AFHTO’s Executive Director Advisory Council (EDAC) met on August 26 with the main purpose of preparing for the quarterly meeting with the FHT unit later in September. At the same meeting, EDAC invited Phil Graham, (manager, Family Health Teams & Related Programs, Primary Health Care Branch) and Fernando Tavares (program manager) to clarify the context and the process for 2013/14 budget adjustment experienced by many FHTs. EDAC’s mandate is to advise the AFHTO board and staff on matters affecting the operations of our member organizations. Budget Reduction in 2013/14: Phil Graham, manager of MOHLTC’s FHT Unit, gave EDAC the following background on the ministry’s decisions to adjust the budgets of a number of FHTs:
- In a managed-growth budget environment, the MOHLTC wants to maximize the use of existing dollars available within the FHT program.
- In reviewing expenditure trends over the past three years, the MOHLTC determined there is on average a ~12% gap between what is allocated by the ministry and what is spent by FHTs. This means that $20-$40 million has been recovered following the end of each fiscal year.
- Based on this data, the ministry undertook a budget right-sizing effort to bring the ministry’s allocation in better alignment with FHT expenditures. This included a 0.5% base funding adjustment for FHTs with budgets between $1-$2 million and a 1% base funding adjustment for FHTs with budgets in excess of $2 million. FHTs with budgets less than $1 million were not impacted by this adjustment nor were FHTs who were utilizing their full allocation.
- The ministry also looked at Specialist Sessional funding and found that this area in particular was considerably underspent. Adjustments were made to Specialist Sessional funding based on historical trends.
- Looking forward, this adjustment will help to enhance financial flexibility for other FHT initiatives and to address service needs.
A total of 105 out of Ontario’s 185 FHTs experienced this adjustment. While each of these FHTs received notice of the reduction to their own FHT’s budget, based on the feedback received, the communication process will be improved in the future. Phil acknowledged there may be some gaps that have resulted from this approach, particularly but not exclusively related to Specialist Sessional adjustments. To ensure that the budget reductions do not impact negatively on service delivery, he noted that the Ministry coordinators have been instructed to be flexible and to work with FHTs on a case-by-case basis to free up funds within the approved FHT budget. Other options will be considered if solutions can’t be found within the FHT’s current budget. He also confirmed the Ministry is looking at enhancing budget flexibility in future years, to give FHTs greater ability to manage their budget to meet patient need. Preparation to address Budget Flexibility and Accountability with MOHLTC: The ministry’s interest in greater budget flexibility is welcome news for FHTs, however the question for FHTs is, what is the “desired future state” to aim for? To help answer this question, a group of EDAC volunteers looked into the advantages, constraints and risks associated with global budgets. Having reviewed and discussed the issues, EDAC members are recommending to the AFHTO Board the following position to take in discussions with the FHT Unit:
- A global budget divided into “two buckets”, one for HR and the other for operations.
- The HR “bucket” should allow for complete flexibility in determining the positions.
- A provincial salary grid for each position should continue to be enforced to avoid unproductive competition for staff. (AFHTO continues to join with our primary care partners in advocacy for a more competitive primary care compensation structure.)
- Ask MOHLTC for clarity on existing funding formulas, in order to understand and advise on ways to ensure global budgets remain current with service needs and market conditions.
Accountability for wise use of the funds goes hand-in-hand with the desire for greater budget flexibility; EDAC will engage in further discussion on this topic. Agenda items for the quarterly meeting with the Ministry FHT unit: The EDAC members are recommending the following agenda items for the September meeting with the MOHLTC FHT unit:
- Preparing for the 2014/15 Budget process
- Budget flexibility is a particular focus
- Current fiscal year budget issues
- Request for updates on:
- Transfer of Rostered patient issue
- QIDSS program
- IHPs in non- FHT models
- Physiotherapy in FHTs
- QIP – process for determining mandated domains for next year.
- Possible review of sessional fees in MOHLTC-OMA negotiations
- “Good news” items: AFHTO conference and Bright Lights Award nominees