Family Medicine Matters

Health System Changes Need Family Doctors

Updated February 21, 2019


Photo of OCFP 2018-19 President Dr. Jennifer Young

My fellow family physicians,

We now have an arbitrated settlement between the OMA and the provincial government. Along with mandated annual fee increases for doctors, no changes to any Patient Enrollment Models including FHOs, and other provisions, this new contract also presents the opportunity to tackle some of the known issues – notably access to us, and identifying inappropriate/overused physician services.

Other change is on the way in Ontario. And with it, some debate about the merits of centralized versus decentralized ways to deliver health care.

What’s not up for debate is the fact that any model of care that contemplates integration as a key principle, relies on family doctors. Like no other provider in the health system, we have continuity of care across many settings, and throughout the lifetime of our patients and families. We’re the ‘integrator’ of care. Just look at our professional profile to see the scope of our role.

We know changes are needed in the way care is provided in this province. The initial report of the Premier’s Council, released on Jan. 31, 2019, outlined key challenges; the healthcare system “is too complicated to navigate, people are waiting too long to receive care and too often are receiving care in the wrong place.”

And we know that the Ontario government is contemplating an extensive overhaul of the health system. Here’s some of what’s expected, what may happen next, and how the OCFP hopes to support you.


A Framework for Integrated Care Delivery

On the heels of the Council’s report, media reported what appears to be the government’s draft plans for sweeping healthcare transformation. This includes draft legislation that would see the creation of a “super agency” serving as a highly centralized administrator for the entire healthcare system. What we know and don’t know about this:

  • We do know that there’s a focus on addressing integrated, frontline care, and having better access for patients in primary care.
  • There are likely to be new ways of delivering care modeled on Accountable Care Organizations (ACOs) in the United States and designed to provide patients with coordinated care and a single team of providers for all their care needs. Of note, US ACOs sponsored by physicians or rural providers can apply to receive payments in advance to help them build the infrastructure necessary for coordinated care.
  • We know, based on evidence, that the most successful ACOs were led in primary care through Patient-Centred Medical Home practices and with family physician leadership[2]. Primary care physicians serve as the linchpin of the program in the US.
  • What we don’t know is the role we’re expected to play in these proposed reforms.

While it’s tempting to make assumptions about what will happen, what grounds our role and practices – and a key foundation of successful systems worldwide – are the features of the Patient Medical Home and living into our Family Medicine Professional Profile. We are experts in being community adaptive and will need to be able to draw on these skills in new geographic or population-based models. (White Paper: ADVANCED PRIMARY CARE: A Key Contributor to Successful ACOs').


The Family Doctor’s Vital Role in Care Delivery and Planning

The features of the CFPC’s Patient Medical Home (PMH) in Canada, as defined by family doctors, represent the very principles that are required for effective integration of care. We’ll reinforce with government and other providers the importance of these key PMH features, such as accessible, patient-centered, socially accountable and comprehensive team-based care, with continuity. These are integral elements of any initiative that seeks to enhance system integration.

We continue to work with the OMA’s Section on General and Family Practice and the Association of Family Health Teams of Ontario to create and amplify a strong, shared voice for family medicine and primary care.

We’ll advocate for you to have a role in shaping reform, based on your frontline experience and with many of you who took on clinical leadership roles in your communities. To that end, our Leadership in Primary Care Mentoring Network, just launching, provides a rich opportunity to support current leaders and cultivate new ones in family medicine.

Change is coming and is greatly needed. As family doctors, we can bring our experience and energy to the fore and help shape a stronger system. Indeed, it can never be repeated enough: strong primary care is foundational to excellence in a high-quality health system. Without this foundation in place, no government will be able to increase efficiency and improve care for Ontarians.

The OCFP’s job is to support you and we are proud to represent you. Stay tuned – we’ll let you know as we learn more in the weeks and months ahead, as the transformation agenda becomes clear.

Have ideas or questions? Send them to me at [email protected]. Follow me on Twitter: @OCFP_President

 


[1] Patients’ perceptions of access to primary care - Canadian Family Physician, March 2018

[2] Advanced Primary Care: A Key Contributor to Successful ACOs - Patient-Centered Primary Care Collaborative and the Robert Graham Center