The quarterly meeting between AFHTO and the MOHLTC’s Primary Health Care Branch was held on November 21^st 2014. The meeting focused on:

• Process to revise Ministry contract templates and schedules
• Recruitment and retention
• 2014/15 funding, reporting & budget reallocation
• 2015/16 Operating Plan process
• Funding envelope for interprofessional primary care

Process to revise Ministry contract templates and schedules

Following from the AFHTO membership’s work to develop a common direction — Toward the next ministry contract: Principles and guidance for moving forward –  AFHTO and PHC Branch have begun to map out a path to put in place new contract templates before the current Ministry-FHT contracts expire on March 31, 2016. With this comes the opportunity to develop more mature and meaningful contracts that will support interprofessional teams to continue to deliver high-quality primary care and improve the health of the people in the communities served. While these discussions focus on FHTs, AFHTO retains a clear focus on the needs of, and implications for, our NPLC members. Discussion with PHC Branch focused on the process to review and renew the contract template, which identifies the terms and conditions of funding in addition to some programmatic elements. The Ministry is looking to our members to provide recommendations on possible amendments to the contract template that will support FHTs in achieving their objectives. Discussion also focused on the process to determine the performance measures to be reported under Schedule A of the contract. Members have agreed that:

• Financial and clinical reporting should minimize duplication in data collection and reporting.
• Accountability should be defined in terms of collectively agreed upon measures that reflect value delivered.
• Reporting requirements should place more emphasis on the work of the team to achieve outcomes and less on individual member activities and patient encounters.

The ministry is looking to AFHTO, in collaboration with other relevant stakeholders, to recommend performance measures aligned with the ministry’s focus on enhancing access/integration and supporting quality and sustainability in primary care.  We are well-positioned to do this, by leveraging our collective work on the next iteration of Data to Decisions  (D2D 2.0) and continuing to engage our members and other stakeholders (ICES, HQO, AOHC, OMA). Ministry representation will be added to the process.  As a collective, we will continue to identify manageable and meaningful measurement and demonstrate the value and impact of interprofessional primary care as we work towards the next ministry contract.

Recruitment & retention

Recruitment and retention remains the most significant challenge for FHTs and NPLCs. This issue is well-recognized in the PHC Branch. AFHTO members:  This issue can only be addressed at the political level of government. We understand planning work is underway, and are encouraged by support that has emerged from the opposition parties – seen in a question in the Legislature from the NDP Health Critic (Oct.28) and a Member’s Statement from the PC member from Huron-Perth riding this past week. The best thing AFHTO members could do at this point is continue to meet with MPPs – this is the political pressure that will be the most effective at this point. To help you in this work– click here for:

• A brochure, key messages and a powerpoint you can use in MPP meetings.
• AFHTO-AOHC-NPAO joint report and recommendations on recruitment and retention in primary care

2014/15 funding, reporting & budget reallocation

All budget letters have been mailed out to the FHTs; NPLC letters are in the approval process. For FHTs that requested funding for physiotherapy, these letters are separate and should be sent out over the next few weeks. The need for transparent letters that clearly identify funding increases versus reinstatement of funds was noted. Ministry representatives accepted the feedback but noted that the letters are based on standard ministry templates they are required to use. The approved funding for QIDSS positions was also reviewed. While we are pleased to see some increase in QIDSS positions, MOHLTC was able to fund only 3.5 FTEs out of the 13 requested. The ministry signalled the commitment to continue with performance measuring and maintaining a strong focus on quality yet stressed the limitation of working within confined budgets. There is a need to develop more clear expectations for host sites of QIDSS; AFHTO will work with our host and partner sites to develop advice for the ministry accordingly. While funding is tight there is room for flexibility in use of budgets.  PHC Branch noted there are still dollars being returned at the end of each fiscal year. FHTs and NPLCs are encouraged to request reallocation of approved budgets to meeting needs.  This includes requests to move funds for current vacant positions (clinical or admin) to a QIDSS position. For the quarterly reports, the ministry noted that there is no expectation for FHTs to backfill data for Q1 or Q2, the expectation is that data will be provided for Q3 only.

Accountability Reform Initiative

Now that budget letters have gone out, this will be the next focus for the ministry. Stay tuned for ARI approvals and information on the next cycle of applications. AFHTO’s Fundamentals of Governance guidebook, videos and toolkit is available to help members take the steps needed to meet the requirements.

2015/16 Operating Plan

AFHTO conveyed members concerns regarding the challenge of meeting reporting deadlines and then waiting 8 months for approvals. We acknowledge that much of the approval process takes place beyond the control of PHC Branch, but both sides are interested in continuing to find ways to improve the process that takes place within the branch. Ministry staff are currently working on  process and timelines for the 2015-16 operating plan and budget submissions. Draft material will be shared in the next couple of weeks; the ED Advisory Council will review during their December meeting and provide feedback. As the process unfolds, AFHTO will work closely with our members to support them in completing the submission requirements.

Funding envelope for interprofessional primary care

The current budget allocated for Interprofessional Programs (FHTs, NPLCs and AHACs) has pretty well reached the limit.  The message to AFHTO members is:

• Your association will continue to use all available evidence to make the case for investment in interprofessional primary care.
• In order to do this, we must collectively demonstrate and document the value to health and the health system from Ontario’s investment in interprofessional primary care.
• Our collective work to advance manageable and meaningful measurement, aligned with the Starfield principles, is a fundamental key to accomplishing this.

In the current fiscal climate, it will be challenging to expand the budget envelope.  As we approach the next cycle of operating plans, we must all be prepared for no new money, and find ways to make optimal use of available funds.