Government has taken a key step to move forward with its proposal for health care – the Patients First Act has been tabled in the legislature today.

If passed into legislation, the Act would:

• Add FHTs, NPLCs and AHACs (excluding physician component) to the list of health service providers (HSPs) that LHINs are allowed to fund and have accountability relationships
• Require LHINs to establish sub-regions
• Wind down CCACs
• Give Ministry authority to set standards for LHINs and HSPs, and to issue directives, investigate or supervise LHINs
• Give LHINs authority to issue directives, investigate or supervise HSPs (with some limitations for hospitals and long-term care)

There is more:

• Click here for the Government of Ontario’s summary of the legislation and
• Click here for Government’s full report back on the Patients First consultation and how this legislation responds to what they heard. (See page 7 for details on primary care.)
• MOHLTC – Patients First Presentation to AFHTO Board (June 21 2016)
• Opinion piece by Dr. Sean Blaine, Clinical Lead, STAR FHT and AFHTO President

Implementation details

AFHTO participated in briefings with the Minister’s Office and with the Deputy Minister and other senior staff. Here’s what we understand so far:

Timing

Expect LHINs to get going right away to establish subLHINs and build relationship with primary care. They don’t need legislative change to move ahead with this.

Legislative process is anticipated to be completed in late fall, aiming for structural items to be in place by April 1, 2017. It will take 3-5 years for implementation.

FHT/NPLC/AHAC funding and accountability

The legislation enables LHIN funding – which will make it much easier for primary care teams to receive Health Link funding directly, and likewise for other local LHIN-funded initiatives.

AFHTO has emphasized that, before LHINs are allowed to take any greater role in funding and accountability of primary care, the Ministry must assess and ensure each LHIN’s capacity to understand and fulfill their role. AFHTO has compared this to the “readiness assessment process” each FHT has been required to complete successfully in order to be given greater authority over their budgets. Ministry understands this need.

Ministry will be working with AFHTO (and other stakeholders where appropriate) to put in place new FHT contract templates by April 1, 2017. These contracts will be with the Ministry; the legislation would allow the Ministry to transfer the contracts to LHINs at some future point in time.

No change to board governance

Health care organizations remain intact. An expanded LHIN board (3 extra people) will govern; no new governance layer is to be added for subLHINs. LHIN staff would be assigned to convene providers in each subLHIN. Expect subLHINs to have populations sizes ranging from under 50k to close to 500K, with most being between 100k – 200k.

Physicians/clinicians

Physician funding and contract negotiations remain with Ministry. Legislation would give LHINs ability to act on behalf of the Minister to monitor and manage (but not negotiate) contracts with physicians. It would also require LHIN planning to include physician resources, and to this end, require physicians to notify LHINs of upcoming practice changes.

The Act would also set up an “Integrated Clinical Council” under Health Quality Ontario to develop standards. AFHTO has cautioned about the limitations of a “disease and body part approach”, stating that standards set for primary care will need to be relevant to “whole people”.

Care coordination in primary care

The legislation would allow the Ministry to begin the transfer of CCAC employees and assets to LHINs, and once completed, dissolve the CCACs. AFHTO, together with OPCC colleagues, continues to press the need for care coordinators to be embedded in primary care. We believe we will see a gradual change in their placement over time.

As seen in yesterday’s report on care coordination from Health Quality Ontario, primary care providers in Ontario face the biggest challenges compared to other provinces and countries. AFHTO has just released a new case study – Effectively Embedding Care Coordinators within Primary Care – to help AFHTO members learn from colleagues who have already embedded CCAC care coordinators in their operations.

Investment in primary care

Team-based primary care is already making a HUGE contribution in moving toward the vision expressed in Patients First. AFHTO is continually pressing this case – our membership’s vision is that all Ontarians will have access to high-quality, comprehensive, interprofessional primary care.  We think the reforms introduced in the Patients First Act bring much greater attention to the role and importance of primary care, and with that, the potential for greater investment.

Public health connection

The legislation is a starting point that sets the expectation for LHINs and boards of health to do joint health services planning.  An expert panel on public health will be established to explore deeper partnerships between LHINs and Boards of Health.

Indigenous health

The Patients First discussion document acknowledged the need to identify changes to ensure health services address the unique needs of First Nations, Inuit and Métis peoples. While there is no change presented in the current legislation, government has announced a First Nations Health Action Plan. AFHTO’s Aboriginal and Inuit FHTs have been invited to join with AOHC’s AHACs and Aboriginal CHCs to examine options towards improving health for Indigenous peoples.

AFHTO position on the Patients First Act

We see the potential enabled by this legislation, and we see the work ahead to ensure implementation achieves optimal outcomes for Ontarians – patients, the underserved, and health providers. It also reinforces the need – and creates possible mechanisms – for investment to expand team-based primary care.