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Tag: AFHTO Policy Positions

  • AFHTO’s 2020 Pre-Budget Submission

    AFHTO submitted its recommendations to the Ministry of Finance as part of the 2020 Ontario Pre-Budget Consultations in early January. The submission is entitled “It Takes a Team: Interprofessional Primary Care as the Foundation of Health System Transformation.”

    Our recommendations are the following:

    1. Increase access to interprofessional team-based primary care for Ontarians who need it. As the population ages, more people will spend more years living with multiple chronic conditions, significantly increasing strain on health services. Interprofessional primary care teams are integrated around patients and their caregivers to promote, maintain or improve health and wellbeing. As Ontario Health Teams start rolling out, ensure comprehensive primary care is at the heart of the health system, so patients get care from the right provider when and where they need it.

    2. Invest in clinical leadership to ensure successful roll-out of Ontario Health Teams. Primary care providers know patients and their families best. They are the best resource government has for shifting the profession and the health system towards a shared vision and purpose. It is critical that they all be empowered to lead OHT development. Successfully building integrated care in OHTs, led by primary care, will require investing in and supporting clinical leadership.

    3. Embed mental health and addictions support in primary care. Ontario is on the verge of a mental health and addictions crisis. We need to provide continuity of care and can’t wait for the full roll-out of OHTs to achieve this. These resources need to be in the community where the person lives and receives comprehensive care, and not in an expensive acute care centre.

    4. Help end hallway health care by embedding home and community care coordination with primary care. 
    The function and associated resources of community care coordination should be transitioned to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions for patients. This will allow for greater continuity of care.

    5. Support digital health options in primary care. Patients want convenient access to their health care team and to know their health information is all in one place, so stories don’t have to be repeated over and over again. We recommend government adopt a digital health strategy that is co-designed by providers and patients, and provide billing codes to recognize that care delivered digitally is valued as much as an in-person visit. This cannot happen without modernizing our current model and thinking about how care is delivered. 

     

    Relevant links:

  • AFHTO’s Submission on Bill 74: The People’s Health Care Act, 2019

    On April 2 AFHTO presented its submission to the Standing Committee on Social Policy on Bill 74: The People’s Health Care Act, 2019. Our key recommendations are:

    1. That Bill 74 require primary care to be part of an Ontario Health Team (OHT). It is also recommended that primary care teams be the lead of an OHT in areas with highly functioning teams who can continue to be leaders in delivering truly integrated care. Primary care is the entry point to the health care system. These are the health care providers who know the patients and their families the best.

    2. That Bill 74 (Part IV – Definitions) be strengthened by including the vision of the Patient’s Medical Home when speaking about the Integrated Care Delivery Systems, with specific notation made to the Minister’s Patient and Family Advisory Council Patient Declaration of Values. While there is notation in the preamble about the importance of the patient in the development of Bill 74, it is important that there also be a strong vision for this health system restructuring, especially with the creation of the local level Ontario Health Teams. The Patient Medical Home encompasses that vision – it puts the patient and the family in the center of care while also recognizing the importance of the Quadruple Aim through its pillars.

    3. That there be an addition in Part IV of the Bill under Integrated Care Delivery Systems that specifically outlines governance of integration, including principles of collaborative governance and what the requirements will be of the Boards of the HSPs that are coming together to change the way care is being delivered in their community. For integrated health care systems, it is truly placing the patient at the center of care – not the organization where the care is being delivered. And that, for many, will require a tremendous amount of change management support. Health care organizations have been funded in siloes for decades with targets and indicators that are very specific to their funding. A move towards a shared budget will require a shift in thinking, new partnership building and, fundamentally, trust.

    4. a)  As Ontario Health starts becoming operational, we recommend it stay true to Part II (The Agency) Objects and General Powers and support the health service providers in the sector as outlined in the Bill and NOT be involved in direct service delivery, including in the area of home and community care.
    b)    We ask that the relationship between primary care and home and community care be strengthened by transitioning the function and associated resources of care coordination to primary care.
    c)    It should also be noted that in any application for an OHT, there should be concerted effort made to ensure that primary care and mental health and addictions supports are integrated and it is our recommendation that this is a priority for each integrated care delivery system in the province.

    AFHTO is pleased to see the government’s commitment towards truly integrated patient-centred care. Health care providers in interprofessional team-based primary care have been working in integrated systems of care for years but have felt that there is still fragmentation in the care they are able to provide, mainly because of the disconnect between the siloes of care, from acute to home care, from mental health and addictions to long-term care. Primary care is the entry point to the health system and for many patients in the province, the relationship they have with their family physician or nurse practitioner is everlasting and built on trust. A truly effective, high quality health care system needs to be coordinated, integrated and foundationally built in primary care, which will ensure we are delivering a sustainable health system for the future.

    Team-based primary care is popular with its 3.5 million patients because it provides a better patient experience, helping people avoid long and confusing waits for referrals and getting lost navigating our complex system. We need to expand this experience so that every Ontarian can get access to the care they need when they need it. We look forward to working with the government as it starts the journey on implementing this very important health restructuring plan and creating a new integrated system of care that is focused around the patient.

    Relevant Links:

  • AFHTO’s 2019 Pre-Budget Submission

    AFHTO submitted its recommendations to the Standing Committee on Finance and Economic Affairs as part of the 2019 Ontario Pre-Budget Consultations in January. Our key recommendations are:

    1. We need a health system that is truly integrated, one where patients don’t have to move from one part of the system to another part to get their care, especially care for mental health and addictions – primary care and mental health care providers need to work together to ensure that mental health and addictions investments are integrated in primary care.
    2. The relationship between primary care and home and community care can be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients.
    3. Support expansion of interprofessional team-based care across Ontario. This can start with communities that don’t have a team at all and then expand to all Ontarians who wish for it. Allow for local-level innovation but ensure that primary care providers are involved in the co-design on what would work best for them in their communities and for their patients.
    4. Look at existing models of performance measurement in primary care and facilitate and fund a strategy that spreads it across the system. This strategy must measure outcomes that matter to patients and providers while assisting in lower system costs. To support this, there needs to be further investments in quality improvement practice facilitators to help support front line providers.

    Relevant Links:

  • AFHTO’s 2019 Pre-Budget Submission

    AFHTO submitted its recommendations to the Standing Committee on Finance and Economic Affairs as part of the 2019 Ontario Pre-Budget Consultations in January. Our key recommendations are:

    1. We need a health system that is truly integrated, one where patients don’t have to move from one part of the system to another part to get their care, especially care for mental health and addictions – primary care and mental health care providers need to work together to ensure that mental health and addictions investments are integrated in primary care.
    2. The relationship between primary care and home and community care can be strengthened by transitioning the function and associated resources of care coordination to primary care. This will bring greater efficiency and patient-centredness to care. Care will be integrated, allowing for seamless transitions of care for patients.
    3. Support expansion of interprofessional team-based care across Ontario. This can start with communities that don’t have a team at all and then expand to all Ontarians who wish for it. Allow for local-level innovation but ensure that primary care providers are involved in the co-design on what would work best for them in their communities and for their patients.
    4. Look at existing models of performance measurement in primary care and facilitate and fund a strategy that spreads it across the system. This strategy must measure outcomes that matter to patients and providers while assisting in lower system costs. To support this, there needs to be further investments in quality improvement practice facilitators to help support front line providers.

    Relevant Links:

  • AFHTO’s recommendations re Bill 41, Patients First

    “Moving care coordinators from CCACs to LHINs does not remove barriers, it just moves them from one bureaucracy to another. If primary care providers were supported to coordinate care, it would make a significant difference for the health of patients and their experience of care.”

    With this and other comments, AFHTO presented to the Standing Committee on the Legislative Assembly on Bill 41-Patients First Act, 2016 on Nov. 21. Grounded in evidence regarding drivers of quality and value in the health system – namely, a strong foundation of primary care- it summarized what’s most valuable in Bill 41 and further steps needed to avoid unintended consequences.

    Key Recommendations:

    • To wrap care around patients, ensure that care coordinators will be embedded in primary care (Keep LHINs free from conflict of interest).
      • Require LHINs to develop plans to transition functions and staff from CCACs to the most appropriate health service providers within an appropriate length of time.
      • Following this, LHINs would be forbidden from being involved in direct service delivery.
    • To serve the public interest, ensure strategy, leadership, stewardship and a curb on bureaucracy and unilateral action
      • More specific guidance and direction is needed as to what “public interest” means.
      • Appropriate checks and balances on the use of the powers to issue directives, initiate investigations and appoint supervisors, must also be ensured.
    • Ensure the transition of FHTs and NPLCs from Ministry to LHINs is done in an environment of respect and trust.
      • Take steps to ensure that LHINs have sufficient understanding and capacity to take on expanded powers with primary care, before those powers are transferred.
      • Allow time for government to delay introduction of primary care organizations as “health service providers” so it can build a better relationship with physicians.

    Dec. 8, 2016 Yesterday government passed Bill 41: the Patients First Act, 2016. This Act is anticipated to receive Royal Assent before the House rises on Friday for the winter break and then be implemented shortly thereafter. Our advocacy continues to be driven by AFHTO’s recommendations on Bill 41, presented on behalf of members to the Standing Committee of the Legislative Assembly. Relevant Links:

  • Introducing our new Strategic Plan!

    AFHTO is pleased to share its 2017-2020 Strategic Plan. This plan builds on our experience which shows that team-based comprehensive primary care is delivering better health and better value to patients.

    In the last few years AFHTO and its members have worked hard in supporting, measuring, and promoting the value of well-integrated interprofessional primary care, and advocating for its expansion so that more Ontarians can access high-quality comprehensive care. This Strategic Plan will serve as a blueprint for AFHTO to continue this very important work and assume a leadership role in the ongoing health care transformation agenda in Ontario.

    In the development of the plan, we looked at environmental trends to guide our thinking about what the future may bring and how these trends may affect the provision of primary health care. Taking on a very extensive consultative approach we spoke with our members, our stakeholders and our system partners to arrive at a plan that focuses on three strategic directions:

    • Be a Leader in Primary Health Care Transformation,

    • Demonstrate the Value of Team-Based Care and

    • Advocate for the Tools, Resources, and Conditions to Support an Effective Primary Health Care System.

    And with these strategic directions, we have a new vision that will guide our work –  High quality, sustainable, team-based primary health care.

    We would like to extend our sincerest gratitude to our members whose support has been invaluable in furthering AFHTO’s commitment to be an advocate, champion, network and resource to support FHTs, NPLCs and other interprofessional models of care.

    Our sincerest gratitude also to our partners and stakeholders who have been supportive and collaborative as we collectively work to support primary care teams to continue to deliver on the excellent care that they provide.

    We look forward to continually working with you as we strive to promote and encourage system change and ensure primary care be strengthened to truly become the foundation of a health system that truly puts patients first.

  • Primary care recruitment and retention strategy for Ontario

    Evidence from around the world, and Ontario, demonstrates that the introduction of primary care teams is providing patients with better care, at the best value. But one of interprofessional primary care’s biggest barriers is to attract and keep skilled providers. The key issue? Inability to offer competitive compensation to the non-physician health professionals and administrative staff who work in our community health centres, family health teams, nurse practitioner-led clinics and aboriginal health access centres. Funding for these positions has not changed in well over 7 years.

    Minister Hoskins commits $85 million over three years to interprofessional primary care

    “To ensure these clinics (CHCs, NPLCs, FHTs, AHACs and nursing stations) can effectively recruit and retain qualified interprofessional staff in primary care settings, Ontario will invest an additional $85 million over three years.”  – 2016 Ontario Budget.

    Effective April 1, 2016, this investment will certainly help CHCs, FHTs, NPLCs and AHACs retain staff so as to better serve their patients and communities. We are pleased to have this financial commitment in place and look forward to working quickly through the implementation details; however, the AFHTO-AOHC-NPAO proposal as summarised below remains our goal.

    Compensation Structure for Ontario’s Interprofessional Primary Care Organizations

    In June 2013, the three associations that jointly represent all interprofessional primary care organizations in Ontario – the Association of Family Health Teams of Ontario (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners Association of Ontario (NPAO) – released their joint report to the Ministry of Health and Long-Term Care. It presented indisputable evidence that:

    • Compensation levels in primary care are below market – averaging 15.6% for all non-physician positions, and ranging up to 30% below market.
    • The gap between market and actual compensation is growing – it has increased by an average of 4.9% from 2009 to 2012.
    • Lack of pensions is a key barrier to labour mobility – primary care organizations cannot provide both the HOOPP plan and a reasonable benefits package within the imposed financial limit of 20% of salary.
    • Pay equity challenges are a real risk – two types of positions (registered dietitians and nurse practitioners) have been consistently found to be funded at a salary grade below that of comparable health professions. These positions also post the highest vacancy rates in primary care – 19% and 14% respectively. Health promoters were also found to be in the wrong band.

    Rigorous market study conducted by the Hay Group established a recommended salary structure. It placed all positions into 13 pay bands, with 3 market exceptions. Each band has a recommended salary range and steps for proceeding from minimum to maximum within the range. Full implementation across all of the interprofessional primary care organizations would require a funding increase estimated at just over $120 million. Recognizing the need to phase in such an increase, the three associations recommended:

    • An immediate increase of 2.5% in benefits funding to enable all to participate in HOOPP;
    • Funding that would place all professions in their appropriate salary band; and
    • Funding to reduce the gap between the current and recommended salary rates in steps over four years.

    We continue to advocate to achieve the 2012 recommended salary rates for all staff (IHP and admin) in primary care teams, to be implemented over 4 years. The Ministry recognizes this $85 million commitment is the first step in a process and is committed to working with us to achieve our overall goal. Two years from now, the opportunity for further increases is likely to open up. The Government is committed to eliminating the deficit by the end of 2017-18 and some of the compensation constraints may be lifted for the following fiscal year. This will provide opportunities to address the remaining gaps.

    Relevant Links:

  • Primary care must lead care coordination

    We assert the role of primary care providers to lead care coordination.

    The Association of Family Health Teams of Ontario (AFHTO) endorses and embraces this position statement adopted with our colleagues in the Ontario Primary Care Council in November 2015.  Primary care providers work to ensure access to interprofessional care for patients and identify a single point of contact to help patients and families navigate and access programs and services. Furthermore, AFHTO implores the Ministry of Health and Long-Term Care to work with primary care teams and LHINs to bring greater efficiency and patient-centredness to care delivery, through steps to transition care coordination resources to primary care teams from community care access centres (CCACs). Primary care is an anchor for patients and families, providing comprehensive care throughout their lives. Primary care providers are the first contact or entry into the system for all new needs and problems, and they directly influence the responses of people to their health needs by listening to their concerns and preferences and providing clinical evidence-based assessment and treatment recommendations. Care coordination in primary care has the potential to significantly:

    • Reduce the duplication and role conflict that currently exists in our health system;
    • Improve patient outcomes through much greater continuity and coordination of person-centred care.

    Click to read AFHTO’s position statement: Transitioning care coordination resources to primary care. Primary care teams want to coordinate care for their patients – this was clearly demonstrated by the 200+ leaders who participated in AFHTO’s October 2015 session on Leading Primary Care through the Next Stage. Through their work in Health Links, many primary care teams have demonstrated readiness to take on this role, and their success when they can mobilize the resources to fulfill this role. The transition of care coordination resources from CCACs to primary care teams is the logical next step.

    Resources for AFHTO members:

    Evidence and background on care coordination in Ontario:

  • AFHTO’s response to Patients First Discussion Paper

    Click here to read AFHTO’s overall response to the ministry’s Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario discussion paper, approved by the AFHTO board and submitted on March 3rd, 2016. An initial response was issued with a statement from Dr. Sean Blaine, AFHTO President and Clinical Lead, STAR Family Health Team in Stratford. This was published in various newspapers including The Kingston Whig-Standard, Woodstock Sentinel Review and Beacon Herald.

    Response is grounded in feedback from members

    In early January, AFHTO hosted 14 web meetings for FHT and NPLC leaders in each of the LHIN regions, resulting in priority action items. Member input was further requested on the question of accountability and contractual relationships, summary of results available. These provided the basis for AFHTO’s response.

    A unified response for primary care

    AFHTO chaired work by the Ontario Primary Care Council (OPCC) to develop a joint response to the Minister on the Province’s plans to strengthen our health care system. The six associations of the OPCC provided initial feedback in a letter to Minister Eric Hoskins on January 25, 2016. Finalized at its March 9 meeting, the joint response was submitted on March 24. It offered advice on the following key areas:

    • Ministry stewardship and LHIN mandate
    • Access to interprofessional health providers and access to teams
    • Embedding care co-ordination in primary care and the next steps to support implementation
    • The interface between primary care, mental health and addictions
    • Clinical leadership
    • Governance, performance and accountability
    • Critical enabler: data and information management

    This work has been greatly informed by AFHTO’s consultation with members.

    What’s happening in each region?

    AFHTO members are meeting with their LHINs and working together to strengthen the primary care voice within the LHIN. See below for resources to further support this engagement:

    LHIN # LHIN Implementation Plan (Oct. 9th submission) Results from Regional Consultations
    9 Central East Link Online
    11 Champlain Link Online
    8 Central Link Online
    4 Hamilton Niagara Haldimand Brant Link Online
    6 Mississauga Halton Link Online
    13 North East Link Online
    12 North Simcoe Muskoka Link Online
    14 North West Link Online
    10 South East Link Online
    2 South West Link Online
    3 Waterloo Wellington Link Not currently available
    1 Erie St Clair Not currently available Online
    7 Toronto Central Not currently available Online
    5 Central West Not currently available Online

  • AFHTO’s initial response to Patients First Discussion Paper

    On December 17, 2015, Ontario’s Ministry of Health and Long-Term Care released its discussion paper Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario. On its release, AFHTO issued the statement below from Dr. Sean Blaine, AFHTO President and Clinical Lead, STAR Family Health Team in Stratford ON. This was published in various newspapers including The Kingston Whig-Standard, Woodstock Sentinel Review and Beacon Herald in January. AFHTO will be working with its members in each region of the province to develop a more detailed response to the questions posed in the discussion paper. Particular attention will be paid to those areas where great care must be taken to gain the most benefit for patients and communities, and avoid unintended negative consequences.

    AFHTO’s statement on the release of 

    Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario

    Comparative studies tell us our health system is not performing as well as it could. How can we make it better? We need to have the right people in the right place at the right time to deliver the most appropriate care. This requires effective planning, strong relationships, meaningful measurement and engaged leadership from health professionals. Across the world, cost-effective and high-performing health systems are built on a strong foundation of comprehensive primary care. Over the past decade, Ontario has taken steps to strengthen primary care. Family health teams and nurse practitioner-led clinics emerged as innovative models for bringing together health professionals – doctors, nurses, pharmacists, dietitians, for example – to deliver such care. Unfortunately, only 25% of Ontarians receive their care from such team-based models. Ontario also aimed to improve planning, relationships and performance by setting up Local Health Integration Networks (LHINs). But two parts most critical to keeping people healthy – primary care and public health – were left off the LHINs’ mandate. More needs to be done to ensure people can get the appropriate care and support they need when they need it. With the Patients First proposal, the Ontario government launches the next phase of health system evolution. The proposal would bring all parts of the health system under a single jurisdiction for planning and performance reporting, and focus attention on how best to meet the needs of people living in each community. It pays particular attention to strengthening primary care. These are absolutely critical steps toward ensuring more comprehensive and equitable health care services for all Ontarians. Public health departments must be connected to LHINs. These organizations are focused on understanding whole communities to prevent sickness and the spread of communicable diseases. Public health professionals analyze communities to identify and monitor health risks, and target public education and other programs to promote health wellness and illness prevention within a population. Equally important is the ongoing care individuals and their families receive over their lifetimes. This is primary care – your “medical home” – delivered by family doctors, nurse practitioners and primary care teams who know you, care for you, and coordinate specialized health services when you need them. The proposal also merges community care access centres (CCACs) into the LHINs enabling greater local coordination of care, and more efficient use of health resources. If LHINs then deploy care coordination expertise into primary care settings, it will help patients and families identify a single point of contact to navigate and access programs and services. As a family doctor working in a family health team, I can see the potential in this proposal, as well as some cautions:

    • Greater consistency: Right now we see significant variation in the access, experience and cost of health care in Ontario. Many of these variations are the result of unique local problems. By planning and monitoring at the local level, gaps can be identified and local solutions can be found – but only if local leadership is engaged and empowered to harness all sectors of the health system to address the unique needs of that community.
    • Better coordination of care for patients: Moving care coordinators from the CCAC to the LHIN could help break down silos that have long separated my patients from getting care they need. But the LHIN will have to ensure these care coordinators work much more closely with family doctors and nurse practitioners; otherwise, this just moves one bureaucracy into another.
    • Measurement for improvement: This is critical to assessing and improving quality of care. While many primary care teams have been measuring performance, this will be new for the majority of our primary care colleagues. As we’ve learned – there’s nothing to fear from being held accountable. But clinicians will need to receive support to help identify and capture the most meaningful and manageable data to improve care for patients.
    • Spreading best practice: Performance measures must be consistent and comparable across the province, to help clinicians learn from one another. By identifying those who excel at care delivery, we can spread and scale up improvements to providers in a positive and not punitive way.

    Every region of this province empowered to bring together all local health system players to focus on every community’s true health needs. Primary care strengthened and supported to wrap the most appropriate care around each person. If well implemented, Patients First is an important next step to improve our health system for better health for all Ontarians. Sean Blaine MD Family Physician, Stratford, Ontario Clinical Lead, STAR Family Health Team President, Association of Family Health Teams of Ontario (AFHTO) Note: This statement was published in various newspapers including The Kingston Whig-Standard, Woodstock Sentinel Review and Beacon Herald in January.