The Ministry template for FHT Funding Agreements has serious implications for FHTs, therefore this message is being sent to all FHT leaders, AFHTO members and non-members alike. This message follows up on an e-mail sent to all AFHTO members on March 25 and a related message sent to non-members on March 26. The AFHTO board of directors met this evening (March 27) to review the results of the membership survey on the Funding Agreement (53 responses since Saturday) and outcome of discussions today with Phil Graham, with two different lawyers working with FHTs on this issue, and with various FHT leaders. The key messages for all FHT leaders are: 1. Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation. Our survey results tell us over 60% of responding FHTs cannot meet the deadline. The Ministry’s FHT Unit has said it is looking for “best efforts for sign-back” and will consider requests for extensions, as long as the FHT is specific in identifying the additional issues that need to be addressed. 2. Review the problems with the template agreements listed below, and seek legal advice as needed to deal with your FHT’s unique situation. Our survey results show that the “all funded positions shall be employees” clause will create significant hardship for the majority of FHTs. Additional issues identified to date in the three template agreements (one for each of the three governance models) are identified below. 3. In a letter to your Ministry consultant, indicate very clearly the clauses in the Agreement that are of concern. In sending the letter, your FHT could append the signed Agreement, having first struck out and initialled all of the problematic clauses in the agreement. 4. E-mail a copy of your cover letter to AFHTO — angie.heydon@afhto.ca. AFHTO is ready to gather FHT opinions and coordinate discussion. Our goal is to facilitate resolution of issues that are common among FHTs. Concerns with the template agreements · “All funded positions shall be employees” clause: From the survey response, this is a problem affecting pharmacists in about 1/3 of responding FHTs, admin staff and social workers in about 1/4 of these FHTs, RNs and dieticians in 15% of these FHTS, and NPs in just under 10%. Among the 19 FHTs who reporting having psychologists, 11 FHTs would be challenged in converting them to employees. Twenty-eight FHTs reported having mental health workers; 9 of these FHTs would have the same conversion challenge. AFHTO acknowledges that a government-wide directive on “transfer payment accountability” has led to inclusion of this clause, and that the clause allows for exceptions. From discussions Friday and today, it is clear that each requesting FHT will have to go to inordinate lengths to prove they cannot fill these positions with employees, and very few exceptions would be granted in the end. While AFHTO believes it will be possible to find solutions that uphold government’s principles for transfer payment accountability, without jeopardizing patient care, the FHT Unit has indicated they are not prepared to discuss it further. · Governance problems in “Mixed Governance” and “Provider-led” templates: For Mixed Governance FHTs: the requirements are highly prescriptive (and include some errors, e.g. a FHT cannot be a member of itself) and will generate costs to amend and implement the resulting bylaw changes. For Provider-led FHTs: their governance is undermined by the lack of any reference to the FHT board as the governors, and gives authority for the contract to the “Lead Physician and Associate Lead Physician as designated or redesignated under its Physician Services Contract”. · Other concerns to note: AFHTO members have also flagged concerns about: – the process by which payment could be reduced or suspended – the restrictive bands on compensation levels – liabilities for the physician group if the FHT is wound up – the requirement to consult with the Ministry before participating in media communications and publications. AFHTO will continue to work on behalf of members to identify and work to resolve common issues. We will provide updates and share solutions with AFHTO members as they emerge. For those who are not yet members of AFHTO, this is an excellent time to join. Go to www.afhto.ca for more information.
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