Dec. 8, 2016

Pulse on Family Medicine: Primary Care Policy Update

The Paradox of Putting Patients First Without Engaging Family Physicians

The OCFP is disheartened that the framework for Patients First implementation is now law through the passage of Bill 41, Patients First Act, 2016 when there is a deep and growing impasse between the Ontario government and physicians, including family physicians.
 
This impasse has destabilized the profession and devalues the significant role that family physicians play in keeping Ontarians healthy. The adverse environment is not supporting the meaningful engagement of family physicians that we know is the key ingredient for any sustainable and effective primary care transformation efforts.
 
Our research of other jurisdictions that transformed primary care confirmed that without meaningful family physician engagement, efforts were not successful, stalled and failed. The OCFP has been monitoring the planning of primary care to support Patients First, much of which has been done without the benefit of full engagement with frontline providers. A top down approach does not reflect frontline experiences, needs or realities of practice.
 
Family physicians are aware of the challenges that they and their patients face every day. They are also aware of opportunities to improve both primary and secondary care. Many family physicians are leaders in clinical improvements, primary care networks, medical education and mentoring, hospital coordination of services, and provincial and regional committees, all aimed at changing the delivery of health care to meet the needs of their patients and communities.
 
In Ontario, family physicians have often provided their expertise without support for their time because of their genuine willingness to improve the system for their patients, and with a genuine belief that their input mattered. The frustration that exists currently among Ontario's family physicians will make engagement more difficult, and any real change challenging to implement. Further, many new family medicine graduates and residents are facing barriers to entering into or establishing the kinds of comprehensive team-based practices in which they have become familiar through their training. This will have consequences for the future of family medicine.
 
The bill's passage now enables moving from planning to implementation of Patients First. The government now needs to address the issues that are challenging for family physicians in practice such as wait times for specialists, inconsistent information to improve coordination between primary care and the hospital sector, patient accountability, and equitable access to inter-professional health-care provider resources.
 
The OCFP hopes the Ontario government will place a high value on the services of family physicians and not continue to expand the services of other providers without a vision for primary care, the Patient's Medical Home, that supports the critical role of the family physician working with an inter-disciplinary team to provide comprehensive, coordinated and continuous care for patients.
 
The Board of Directors of the OCFP is discouraged by the ongoing tensions between the government and the medical profession, and will continue to advocate for the Ministry of Health and Long-Term Care to reach a negotiated agreement with the OMA, ratified by the membership.
 
Building a strong primary care foundation requires frontline family physicians to be engaged in planning that is clear enough to reduce variability, but innovative enough to develop local solutions that can be implemented effectively because they reflect the realities of local practices, community context and the population needs being served.
 
The OCFP will continue to support members to address clinical priorities through continuing professional development and mentoring networks. And we will continue to promote the Patient's Medical Home as the vision for primary care - a patient-centred model where comprehensive, continuous and coordinated care is provided by an inter-professional team led by a family physician.
 
We continue to listen to your comments and feedback in all the ways that we are able. We know that family physicians want faster access to specialists, better tools for providing care, better access to mental health resources, and support for managing patients with chronic pain and addictions. We will advocate for e-consults and meaningful digital tools to support access to care, improved resources for palliative care and medical assistance in dying, better integration and coordination between primary and secondary care, and additional inter-professional resources to help you to support your patients.
 
We hope that the messages expressed are helpful to you should you wish to make your views known either to the OCFP or within your primary care networks, and that they represent the important priorities of family physicians. Please let us know about other issues you want the OCFP to address at ocfppulse@cfpc.ca.

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