​October 1, 2015

Pulse on ​Family Medicine: Primary Care Policy Update

Price, Patient Care Groups and Primary Care…

It is fair to say there is a lot of discussion about what is going on in primary care – the Ministry of Health and Long-Term Care’s plans for ongoing transformation, in addition to fee cuts.

While we do not know the Ministry’s overall plans, we do know they sought advice from, among others, the Expert Advisory Committee on Strengthening Primary Health Care in Ontario. This advice was provided in a report commonly called “​The Price Report” after lead author Dr. David Price. While the final report is not yet public, there is a great deal of information in our communities about its contents. We understand that a key focus is the concept of population-based planning and delivery of primary care, with the goals of improving access, equity and quality across Ontario.

Most primary care transformation seeks to address pressing health system issues – recognizing that primary care is the foundation of high-functioning health-care systems. As a way to anticipate how the concept of population-based primary care planning and delivery will affect family physicians, the OCFP undertook a review of the evidence from literature and experiences in Ontario and from other jurisdictions that have embarked on primary care transformation (U.K., Australia and New Zealand). This research was augmented with a series of interviews with people involved with transformation work.

We know that some of the challenges in Ontario include:
  • Over 90% of Ontarians now have a family physician and yet over 40% of patients cannot access their family physician when they feel they need to[i].
  • There is inequitable distribution of resources in primary care.
  • Primary care is the foundation of our health-care system and yet is lacking infrastructure to support changes. Family physicians cannot embrace and lead change by working on it off the side of their desks.
  • The ability to provide seamless, integrated care, both across and between primary care settings.

And yet, in Ontario we know that family physicians:

  • Provide high-quality care for their patients, and it is this relationship between patients and their physician that is central to the guiding principles of family medicine.
  • Can and will lead when meaningfully engaged.
  • Have ideas about how to improve their practices and make a difference in their communities, and have a strong commitment to mentoring their peers.

The evidence review identified several additional important themes:

  • Successful implementation of primary care transformation requires a strong and vocal commitment from government, local health authorities, clinician leaders and stakeholders who share aspirational goals for high-quality, patient-centred primary care.
  • Family physicians need to be engaged at the outset to develop, support and share accountability for achieving health system goals.
  • A change in the culture of family medicine is needed, along with the development of a culture of change at the practice level. This underscores the importance of family physicians being part of the solution.
  • There needs to be a balance between clear articulation of the model requirements and the opportunity to experiment and innovate locally in order to improve care and system performance.

Based on the findings of the review, the OCFP developed an evidence brief that outlines what we know about the devolution of the primary and community-based health care sector to the local level. While MOHLTC’s plans are unknown, the OCFP assumes that organizations responsible for planning and delivering primary care services for a defined population of residents (“patient care groups” in the Expert Panel’s report), will be formed at the sub-LHIN level. This has been some of the behind-the-scenes work taking place in pockets of the province.

We are providing you as a member of the Ontario College the draft version of the executive summary to support you as you consider changes in your practice, within your community, and with colleagues in your region.

We understand the need for both system leaders and practice-based physicians to have sufficient time and ‘headspace’ to enable culture change and we know this needs to be properly resourced. We believe that what family physicians need in order to support system change should be widely understood. To that end, we will be providing the executive summary of the evidence brief to the MOHLTC, the 14 LHIN CEOs and other partners in primary care to ensure the findings are part of the advice being considered.

The OCFP’s mission is to support you to provide high-quality care for patients and families. The collective experience and voice of family physicians needs to be a part of shaping primary care transformation. Thank you for taking the time to read the executive summary. Your feedback is important so please let us know what you think. The full report will be available later in October.

Dr. Cathy Faulds
President, OCFP

Read the Executive Summary

[i] Commonwealth Fund International Health Policy Surveys