Invitation to participate in shaping the next Ministry contract

You are invited to participate in shaping the relationship between the Ministry and the FHT/NPLC by:

• Responding to a survey on the key principles and priorities for new contracts, by Sept. 26, please.
• Participating in “Towards the next Ministry contract” – the annual leadership session immediately before the AFHTO conference–  Wednesday , Oct.15, 10 AM – 12 Noon, Westin Harbour Castle, Toronto

Contracts and public governance Contracts are the means through which an organization receives money and is held accountable for delivering what’s expected in exchange for those funds. In the public sector, they articulate what government, on behalf of the public, wants the publicly-funded organizations to do, what it’s prepared to pay, and how accountability will be enforced. The contract is a critical ingredient for effective governance between government (on behalf of the public) and the organization’s board of directors, and through the board, to govern the use of public resources for optimal public benefit. Governance and quality of care In primary care, emerging evidence tells us that the governance and leadership are key factors affecting the ability to develop high functioning interprofessional teams that see improvements in “Triple Aim” measures – better health, better patient experience, lower cost of care. The question is, to what extent do existing Ministry-FHT/NPLC contracts help or hinder boards in achieving these outcomes? Opportunity to shape contract content For FHTs, current contracts will expire on March 31, 2016. For NPLCs and all models of interprofessional primary care, contracts are expected to evolve toward greater consistency and alignment among the various models. Through AFHTO, members have the opportunity to influence the content of the next set of contract templates – how interprofessional primary care organizations and their purpose is described in the contract and the nature of the funding and accountability arrangements. This content can greatly influence the next stage of evolution for interprofessional primary care. Current state of contracts A number of governance and operational issues have been raised which can be related directly to the terms of the contract and the limitations set by the framework. For example:

• Reporting focuses on activities, not outcomes.
• The people who make critical contributions toward achieving those outcomes are not all included within the scope of accountability within the contract. Currently it is limited to those positions directly funded through the contract and excludes people who work within the team but are employed by other publicly-funded organizations (e.g. CCAC case managers, diabetes educators).  For all but NPLCs and FHTs with blended-salary model physicians, current contracts exclude the key role of physicians.
• The reporting burden is seen to be very high, with relatively low value in the data collected.
• There are significant restrictions on how funds can be used.
• Many have expressed the need for greater clarity in the relationship between funding and meeting patient/community needs and expectations.

Participate in the survey (by September 26, please) and the October 15 Leadership Session This survey is the first step in shaping the relationship between the Ministry and FHTs/NPLCs, through the contractual agreement. The results will be used to design the content for “Towards the next Ministry contract” – the annual Leadership Session immediately before the AFHTO conference, taking place Wednesday, Oct.15, 10 AM – 12 Noon. The objective for the Session is to develop a common statement of principles and a set of agreed priorities to guide AFHTO’s work toward new contract template.