CPSO Continuity of Care draft policies

A high-level perspective from the OCFP

image of CPSO's Community of Care Consultation graphicThe Ontario College of Family Physicians (OCFP) is preparing its organizational response to the College of Physicians and Surgeons of Ontario’s (CPSO’s) proposed Continuity of Care Policies, which is due to be submitted to the CPSO by December 9, 2018.

We look forward to sharing our official response with members in our December eNews. In the meantime, below is a high-level overview of the OCFP’s perspective on the draft policies, informed predominantly through member feedback and OCFP participation in two CPSO stakeholder meetings.

  • To solicit feedback on the Continuity of Care Policy, in late summer/early fall the OCFP surveyed its family physician members on the key elements impacting their practice. Nearly 100 family physicians provided detailed and thoughtful perspectives based on their practice realities.
  • Given the central role family physicians play in a patient’s lifelong care and medical journey, several members mentioned that setting out expectations related to Continuity of Care is a positive step forward. However, the feedback in general highlighted some key areas of concern for members. Of note in particular:
    • Expectations of physicians regarding after-hours coverage, and coverage during temporary absences from practice, such as maintaining an active telephone line or voicemail and structuring their practice to enable triaging of patients with time-sensitive issues.
    • For physicians who order any type of test, tracking test results for high-risk patients, including verifying whether the patient has taken the test and ensuring that the result is sent to the physician.
    • Requiring referring physicians to communicate the estimated or actual specialist appointment date and time to the patient (unless the specialist has indicated they have already done so or intend to do so).
    • Requiring physicians practising in a walk-in clinic to provide the patient’s primary care provider with a record of the encounter. As well, advising that walk-in clinic physicians offer comprehensive primary care to orphaned patients unable to locate a primary care provider.
  • Overall, concerns were expressed related to the following:
    • Members noted that several elements of the proposed Continuity of Care Policies rely on appropriate system supports (i.e., do not sufficiently account for the infrastructure needed for implementation), particularly for certain practice types and geographies (e.g., rural and remote).
    • They are increasingly facing more demands and expectations, all within stretched resources, and some of the proposed policy requirements would add to their administrative burden.
    • They pointed to the need for clear agreement on the role of patients in the co-management of their care, and enhanced clarity of accountability and responsibility among physicians and other providers.
    • Given the above, there will be risks to successful implementation with the policies as currently written and consequences for family physicians in terms of added workload and burnout. In some of the policy areas, members offered other potential solutions towards the goal of enhancing Continuity of Care across the health system.
  • In preparing our comprehensive response to the draft CPSO policies, the OCFP will summarize the anticipated issues our members foresee and potential solutions – including proposing alternate policy language in certain instances. This response is being developed based largely on the OCFP member survey and our participation at two CPSO stakeholder sessions, along with a review of other provincial regulatory college policies, consultation with colleagues at the Ontario Medical Association (OMA), the OMA’s Section on General and Family Practice, and the Ontario Hospital Association, consideration of Canadian Medical Protective Association policy, and feedback from the OCFP’s Board of Directors. As noted, the OCFP looks forward to sharing its official response with members in December’s edition of eNews.

  • We also look forward to discussing our response in more detail with the CPSO to ensure our members are best supported in their roles and are advancing solutions that will drive cohesion and continuity in our health system, while improving patient outcomes.