• Patients First Updates & Advice from Member Leaders

  Sent to: Board Chairs, Executive Directors and Lead MDs/NPs in AFHTO-member FHTs and NPLCs

  On May 12, forty AFHTO members from around the province – Physician Leadership Council (PLC),
  ED Advisory Council (EDAC) and the NPLC Council – received updates on the Ministry’s plans for Patients First, and then  strategized on how to ensure each LHIN moves in a direction that will strengthen primary care to be the foundation of the health system. Additional updates were provided, e.g. roll-out of compensation increases, development of new FHT contract templates, and more.

  • Top 3 messages from the meeting overall
  • What we heard from the Ministry
  • What we’ve been learning about LHINs
  • EDAC/PLC/NPLC advice for AFHTO members
  • Additional updates from AFHTO
  • AFHTO: advocate, network and resource centre

  Top 3 messages from the meeting overall

• While we don’t yet know when legislative changes will be introduced to implement many aspects of Patients First, nor how the LHIN relationship with primary care will evolve, we do know that government remains committed to the overarching principles of Patients First – i.e. population health and integration at the local level, with particular attention to primary care, home and community care, and public health.
• We DO know there remains great opportunity for primary care organizations to shape what this future will look like. FHTs and NPLCs can – and are – further developing their relationships with their LHINs, primary care colleagues and other providers to identify and respond to population health needs in the community.  The Ministry is looking to our membership to identify change leaders, and for input into an ‘implementation work plan’ and ‘collective to-do list’.
• AFHTO is here to help members with information exchange and advocacy support as you work within your LHINs and sub-LHIN Please do not hesitate to contact Bryn.Hamilton@afhto.ca or Angie.Heydon@afhto.ca for advice and/or to pass on updates from your LHIN.

What we heard from the Ministry

Nancy Naylor (Associate Deputy Minister), Tim Hadwen (Assistant Deputy Minister), Phil Graham (PHC Branch Director), and Alison Blair (newly appointed Director for LHIN renewal) made a presentation on key themes emerging from Patients First consultations and next steps.

Key points from their presentation and response to questions:

• Content and date for government to introduce legislative amendments to implement Patients First is not yet known. As a result, many of the questions members were asking do not yet have answers.
  • At the Ministry’s invitation, AFHTO is sending them these unanswered questions to include in theworkplan, as they prepare for when government gives direction.
• In the meantime, the Ministry continues to encourage primary care teams to:
  • Work with the LHINs in identifying sub-LHIN regions;
  • Take a population-based approach to assess the health needs of your local sub-LHIN communities;
  • Look at ways to enhance access to interprofessional team-based care to those who need it.
• Health Links have laid important ground work for collaboration and will be strong predictors for developing sub-LHIN boundaries.
• Governance structures and models may need to be further examined with additional stakeholder input.
  • Together with our colleagues in the Ontario Primary Care Council, AFHTO is calling for sub-LHINs to adopt a collaborative approach to bring together multiple players, and avoid introducing an additional governance layer.
  • Meanwhile, members report that at least 5 of the LHINs are at varying stages of considering merging organizations under a single governance.
• The Rural Health Hub concept is one of these single-governance approaches being considered in some sub-LHIN areas. When asked about it, the Ministry indicated they have not made any decisions about broad implementation of this approach. They believe the concept makes sense in some areas, especially in remote regions. The Ministry indicated that it will not necessarily prescribe what agencies take a lead role on this. How this moves forward will need to be sensitive to local need, capacity and contribution of all the players that exist.
• There is recognition that implementation must proceed carefully.
• The Ministry recognized the influential leadership of AFHTO and its members and shared their willingness to work together as we move towards the implementation phase. They specifically noted the recommendations in AFHTO’s Patients First response and our joint submission of the Ontario Primary Care Council.

What we’ve been learning about LHINs

Following meetings with members and LHIN leaders in 12 of the 14 regions, updates from members covering all LHINs, and polling feedback received during the May 12 web conference, the following picture emerges:

• To date, Health Links appear to have been the key driver for FHTs/NPLCs to have developed relationships with LHIN.
  • 15% of members on the call reported their LHIN has been speaking about Health Links as the foundation for building their primary care strategy.
• Patients First opened doors with LHINs that may have been closed before for primary care teams. For the most part LHINs are looking at improving their structures for engaging primary care.
  • 63% of members on the call reported their LHIN recognizes and support primary care as the strong foundation for the health system.
  • Unfortunately, 23% have no confidence their LHIN will do what’s needed to strengthen primary care.
• LHINs are already taking on the new role of reporting on and fostering improvement in primary care. Almost all LHINs recently published their fourth Integrated Health Service Plans, for 2016-19. All have goals related to access to primary care, and some identify “measures directly attributable to primary care system improvement opportunities.”
  • AFHTO and its members are working very hard to demonstrate that meaningful measurement for primary care must be grounded in comprehensive care and the patient-provider relationship, as reflected in Data to Decisions (D2D) and guided by the Starfield Principles.

EDAC/PLC/NPLC advice for AFHTO members

Members strategized on ways to advance the concepts within Patients First, while influencing direction and proactively preparing for any legislative changes.  Summary of advice to all members included:

• Distributed leadership will be key to successful implementation. Identify leaders at the sub-LHIN level, build the network of engaged primary care leaders in the field to promote the collective primary care voice.
• Get involved in your local Health Link as a starting point to connect with other health service providers and as a platform for building the coordination of services around patient need.
• Continue building relationships and self organizing within your sub-LHIN regions.
• Don’t let the LHIN re-create the wheel when it comes to measurement in primary care. Highlight the work AFHTO is doing, demonstrate the value of meaningful measurement, stress the need to partner together and show the LHIN how our data sets and outcomes can help them reach their performance goals.

Additional updates from AFHTO

Implementation of compensation increase: Our best guess is that funding packages will be out by early summer. AFHTO will be working with AOHC and NPAO to develop supports to help develop and implement compensation plans.   Ministry direction is clear that this funding can only be used for compensation for approved staff positions – and can not be used for any other purposes.

Development of FHT-MOHLTC contract templates: AFHTO CEO has discussed approach and timing for consultation process to inform the development of new FHT-MOHLTC contract templates for March 2017.  We anticipate the consultation across the AFHTO membership (and other key stakeholders) will take place over June to September. Key issues that emerge will be brought to AFHTO’s annual Leadership Session (immediately before the AFHTO conference) for more in-depth discussion and resolution.  The consultation and implementation processes will be supported by close to $110,000 members voluntarily contributed to the Legal and Consulting Fund.

D2D 4.0 indicator survey is open until May 18^th: D2D 4.0 will be released in September 2016. As usual, we need input from you regarding the indicators and definitions to ensure it is manageable and meaningful for members. Please respond to the membership wide survey.

AFHTO: advocate, network and resource centre

Whether it’s developing background materials, advocacy work, structuring messages to stakeholders, building LHIN relations, or simply asking advice, members are reminded AFHTO is here to support YOU.

Let us know what we can do to help: info@afhto.ca.

AFHTO will continue to track Patients First implementation progress across the LHINs and help to build upon relationships where required.