SPOT-SDELK, a non-profit society, oversees the outreach clinic. (Harry Corro/Peninsula News Review)

Saanich Peninsula Outreach Team (SPOT), a clinic that helps marginalized patients without a family doctor, easing burdens on the system, has been told by Island Health that it can no longer operate out of the Saanich Peninsula Hospital come March 31, 2026.

Dr. Michal Pawlik, who leads the clinic with Dr. Kate Evans, said that without public intervention and a contract from the Ministry of Health, it will likely leave 700 high-needs patients vulnerable and place a burden back on the health system.

"We officially got a letter that Island Health will be cancelling our contract effective March," Pawlik told Peninsula News Review (PNR).

"The main thing for me, I'm concerned about the patients we have, because we've attached very vulnerable patients. And without a physical location, and without a contract, we haven't got anywhere for them to go."

The clinic, launched as a non-profit April 1, 2025, at the Saanich Peninsula Hospital by the Saanich Peninsula Outreach Team (SPOT-SDELK), currently provides care to 700 patients facing pre-existing conditions, socio-economic challenges and mental health and substance use issues. Before April 1, the clinic ran for one year under Island Health in a different contract, Pawlik said.

Island Health told PNR that the space was never meant to be a permanent one for SPOT.

"As a partner within the PCN, Island Health agreed to temporarily provide SPOT with clinic space at the Peninsula Health Unit in order to support the establishment of the clinic. The Clinic Licence Agreement that SPOT agreed to last year was always for a one-year term."

Pawlik is not confident that he will be able to find another location for the clinic due to "burnout" and hurdles with the ministry

He also maintained the benefits of having the clinic. Because many patients with complex issues who lack family doctors often end up in the ICU or the ER, Pawlik explained that clinics like SPOT ultimately save lives and are financially better for the health system.

While exact figures vary, research consistently shows that strengthening primary care and addressing the social factors that influence health can reduce hospital and emergency visits - and, in turn, lower overall system costs. A 2015 review by the Association of Family Health Teams of Ontario found that patients without close ties to primary care had annual system costs of about $30,000 per person, compared to roughly $12,000 for those with strong primary care connections, such as those seen through SPOT.

"The evidence is clear. I just don't understand why it's not being done," Pawlik said.

Pawlik said Island Health informed him that there is no longer space for the clinic, which operates out of what he described as their smallest exam room. He added that it lacks important features like an adjustable height exam table. From Pawlik's perspective, there have been underutilized rooms, an ongoing source of frustration for him.

"From what I've seen, there's always plenty of space and underused rooms," he said.

Since the clinic opened in April, Pawlik said conditions, policies and dealing with bureaucratic blame shifting between the ministry, Island Health and PCN made the clinic increasingly difficult to operate.

One of his greatest hurdles is that SPOT is still awaiting an Alternative Payment Plan (APP) contract from the ministry. Because they deal with patients who need longer visits, they need this contract to hire more doctors, he explained.

"Unfortunately, Kate and I are close to burnout and need to get other physicians and resources to continue," he said.

To truly meet community needs, Pawlik said they hoped to incorporate a social worker, a part-time community outreach worker, one full and one part-time registered nurse, a mental health and substance use clinician, an Elder in residence, and a medical director consultant, in addition to its existing staff.

"Government talks about team-based care, but there's really no funding for it," he said.

In a statement, the ministry told Peninsula News Review it is currently reviewing SPOT's application and that there is no timeline for the review. "At this time, the ministry is not in a position to commit new funding for outreach team expansions," the ministry said.

For Pawlik, what he describes as being "totally unsupported" by the government is particularly frustrating, considering the clinic took five years of planning and organizing involving various local stakeholders.

Without the clinic, there will be a critical gap in healthcare access for vulnerable populations within the region, he said.

"This will exacerbate inequities for Indigenous patients, people who are unhoused or at risk, and those living with addiction and multimorbidity -- the core group SPOT-SDELK was created to serve. I think this is systemic discrimination," he said.

"There's nothing on the Peninsula for moderate to severe mental health patients. And when I refer them to the mental health team, it's a three- to six-month wait. I literally had a patient die before they were seen."

For instance, Pawlik said he can prescribe Opioid Agonist Treatment that helps patients with addictions avoid overdosing. "If they're not on this, and they overdose, a lot of times they will end up in emergency, in ICU and then at the brain rehab clinic. And that costs thousands and thousands of dollars, not to mention the disability, the patient costs, the deaths."

However, Pawlik wanted to highlight that the clinic has done a lot of good since it opened and he hopes that a partnership with Island Health could somehow continue.

"We don't want to make it all negative -- we're grateful to Island Health for the space we've been allowed to use, and many patients do get great care. But this program is vital and should continue."

He hopes that public pressure will result in a reversal of the decision and show Island Health and the ministry the importance of the clinic.

"I hope people reading this will write to the Minister of Health and say, 'This clinic matters. These 700 patients have nowhere else to go," Pawlik said.

There are roughly 13,648 patients who are not under the care of a physician on the Saanich Peninsula, with 1,356 believed to be vulnerable and fall into the highly complex category.

Mavis Underwood, who serves as an elected member of the Tsawout band council and has been an advocate for the clinic, said that no matter what happens with Island Health, it doesn't have to be the end for the clinic.

"Just because the clinic is closing on that site, it doesn't mean that it's closing forever. It does mean that we have to look for space, and it means that we have to cultivate good relationships in health to gain more recognition and partnership."