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This email was sent to EDs/Administrative Leads, Board Chairs and Lead Clinicians of AFHTO member organizations.

Dear triad members,

AFHTO’s Leadership Council met on June 3, and executive directors joined our fourth round of regional ED calls on June 1 and 2. This communique is in follow-up to those meetings.

Below is information on the topics discussed on the calls, as well as other updates and supports that we heard would be helpful.

Transitioning to a new normal

• Directive #2 was updated on May 26, enabling health care providers to resume all deferred and non-essential and elective services. The directive can be read here.
• The “COVID-19 Operational Requirement: Health Sector Restart” outlines the operational details and requirements referenced in the directive.
• This restart is in coordination with and with clinical guidance from health regulatory colleges. AFHTO is exploring how we can create a quick reference table that will link to guidance from the colleges, so teams can see the direction health care providers are receiving on delivery of in-person care.
• The province’s Primary Care Advisory Council has been advising the government on a reopening strategy, and were a strong voice in the most recent “COVID-19 Guidance: Primary Care Providers in a Community Setting.”
• Additional resources you may find helpful:
  • A draft guidance document for reopening chiropody services in FHTs and CHCs.
  • The “Re-introduction of In-person Primary Care” from the South West Primary Care Pandemic Response Table is a rough guide to support clinical judgment on which heath care services to provide in phases 1, 2, and 3 of gradual reopening.
  • This response table has also released a more detailed “Re-opening Guide: Primary Care/ Community Specialist Offices,” which includes information that may help with questions raised on the calls, such as office flow, scheduling, screening, sanitizing/cleaning (including gowns and clothing), and home visits.
  • On June 3, Choosing Wisely hosted a webinar entitled “Re-opening, Warily: Re-Thinking Clinical Practice in a Time of Physical Distancing,” which you may find of interest.
  • Miller Thomson has held two webinars that you may also find helpful:
    • Coffee Talk: Health Industry Seminar Series – COVID-19 Lockdown Lifting: Expert Panel on Resumption of Health Care Services (May 26, 2020)
    • Coffee Talk: Board of Directors Series – A Governance Guide for Health Service Resumption: What Directors Need to Know (June 3, 2020)
• AFHTO has been compiling a list of re-opening resources that teams may find useful as we begin to transition to this new normal. As work progresses in each region, we’ll be looking into what other resources or checklists we can provide to support teams through this transition. Check out the current resources, and please consider sharing any you have that you think may help other teams!

PPE

• There is concern across the province about the increased need for PPE that will come with gradual re-opening and an increase in in-person visits.
• Teams are encouraged to read Public Health Ontario’s recommendations on performing a risk assessment to help determine what PPE is best for what circumstances.  
  • Here is a one-page summary on the recommendations for asymptomatic patients and the “Point of Care Risk Assessment – PPE Selection Guide.”
  • Here is Public Health Ontario’s IPAC recommendations for PPE for care of suspect or confirmed COVID-19 cases.
• Check out this guidance on washing and reusing non-medical masks and face coverings and reusing PPE.  
• AFHTO generally heard on the calls that undertaking bulk purchasing and PPE distribution does not make sense for an association to lead. However, AFHTO can help identify regional suppliers with whom to connect teams or to encourage they contact. Please contact us if you are having trouble with your supply route, and we will link you to teams that have been successful.
• The government’s Workplace PPE Supplier Directory provides information on companies that sell PPE, sanitization, sneeze or counter guards, and digital technologies and apps.
• The ministry will be looking at costs late summer/early fall to understand financial impacts being faced by teams due to the unexpected and significant increase in PPE cost.
• A reminder that the OMA SGFP has secured an arrangement for bulk purchasing of PPE with Surgo Surgical Supply. Please connect with your affiliated physician group to get access to this information.

  Virtual care

• On May 20, AFHTO held a webinar on virtual visits with a panel of providers: “Virtual Visits: Beginning to End.” With close to 300 individuals participating in the webinar, we did not have a chance to answer all the questions, so a follow-up Q&A, along with the recording and the presentation, are posted online.
• We are pleased to be hosting our next virtual care webinar this Thursday, June 11, at 12 PM. We’ll be hearing from teams across the province on innovative work they’re doing in the “Team-based Care Supporting Patient Communities through COVID-19” webinar. Register here!
• For providers working remotely, more information can be found here to help with privacy and security concerns, as well as some of the VoIP options that teams are using.
• Primary care teams have adapted to virtual care almost overnight and are leading patient-centric innovations in their community. Take a moment and learn more about what teams across the province are doing, and please share your initiatives with us at improve@afhto.ca.
• Work is still underway with our primary care partners to roll out a provincial primary care patient survey and provider survey to measure the virtual care experience during the pandemic – stay tuned for more information on that!
• The ministry is seeking feedback for its Digital health interoperability – proposed amendments to O. Reg. 329/04. The deadline for feedback is July 22, 2020.

Human Resources

• On May 25, AFHTO signed a joint letter to the premier regarding pandemic pay and the lack of clarification on how it would work and to whom it would apply. On May 29, the province released information on pandemic pay eligibility – the slide deck outlining this can be seen here. AFHTO can confirm the following:
  • Primary care team members (NPs, RNs, RPNs) that have been redeployed to work in the COVID-19 assessment centres, long-term care homes, retirement homes, and hospitals WILL be eligible for the pandemic pay.
  • Any other team members redeployed (administration, social workers, etc.), are not eligible for the pay. The eligible workers can be found on page 4 of the slide deck.
  • Page 9 outlines how the pay will be paid out:
    • Staff member redeployed from an ineligible employer to an eligible employer (e.g. private sector to hospital):
      • Will be paid by the home employer
      • Funds will be paid to receiving employer who will provide funds to home employer under agreement
  • Pandemic pay is an additional $4/hr from April 24 to August 13. An additional $250 monthly stipend applies to frontline staff working at least 40 hours a week in areas considered high risk.
  • The ministry is hoping to roll out the funds through already existing Transfer Payment Agreements in the next two weeks. They will be releasing a FAQs document Tuesday/Wednesday this week to address questions, including logistics for the payment.
• Teams can also use the 10% exemption of payroll taxes to acknowledge staff efforts or recognize those whose responsibilities have increased. One-time bonuses or compensation increases are under the purview of each board, and COVID-specific policies would be needed.
• A reminder to check out the presentation, recording, and documents provided by Maria McDonald, McDonald HR Law, during our recent webcast, “Managing HR and Supporting Staff through COVID-19.”
• A reminder that R&R funding was disbursed in April, and teams should be working on reallocating the increases. For guidance, please see the Recruitment and Retention Planning Document and the Compensation Guidance Document.

As re-opening gradually resumes and we reassess how health care is delivered – both from the impact of this pandemic and the ongoing development of Ontario Health Teams – it is critical to show how team-base primary care is a pillar in a strong healthcare system, and that it is the delivery of comprehensive care to individuals that contributes towards the best population health.

In the midst of a pandemic, there is no better time to demonstrate this. AFHTO is working with our partners to showcase how primary care has stepped up – and will continue to step up – to support Ontarians and to ensure a sustainable and equitable health care system.

As noted in the last communique, to capture the primary care experience, we will be reaching out to schedule interviews with executive directors. We have interviewed a researcher and we hope to start calls in late June. The research we are undertaking will provide a narrative of how essential team-based primary care was during the pandemic, and how critical it will continue to be moving forward.

Keep checking out our COVID-19 section that we regularly update with news, tools, and resources, including the daily situation reports and regular memos from the ministry’s command table.

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