Key Issues

Media coverage highlights value of team-based primary care

Recent media coverage about family health teams and team-based primary care as a whole have pointed to its value to patients in Ontario and the government’s intent to review primary health care models and balance healthcare spending.

Total cost of care – Team-based care improving the bottom line

AFHTO emphasizes that the real issue for the sustainability of our health system is the TOTAL cost of care to keep people as healthy as possible. Research in BC found that total cost of care is $30,000 for the sickest patients who don’t have a strong primary care relationship and $12,000 when well-supported by primary care. This is why AFHTO members are working to advance measurement and improvement in primary care, with the objective to optimize quality, access and total health system cost of care for patients.

Recent Media Coverage

Mar 24 – The Spectator’s View: Family health teams still make sense
The Hamilton Spectator editorial states, family health teams “are a more holistic approach to primary care”. In this editorial managing editor Howard Elliott makes the case for continued government support of the family health team model.

Mar 26 – The Hamilton Spectator published AFHTO’S response “Investment in primary care lowers costs.” It quickly became the most popular letter of the day.

Feb. 25 – The Agenda with Steve Paikin, Healthcare in a Time of Austerity
On TVO’s The Agenda with Steve Paikin, Claudia Mariano, Nurse Practitioner at West Durham FHT and AFHTO Board Member, appeared on the show to discuss the need for increased support for recruitment & retention in primary care. Panelists discussed OMA negotiations and the government’s intentions towards team-based primary care.

Feb 16 – Globe and Mail highlights value of team-based primary care
The Globe and Mail reported, “Family health teams – which put doctors, nurses, dietitians and social workers in the same office — offer a holistic and convenient approach embraced by patients and doctors alike. Why then is the Ontario government backing away?” In this feature article, journalist Kelly Grant delves into the value of FHTs from the perspective of patients as well as the findings of the recent Conference Board of Canada’s evaluation of the FHT initiative.

The article presents the promising benefits of team-based care. It also reports on the associated physician payment models and the challenge of recruiting and retaining other health professionals whose provincially-funded salaries cannot compete with other parts of the health system.

In response to The Globe and Mail, a member, Bruyere Academic Family Health Team, sent the following message to their staff: 

To all staff,

Several people have commented about the Globe and Mail article on Family Health Teams that appeared over the weekend. The commentary in the article gave the impression that the provincial government is moving away from family health teams, likely based upon the Auditor General’s report. We thought that this would be a good opportunity to comment on what our FHT has been specifically doing to achieve the goals of the Family Health Team model.

The first thing to point out is that the government concerns about receiving value for what they have invested in the family health teams has been present for quite some time. The widespread use of the FHT model is a relatively new phenomenon for this province so some growing pains can be expected.

In our FHT we have undertaken numerous activities that would be very difficult for us to accomplish if we did not have all of the members of our team or the infrastructure that supports us. We have an excellent team of providers  and staff.

Access:  Since becoming a FHT in 2006, we have opened a new site (Primrose) and have moved from 4,539 enrolled patients to almost 12,000 across both sites. We continue to try and improve our enrollment numbers, and are taking Ontario patients from Health Care Connect and other sources. In addition, we serve about 4,000 non-enrolled patients for a total of 16,080 patients. We target vulnerable populations, who may have difficulty finding primary care services. Our clerical staff work hard to schedule patients when they wish to be seen and with their appropriate teams.

Integration: We continue to work closely with the CCAC and discharging hospitals to deliver seamless care. Our referrals clerks achieve prompt and appropriate referrals to services within the region.

Procedures on site: Within the walls of our clinics we provide patients with a very wide scope of primary care services delivered by their most responsible provider, residents and other members of the team.  This includes numerous procedures such as biopsy, excision of skin lesions, endometrial biopsy, IUD placement, and MSK injections that many other family practices have moved away from.

Specialty care on site: Our work with integrating shared care has allowed our patients to access a wide scope of psychiatric services, ambulatory gynecology and orthopedic surgery. The latter two services build upon the capabilities that we derive from our MSK clinics and Women’s Procedures clinic.

Preventive care: To prevent more serious health issues for our patients in the future, we have teams that provide chronic disease management, therapeutic lifestyle guidance, diabetes management, and smoking cessation. Other members of our Allied Health group provide assistance with dietary management, medication oversight, social work, kinesiology services, and foot care. We encourage patients in self-management and recommended screenings. We are embarking on a FHT wide primary preventive care emphasis this year with plans for activities centred around obesity prevention and physical activity.

Outreach: The team based activity that we are engaged in does not stop at our front door. We currently deliver outreach services at St. Mary’s Home, the Bethany Hope Center, Maycourt Hospice and the Mission for men.

In addition to the other services, we have other focused practice activities that are designed to assist with our educational mission such as procedures, maternal health and well-baby clinics.

Quality: We also have an extremely active continuous quality improvement program that is allowing us to work in a highly reflective manner. As part of this, we are aggressively measuring multiple aspects of our operation to ensure that we are meeting the goals that we have set for ourselves and that we are being good stewards of the public money entrusted to us. One particularly important measurement is our ongoing patient satisfaction survey.

What all the data is telling us is that the work that we are doing is helping us to move forward. We are doing well on our prevention targets, we are keeping patients out of the emergency departments and our patient satisfaction levels are high.

We continue to be excellent teaching sites for the family physicians and other health professionals of the future, who are provided with many opportunities to learn about the FHT priorities such as collaboration and comprehensive and team based care.

The debate about the value of FHTs will continue for quite some time. Debbie and I feel very strongly that we as a group have done, and continue to do, the kind of work that clearly demonstrates that with the right mix of people and resources, it is possible to profoundly improve care delivery and patient outcomes. This is precisely the goal that the FHT model was created to achieve.

Regards to all,

Jay and Debbie