August 28, 2023
The Honourable Sylvia Jones
Minister of Health and Deputy Premier
Ministry of Health
College Park 5th Floor, 777 Bay Street
Toronto, ON M7A 2J3
Dear Deputy Premier,
Subject: Ensuring Equitable Access to Team-Based Care
On behalf of the Ontario College of Family Physicians, the Association of Family Health Teams of Ontario, and the Alliance for Healthier Communities, we are writing to seek your support to ensure that every Ontarian has access to team-based primary care.
Team-based care in Ontario has proven to be a successful model in providing comprehensive and coordinated primary healthcare services for Ontarians. Integrating services and expertise within a single team enables streamlined access to primary care, enhanced care coordination, equity-based care, and efficient referrals to specialized services when necessary. The involvement of dedicated healthcare professionals ensures seamless information sharing, communication, and follow-up, thereby reducing gaps in care and improving the overall patient experience.
Earlier this year, your government made an investment of $30 million to expand existing interprofessional primary care teams and/or create up to 18 new teams in communities with the greatest need. This investment is an important first step in improving patient care and access to primary care services while supporting primary care professionals, but our work cannot stop here.
2.2 million Ontarians do not have a primary care provider. 75% of Ontarians do not have access to interprofessional, team-based primary care. We are requesting that the government increase your investment in the expansion of team-based care
The number of Ontarians without access to a primary care provider continues to grow, and with a rapidly growing and aging population the demand for primary care is only going to increase. Many providers are choosing to leave their primary care practice because they do not have the required support that they need to see their patients and fulfil their administrative work. This is putting even further strain on the existing system.
Currently, only 1 in 4 Ontarians have access to interprofessional, team-based primary care. The remaining 75% of patients and their primary care providers do not have access to primary care teams.
There is a maldistribution of team-based care province-wide, ranging from areas of high attachment such as in Georgian Bay to lower attachment including areas such as the GTA, Algoma and Ottawa. Marginalized or racialized groups are often most impacted by these gaps.
Team-based care provides a proven solution to better support patients and healthcare workers.
Research shows that when Ontarians have access to comprehensive team-based primary care, the strain on our healthcare system and emergency departments is reduced. In addition, the patient experience improves because it allows Ontarians to have one door to a team of healthcare providers who know them, their family, and their history to support their everyday health and social needs.
The evidence also shows that primary care providers with access to interprofessional healthcare providers for complex patients (i.e., as part of the care team) are associated with better patient outcomes for complex issues; improved medication reconciliation; reduced service and ED utilization; stronger provider buy-in, and reduced workplace stress.
By expanding on your government’s initial investment, and focusing on regions where the need is greatest, we can continue to work towards our shared goal of ensuring that every Ontarian has access to a primary care team.
Taking an equitable approach to closing gaps in primary care access.
Your commitment to invest $30 million to expand access to team-based care is a key first step. However, our collective work must continue to ensure that every Ontarian has access to the primary care they need, and this requires further financial investment in primary care teams.
Following the Expression of Interest (EOI) process we have collected feedback and advice from our membership to help guide further investments to ensure a sustainable and equitable approach to strengthening primary care in Ontario.
We have three recommendations:
1. Implement a data-driven approach to expansion: To best address areas of need and primary care “deserts” it is critical that new or expanded teams are first supported in regions with no or limited access to team-based primary care. By prioritizing areas and populations with the highest unattachment rates, the lowest attachment rates to team-based care and material deprivation, we can ensure that resources are allocated equitably to address primary care “deserts” and serve the unattached effectively.
Black, racialized, Francophone and Indigenous Ontarians are at greater risk for negative health outcomes. Data related to those populations facing disproportionate challenges accessing primary care must inform and be prioritized in the planning and financial allocation process.
In addition, any data collection and use related to these populations needs to fully involve them from the first planning activity through to implementation and ongoing activity to ensure culturally responsive, accessible care.
2. Leverage Ontario Health Teams (OHTs) to support regional planning: With a developed OHT in almost every region of the province it is critical that these teams and established Primary Care Networks (PCNs) within OHTs are involved in primary care planning, including providing local data and assessing regional capacity. This collaborative approach will ensure that investments are well-informed, sustainable, avoid duplication, and are tailored to regional needs.
3. Streamline the application process: While there was significant interest in the recent EOI process, the short timelines to apply and develop proposals were prohibitive for some proponents. Should there be any future EOI process, to facilitate meaningful collaboration and innovation, we suggest extending the time allocated for proposal development, enabling partners to engage in substantive dialogue and construct well-coordinated plans. As well, ensure any process is guided by points #1 and #2 above.
Investing to ensure every Ontarian has access to a primary care team.
Reaching our goal of ensuring that every Ontarian has access to team-based primary care will not be possible without significant investments from governments. However, we also know that investments in primary care will not only better support patients and providers they will also lead to long-term savings through proactive preventative health responses and decreasing pressures on emergency and hospital services.
We look forward to working with you to strengthen our primary care system and ensure equitable access to team-based care for all Ontarians.
Sincerely,
Kimberly Moran, CEO, Ontario College of Family Physicians
Sherry Parsley, Interim CEO, Association of Family Health Teams of Ontario
Sarah Hobbs, CEO, Alliance for Healthier Communities
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