How Canada can fix primary care crisis

Posted on May 23, 2024 in Health Delivery System

Source: — Authors: – Opinion/Editorials
23 May 2024.   Jane Philpott

Dr. Tara Kiran and colleagues in the OurCare study offer a six-point standard that shows Canadians expect primary health care to be universal, team-based, integrated, with accessible records, culturally safe and accountable.

Last week, the Star reported on the growing number of people who receive a cancer diagnosis during a visit to a hospital emergency department. The article described one man who had no family doctor to assess his symptoms. By the time he went to the emergency room his cancer was widespread — making it more difficult, perhaps even impossible, to treat.

This is heartbreaking and avoidable. If we were a country with guaranteed access to primary care, we would be more likely to prevent cancers and detect them earlier. But more than one in five Canadian adults have no primary-care provider. In Ontario, about 2.3 million people have no family doctor, and the Ontario College of Family Physicians says it will reach four million people by 2026.

This crisis is our opportunity to do something bold. We don’t need more studies. Canadians have already described what they want. Drawing on the largest-ever pan-Canadian conversation about the future of primary care — the OurCare study — Dr. Tara Kiran and colleagues offer a six-point standard that shows what Canadians expect. They want primary care to be (1) universal, (2) team-based, (3) integrated, (4) with accessible records, (5) culturally safe, and (6) accountable.

In every neighbourhood in the country, just as there are schools for our children, there should be a primary-care home — or centre — served by a team of doctors, nurse practitioners, nurses, dieticians, therapists, social workers, and others. Each person has an ongoing relationship with a primary-care clinician in this publicly funded team. The team is connected to other parts of the health system and social services. It’s a one-stop shop for your health related needs.

It’s time to commit to this grand vision and make it a reality for the four million people in Ontario who otherwise wouldn’t have primary care. I’m not aware of an existing proposal for how this would be implemented, so I offer one here as a starting point for conversation. Beginning immediately, we could develop and operationalize a master plan for 250 new primary-care teams or health homes — allocated across Ontario’s 444 municipalities based on areas of greatest need. Each would provide care for about 16,000 people — completely closing the gap in access to care for four million people.

Such a plan would accomplish more than closing gaps in access. It would be a new standardized approach to primary care. Doctors would be attracted to this model by a competitive salary with benefits. They would enjoy shared coverage for after-hours and holidays, flexible scheduling and the delegation of administrative tasks to non-clinicians.

Some will say we don’t have enough family doctors and nurses to staff 250 new health homes. That may be true — but the solution is built in. First of all, this model of care is exactly what new family medicine graduates are looking for: predictable hours, time off and administrative support. Even recently retired doctors are interested in returning to practice, under conditions of work like this. More important, these primary care homes are the perfect place to grow the health workforce. Each site would be a teaching unit where family-medicine residents and primary-care nurse practitioners would be among the trainees who learn on the job. Each health home would be affiliated with a medical school. Just as we train surgeons in the operating rooms of publicly funded teaching hospitals, we need to train family doctors in publicly funded community teaching clinics. The learners are part of the health workforce who will close the gaps in access to care.

Who will govern these primary care homes and how will they be accountable? Just as regional school boards ensure neighbourhoods have enough schools, and enough staff to maintain the standard ratio of students per teacher, we need primary-care boards (perhaps a modification of Ontario Health Teams) with the mandate, resources and authority to organize health homes for their region. The boards would be funded to ensure there are enough clinicians to meet the local needs. Locally elected primary care trustees could be the primary-care advocates.

Can we afford this dream? This is the best news of all. Yes, we can. Countries with primary care for everyone achieve the best health outcomes for the lowest costs — largely because of downstream savings. If you detect a health problem early, it’s less costly to treat. If you manage risk factors (such as diabetes, high cholesterol and high blood pressure) over time, people are less likely to develop cardiac disease, strokes, or dementia — all of which are expensive to treat.

What we’re doing now — leaving one in five people with no primary care — is the option we can’t afford any longer.

Jane Philpott is Dean of Health Sciences at Queen’s, and a former federal minister of health.  She is the author of “Health For All: A doctor’s prescription for a healthier Canada.”,SCIENCES%20AT%20QUEEN%E2%80%99S

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