Category: Uncategorized

Dear Executive Directors/Administrative Leads,

With December now here, we would like to share updates on a few issues that are front of mind for many. We also met with the Primary Health Care Branch on December 1, and they provided some insight that we would like to share.

Bill 124
Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, 2019 was declared “to be void and of no effect” by Justice Koehnen of the Ontario Superior Court on November 29. The court declared Bill 124 was unconstitutional and a violation of the Canadian Charter of Rights and Freedoms.

AFHTO, along with our health system partners, have been advocating to government to repeal this law since it was proclaimed in 2019, so we welcome this news. We hope it will start the pathway toward fair and equitable compensation for healthcare workers.

The government plans to appeal the decision, but they have stated that they will not use the notwithstanding clause, so this appeal could take years to settle.

What does this mean for primary care teams?
Maria McDonald of McDonald HR Law sent a communique on November 30 that noted:
As of November 29, 2022, Bill 124 is not an enforceable law. It is unknown what the government will do but an appeal could take years. It is highly unlikely government will make any revised law retroactive. As such, right now, Bill 124 (which does not exist because it is void and unenforceable) does not prevent granting bonuses.

However, it’s important to note that there are clauses in your agreement that will direct how you can interpret this for your team. For FHTs, this is referenced in Clause 7.3:
“All Funding shall be applied directly to the payment of Schedule “B” expenditures, and for no other purpose. The Recipient shall expend the Funding in each Funding Year only in accordance with the Annual Budget for each Funding Year. No changes to the approved items in Schedule “B” are permitted without the prior written consent of the Ministry, unless otherwise specified in this Agreement.”

For NPLCs, refer to Clause 3.03:
“All funding shall be applied directly to the payment of Schedule “A” and “A-Appendix 1” expenditures, and for no other purpose. No changes to any Schedules are permitted without the prior written consent of the Ministry as set out in section 2.09. Continued Funding under this Agreement is subject to Ministry review and approval of Approved Annual Operating Budgets and Banking and Payment Schedules and Service Requirements.”

All other models, please reference your agreements for relevant clauses.

In 2019, the Ministry provided some guidance on how best to interpret increases with staff. This guidance still applies:

• If you increase salaries, ensure you have sustainable funding to maintain the increase as the Ministry will not be providing additional funding.
• You cannot eliminate a position to accommodate for increases. During reconciliation, your budget will be ‘right-sized’ if you no longer need that position, and the funding will be taken back.
• If performance-based merit pay is part of the organization’s compensation plan and fits within the HR budget, this would be allowable.
• Vacant positions or underfilled FTE positions cannot be used to fund additional compensation for other positions. Funding needs to be allocated for all funded positions within the framework of the board’s compensation plan and policies.

As we learn more about what is now allowable with the repealing of the Bill, we’ll share this information with you.

A reminder that we are working on a compensation market refresh with our partners in interprofessional primary care, mental health and addiction, community care, and not-for-profit long-term care: Addiction and Mental Health Ontario, AdvantAge Ontario, Alliance for Healthier Communities, Canadian Mental Health Association (Ontario), Children’s Mental Health Ontario, Family Service Ontario, Indigenous Primary Health Care Council, Nurse Practitioner-Led Clinic Association, and Ontario Community Support Association.

This work will be the grounding for advocacy for sustainable increases in salaries. We’ll share more once the work is underway with our recently approved vendor.

If teams have questions, please contact us any time.

Mental Health and Addiction Funding

Funding packages for the MHA one-time funding are still in approvals. Funding is expected to flow in January, and it will cover expenses from October 1, 2022, to March 31, 2023.
We know that this isn’t enough time to spend the funds. Planning is very important, so we encourage you consider the following given the tight time frame you will be working in:

• Work with your fellow primary care teams to discuss pooling the funding to purchase MHA supports for teams, OHT, and/or unaffiliated physicians. We encourage you also work with other mental health organizations and providers, such as CMHA, AMHO organizations, and private psychologists regarding pooling or transferring funding.
• Increase the FTE of your MHA staff or hire temporary staff to support the backlog of MHA in your team or in your community.

We appreciate this is difficult without knowing the funding amount you’ll be receiving. However, we hope you can get a general plan in place with or without your partners as you await confirmation of the amount and flow of the funding.

We’ll be in touch next year to ask about how funding was used as this will help the Ministry build a case for sustainable funding to embed much-needed MHA supports in primary care.

Approval Process for Extra Costs Incurred During this Respiratory Season
The Ministry memo from November 21 is still front of mind for many teams. A reminder that the memo, though not well communicated, was about communications to your patients and doing your best to support this respiratory illness surge.

If your team is planning to increase capacity, we encourage you do your projections to year-end and assess your existing funding. If you still feel unable to fund the increased work you wish to do, please reach out to your program consultant to demonstrate this, and then begin discussion for funding support. If you have any issues, please outreach to us at any time.

FHT Contract Recommendations
Thank you to everyone who participated in AFHTO’s FHT contract recommendations. Your advice and suggestions were critical for us to develop a thoughtful set of recommendations for the Ministry.  
The recommendations for modernizing the FHT contract, Schedule A, the governance attestation document, and the annual operating plan have been submitted. You can read more here. We expect to hear back soon on next steps.

Budget Planning for FY 2023/2024
Many of you have heard that CHCs were asked by Ontario Health to plan for a 2% increase in their base funding as part of their planning assumptions for the next year. OH has said that planning assumptions are not a confirmation of funding and should be used for planning purposes only.

Funding comes from the Ministry, so there is no guarantee of an increase; however, AFHTO has strongly advocated that any increases to CHCs are given to all interprofessional team-based primary care models. We hope to hear soon about the budget approvals.

TRIN funding
FHTs and CHCs should have received their temporary retention incentive for nursing (TRIN) funding, and NPLCs were sent their approval letters on November 30 with anticipation of flow-through of funding in January.

Nurses paid directly by physicians and specialists are still waiting on their incentive funding. These funds will start making their way to the privately funded nurses in the next few months. Any questions should be directed to pcoinquiries@ontario.ca.

Procurement Activity Reporting
The Ministry of Public and Business Service Delivery has added large primary care teams to the list of funded organizations responsible for procurement activity reporting. This applies to teams that receive $10M or more in funding. These teams received an email from their senior program consultant notifying them that they now need to submit their procurement activities as a Broader Public Sector (BPS) accountability measure.

If these teams have any questions about the initiative, please contact SCO.Reporting@ontario.ca who can provide you with access to your portal and answer your questions.

We know 2022 has been another exhausting year and that you’re juggling so many priorities. As administrators, you are at the front lines, working to increase morale of your team members while ensuring exceptional care is being provided to your patients and communities. We hope you do not forget to take care of yourself and that you enjoy some much-deserved rest and time with your loved ones soon.

We wish you a safe, happy, and healthy holiday season. Thank you for everything you do.

Yours in good health,

Your AFHTO Team