EDAC meeting report: Shaping the future of MOHLTC contracts and the “Primary Care Guarantee”

Yesterday’s meeting (Aug. 20) of AFHTO’s Executive Director Advisory Council (EDAC) included preliminary discussion to prepare AFHTO for advocacy on behalf of members on two key topics:

• The contractual relationship between Ministry and primary care organizations
• Shaping the Ontario government’s “Primary Care Guarantee”

 Towards the next Ministry contract Current contracts between MOHLTC and FHTs will expire on March 31, 2016. MOHLTC has signalled its intent to maintain consistency in contractual requirements across NPLCs, FHTs and other interprofessional models. Over the next year AFHTO members – through their association – have a critical, time-sensitive opportunity to shape their contractual relationship with their primary funder. Ideally, the MOHLTC contract would set up a framework that would allow for things such as:

1. Accountability based on patient outcomes, access/quality of comprehensive primary care, and appropriate use of public funds.
2. Funding that supports optimal use of resources to deliver quality care and patient outcomes.
3. Measures to harmonize work where more than one organizational entity (e.g. FHT and physician group, FHT/NPLC and embedded CCAC or other staff) is involved, to optimize the performance of the clinical team

EDAC members were asked for feedback on the process for engaging board chairs, MD/NP leads and EDs of AFHTO member organizations. The annual Leadership Session on October 15, immediately preceding the AFHTO annual conference, will be the first step in engaging members to define their collective vision and priorities for shaping this contractual relationship with the Ministry. Prior to the session, a survey accompanied by a concise backgrounder on the issues will be sent out to all board chairs, MD/NP leads and EDs. The purpose of the survey will be to both inform all of the leaders in our membership as well as to assess which issues are central to developing guiding principles. The survey will be piloted with a small group of volunteer EDs from EDAC in late August. The survey will be sent to all our members by September 17. Shaping the “Primary Care Guarantee” In the recent election campaign, the now-governing Liberals declared a “Primary Care Guarantee” – it “will ensure that every Ontarian has access to a primary care provider by 2018”. This document stated: To make the Guarantee a reality, Premier Kathleen Wynne’s Liberals will:

• Focus on northern, rural, and fast-growing communities to improve availability and access to primary care, including the use of Community Health Centres and satellites.
• Work with our physician partners to help them take on more patients, faster.
• Improve the recruitment and retention of community-based primary care teams.

On behalf of members, AFHTO’s priority issues have been recruitment and retention of primary care staff, expanding access to interprofessional teams, and support for measurement. These were the three key messages in AFHTO’s “Better Care. Healthier Families. Best Value” campaign before and during the provincial election. As a sector, we now have the opportunity to work with government to shape its direction for achieving the “Guarantee”, in line with what our members believe to be the priorities and needs for advancing the membership’s vision – that all Ontarians have access to high-quality, comprehensive primary care, that is informed by the social determinants of health, delivered by collaborative teams, anchored in an integrated, equitable and sustainable health system. EDAC was asked for input in the early development of advice for government. Discussion resulted in the following list of factors to explore:

• Staffing:
  • Extent to which reduction in current vacancy and turnover rates could improve access to primary care
  • Opportunities to expand “grow your own” programs to address skills shortages in some communities
• Opportunities to support and deploy teams as effectively as possible:
  • Need for appropriate IT infrastructure: deficiencies impact the capacity of health professionals to provide care and present challenges in a competitive recruiting environment.  Solutions to the barriers/limitations of current IT funding models may enhance capacity to care for more patients.
  • Opportunities within the team:  patient needs met by right professional at the right time, working to full scope of practice. Flexibility to shift skills mix as needs change
• Need for community-based planning:
  • Planning to meet needs must be done at the local level
  • Interprofessional teams can (and do) play a key role in assessing and addressing community needs
  • Explore opportunities to improve access by expanding existing teams
• Need for measurement that allows for capacity and quality to be tracked, to better inform on what’s working and where further support/investment is needed:
  • The Starfield Model, AFHTO’s approach to primary care measurement will by a key factor. It focuses on the relationship with patients and ability to deliver the care patients value. Its objective is to optimize quality, access and total health system cost of care for patients, using indicators from Health Quality Ontario’s Primary Care Performance Measurement Framework. The model and a case study of its implementation was just published in the Healthcare Management Forum – The Starfield model: Measuring comprehensive primary care for system benefit.

AFHTO looks forward to working with members to continue to develop and refine our advocacy priorities and recommendations on these topics.

• Members are welcome to send comments on these advocacy topics to AFHTO’s Executive Director – Angie.Heydon@afhto.ca.
• Questions and comments regarding EDAC can be sent to AFHTO’s Provincial Lead for Governance and Leadership – Clarys.Tirel@afhto.ca.