHORE MUNICIPAL APPROACHES

Esquimalt – Density Bonusing and Space Provision

The Township of Esquimalt has pursued an approach using density bonusing to secure purpose-built clinical space within new developments. This model has reduced direct capital costs to the municipality and integrated health care space into mixed-use areas.

Public reporting and media coverage indicate that while appropriate clinical space has been secured, there have been ongoing challenges filling that space with physicians. The primary constraints have been physician supply, operational sustainability, and affordability of clinic operations, rather than the availability of physical space alone.

Colwood – Municipally Employed Physician Model

The City of Colwood has taken a more direct approach by hiring physicians as municipal employees and providing salary, administrative support, and clinic space. This model has received national media attention.

While early indications suggest success in attaching patients, this approach carries considerations related to long-term financial exposure, expansion of municipal roles beyond traditional functions, physician retention risk, and equity implications between municipalities.

Langford – Third-Party Partnership Model

The City of Langford has focused on working with third-party partners to facilitate the development of clinic space and operational models. The municipal role has largely been facilitative rather than operational. While clinic capacity has improved, physician supply and affordable space remain limiting factors.

EMERGING OPPORTUNITIES FOR CLINIC SPACE AND OPERATIONS

During the current term of Council, I have witnessed and reviewed several expressions of interest related to clinic space and primary care operations within View Royal. These have included proposals for clinic space and opportunities to partner with nonprofit societies seeking a relationship with the Town involving compensated or augmented rent in exchange for the provision of primary care services.

Historically, there has been a shortage of physicians with the capacity to accept unattached patients, even where space existed. That constraint remains relevant; however, interest in establishing clinic space in View Royal appears to be increasing as limited opportunities emerge.

Recent and current development activity has generated interest in clinic uses, including an existing development at 298 Old Island Highway and a proposal at 346 Island Highway. Although opportunities for clinic space in View Royal are limited, these locations have attracted interest from potential operators.

More recently, I met with the owners of Aroga Medicine in Eagle Creek, who have expressed interest in forming a separate nonprofit society to provide primary care services for unattached patients in View Royal. They are seeking a potential relationship with the Town whereby municipal participation could assist in augmenting rent in exchange for the delivery of primary care services and the attachment of currently unattached View Royal residents.

I have also been advised that space has become available within the same building that could be suitable for primary care use. Subject to further exploration, this space could serve View Royal’s needs and, should Council wish to consider broader collaboration, could also potentially support cost-sharing arrangements with neighbouring municipalities such as the Township of Esquimalt.

These opportunities remain preliminary and would require further due diligence, alignment with Island Health and Provincial Health priorities, and clear Council direction before any commitments could be contemplated.

KEY OBSERVATIONS

Across the West Shore, several consistent themes emerge:

• Physician supply and the availability of suitable, affordable clinic space remain the primary constraints, with workforce availability being the dominant limiting factor even where space has been secured. However, trends on Physician and Primary Care Providers supply are improving with a new intake stream primarily from the United States and advances in fast tracking licensing.
• Municipal tools are most effective when aligned with provincial and Island Health initiatives.
• No single model guarantees success; each involves trade-offs in cost, risk, and municipal role definition.
• Public expectations for municipal leadership on primary care access continue to increase, regardless of jurisdictional limits.

CONCLUSION

Access to primary care represents a significant and growing concern for View Royal residents. While municipalities do not deliver health care, neighbouring West Shore communities have demonstrated a range of approaches to supporting access, each with benefits and limitations. Physician supply and affordable clinic space remain binding constraints. This report is intended to inform Council and support informed discussion as further opportunities are explored.

RECOMMENDATIONS

1. That the Committee recommend to Council that Council receive the report for information, and;
2. that the Mayor and Chief Administrative Officer be authorized to continue discussions with health care providers, property owners, and Island Health, and to report back to Council with updates and any proposals intended to increase primary health care coverage for the residents of View Royal.

Respectfully submitted,

Sid Tobias Mayor