This email was sent to EDs/Administrative Leads, Board Chairs and Lead Clinicians of AFHTO member organizations.
Dear triad members,
Thank you to all the executive directors who joined our second round of regional ED calls last week. It’s proving helpful to hear what is working well, how you are managing the challenges you’re facing, and how we can help.
This email is a follow-up to provide the information promised during the calls, as well as other updates and supports.
PPE
- AFHTO, OCFP, and NPAO issued a joint letter to the Minister of Health on April 15 regarding the urgency for PPE across the primary care sector.
- Teams are encouraged to reach out to their Ontario Health regional leads to ensure they are part of regular communication across regions, and to provide updates and need regarding PPE supply. Regional table leads can be seen here.
- The ministry will be releasing PPE guidelines in about a week’s time, which will include an outline on how distribution is prioritised and strategies to help ensure PPE conservation.
Virtual care
- Two documents have been posted to assist with virtual care: Hosting Group Platforms Virtually and Summary of Virtual Visit Platform Solutions.
- The amount of care that is being delivered in-person is fairly consistent across teams. Polls during the ED calls showed that the majority of physicians and nurse practitioners – 79% and 80%, respectively – are delivering 10% or less of the care in-person.
- Almost all teams polled on the calls have RNs and RPNs delivering at least some in-person care (97%). The other three professions most likely to be delivering in-person care, across the teams polled, were pharmacists (18%), chiropodists (15%), and physician assistants (13%).
Financial Information
- The federal and provincial governments have announced a series of tax changes and financial measures to build on the federal government’s COVID-19 Economic Response Plan, including:
- 10% wage subsidy – teams may qualify for a federal payroll deduction rebate for employee compensation paid between March 18, 2020, and June 19, 2020 (up to $1,375 per employee and to a maximum of $25,000 total per employer).
- Employer Health Tax (EHT) – Retroactive to January 1, 2020, the EHT exemption for 2020 will be increased from $490,000 to $1 million. If you have been remitting EHT, you can contact the Ministry of Finance to check your organization’s EHT account.
- Teams should work with their accountants or financial advisors to determine and understand eligibility for any financial subsidies.
- For teams that qualify, they can request repurposing money towards COVID-related costs. The ministry is developing guidelines on eligible reallocations for unintended expenses through the normal reallocation process. Teams are encouraged to contact their senior program consultant about applying for reallocations.
Human resources
- AFHTO has confirmed WSIB’s new Classification Structure does not apply to FHTs and NPLCs. These changes only impact Schedule 2 organizations (e.g. those that have a public board appointed municipally or provincially), so it is not mandatory for teams to carry WSIB coverage at this time.
- We heard many teams are beginning to redeploy staff to other sectors/organizations in need of support. We encourage all teams to check with their insurers on the best approach to redeployment to mitigate risk and liability concerns. We can also provide teams with a sample secondment agreement to help outline the terms and conditions of deployment.
- The current emergency order prohibits long-term care employees from working in more than one long-term care home, retirement home, or health care setting. However, if primary care staff are redeployed to a long-term care home (or hospital setting or a testing/assessment centre), there is no provincial recommendation preventing them from continuing to work at their home organization. Similarly, there is nothing prohibiting staff from working across multiple primary care sites. That said, we encourage teams to follow these best practice tips for staff that are working in more than one sector or organization:
- Ensure staff working in other settings are provided with appropriate PPE.
- Encourage staff working in more than one setting to provide as much virtual care as possible and limit any in-person visits to those deemed necessary.
- Where possible, loan staff on a full-time basis to other sectors as required to limit the need to work in two different settings.
- AFHTO will update teams if/when further provincial guidance is offered on redeployment.
Quality and research projects
- A brief web-based survey is underway to understand the experiences of IHPs in FHTs and to describe their state of practice during the COVID-19 pandemic. We encourage you share the link to the survey with your teams: https://queensu.qualtrics.com/jfe/form/SV_cZQNQrpCqKAc8K1
- The QI in PC Council has started two projects to support all teams. Please consider speaking with QIDSS and QIDSS-like individuals to encourage they join these groups, and contact Sandeep Gill with any questions:
- Standardized Queries for Chronic Diseases & High-risk Patients: Creating standardized queries to identify chronic disease patients, high-risk patients, and OHT priority populations. This will help with lists for vulnerable check-in calls during COVID-19 and priority population identification for OHTs post-COVID-19
- Let’s Measure the Impact of Primary Care during COVID-19: Creating meaningful indicators for primary care that can measure care provided during COVID-19 (ex: support provided to patients by IHPs, number of screenings completed, number of case reports sent to Public Health). This will create indicators to measure the impact of virtual care transition pre-, during, and post-COVID-19
A few other things
- On April 25, the government announced an additional $4/hour of ‘pandemic pay’ for the next four months for frontline workers. The current list of eligible workplaces and workers does not seem to include primary care, but we are seeking clarity, especially for those who have been redeployed to COVID-19 assessment centres, LTC/retirement homes, or hospitals, and for those providing in-person clinical care.
- On April 25, the ministry also released version 4 of “COVID-19 Guidance: Primary Care Providers in a Community Setting.” There are significant inconsistencies in the document, including the misalignment between the case definition and the screening guidance and when full PPE should be used in the clinics. We have let the Emergency Operations Centre know that there are inconsistencies and requested a thorough review be done before dissemination.
- On April 27, the premier announced a high-level framework for the reopening of the province. The news release, which includes a link to the framework, is here.
- The provincial government has announced it’s partnering with the federal government to provide urgent rent relief for small businesses.
- The CEO of Ontario Health, Matt Anderson, issued an update on Wednesday, April 22, from Ontario Health’s COVID-19 Health System Response Team. You can read the memo here.
- AFHTO will be reaching out to EDs in the coming weeks to arrange an interview on teams’ pandemic approach, how virtual care changed practice, and a vision for primary care post-COVID in the ‘new normal.’
Be sure to watch last Friday’s episode of The Agenda, where AFHTO’s president and board chair, Dr. Tom Richard, joined Dr. Sarah Newbery and Dr. Javed Alloo to discuss how family physicians and primary care are coping with caring for patients during the COVID-19 pandemic.
Please consider sharing success stories that we can post and spread to help teams learn from one another, and to continue to show how team-based primary care is stepping up in the wake of this pandemic.
We’ll continue to keep you updated, and we’ll arrange another round of check-in calls to happen in about 2-3 weeks’ time.
Please contact us any time. We’re here to support you through this.
Sincerely,
Your AFHTO Team