AFHTO Policy Positions

AFHTO’s initial response to Patients First Discussion Paper

On December 17, 2015, Ontario’s Ministry of Health and Long-Term Care released its discussion paper Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. On its release, AFHTO issued the statement below from Dr. Sean Blaine, AFHTO President and Clinical Lead, STAR Family Health Team in Stratford ON. This was published in various newspapers including The Kingston Whig-StandardWoodstock Sentinel Review and Beacon Herald in January.

AFHTO will be working with its members in each region of the province to develop a more detailed response to the questions posed in the discussion paper. Particular attention will be paid to those areas where great care must be taken to gain the most benefit for patients and communities, and avoid unintended negative consequences.

AFHTO’s statement on the release of 

Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario

Comparative studies tell us our health system is not performing as well as it could. How can we make it better?

We need to have the right people in the right place at the right time to deliver the most appropriate care. This requires effective planning, strong relationships, meaningful measurement and engaged leadership from health professionals. Across the world, cost-effective and high-performing health systems are built on a strong foundation of comprehensive primary care.

Over the past decade, Ontario has taken steps to strengthen primary care. Family health teams and nurse practitioner-led clinics emerged as innovative models for bringing together health professionals – doctors, nurses, pharmacists, dietitians, for example – to deliver such care. Unfortunately, only 25% of Ontarians receive their care from such team-based models.

Ontario also aimed to improve planning, relationships and performance by setting up Local Health Integration Networks (LHINs). But two parts most critical to keeping people healthy – primary care and public health – were left off the LHINs’ mandate.

More needs to be done to ensure people can get the appropriate care and support they need when they need it.

With the Patients First proposal, the Ontario government launches the next phase of health system evolution. The proposal would bring all parts of the health system under a single jurisdiction for planning and performance reporting, and focus attention on how best to meet the needs of people living in each community. It pays particular attention to strengthening primary care. These are absolutely critical steps toward ensuring more comprehensive and equitable health care services for all Ontarians.

Public health departments must be connected to LHINs. These organizations are focused on understanding whole communities to prevent sickness and the spread of communicable diseases. Public health professionals analyze communities to identify and monitor health risks, and target public education and other programs to promote health wellness and illness prevention within a population.

Equally important is the ongoing care individuals and their families receive over their lifetimes. This is primary care – your “medical home” – delivered by family doctors, nurse practitioners and primary care teams who know you, care for you, and coordinate specialized health services when you need them.

The proposal also merges community care access centres (CCACs) into the LHINs enabling greater local coordination of care, and more efficient use of health resources. If LHINs then deploy care coordination expertise into primary care settings, it will help patients and families identify a single point of contact to navigate and access programs and services.

As a family doctor working in a family health team, I can see the potential in this proposal, as well as some cautions:

  • Greater consistency: Right now we see significant variation in the access, experience and cost of health care in Ontario. Many of these variations are the result of unique local problems. By planning and monitoring at the local level, gaps can be identified and local solutions can be found – but only if local leadership is engaged and empowered to harness all sectors of the health system to address the unique needs of that community.
  • Better coordination of care for patients: Moving care coordinators from the CCAC to the LHIN could help break down silos that have long separated my patients from getting care they need. But the LHIN will have to ensure these care coordinators work much more closely with family doctors and nurse practitioners; otherwise, this just moves one bureaucracy into another.
  • Measurement for improvement: This is critical to assessing and improving quality of care. While many primary care teams have been measuring performance, this will be new for the majority of our primary care colleagues. As we’ve learned – there’s nothing to fear from being held accountable. But clinicians will need to receive support to help identify and capture the most meaningful and manageable data to improve care for patients.
  • Spreading best practice: Performance measures must be consistent and comparable across the province, to help clinicians learn from one another. By identifying those who excel at care delivery, we can spread and scale up improvements to providers in a positive and not punitive way.

Every region of this province empowered to bring together all local health system players to focus on every community’s true health needs. Primary care strengthened and supported to wrap the most appropriate care around each person. If well implemented, Patients First is an important next step to improve our health system for better health for all Ontarians.

Sean Blaine MD
Family Physician, Stratford, Ontario
Clinical Lead, STAR Family Health Team
President, Association of Family Health Teams of Ontario (AFHTO)

Note: This statement was published in various newspapers including The Kingston Whig-StandardWoodstock Sentinel Review and Beacon Herald in January.