This risk assessment tool is a simple matrix that helps boards to systematically identify, assess and manage risk in their FHT. This is in Word format so you can download and use it in your FHT. A completed matrix is also posted as a PDF file to serve as an example of how the tool can be used.
The central goal of the 2012 Ontario Budget is captured in the title of its news release: “A Plan to Balance the Budget, Create Jobs, Protect Education and Health Care.”
The 2012 Budget reiterates the Action Plan commitments to expand same-day and next-day appointments and after-hours primary care, to integrate planning for primary care into LHINs. It also references plans to introduce reforms to enable LHINs to promote a seamless coordination of treatment and continuing focus on reducing Alternative Level of Care (ALC). It once again mentions accelerating “the evidence-based approach to care by building on the mandate of Health Quality Ontario (HQO) to provide recommendations to direct funding to where evidence shows the greatest value, without compromising access to services deemed medically necessary.” It gives no additional details on these commitments. Public-Sector Compensation The budget states government’s intention to hold the line on compensation for physicians (noted above) and public sector unions (while respecting collective bargaining), and extending the pay freeze for executives at hospitals, universities, colleges, school boards and agencies for another two years. It states, “The government expects its partners to consider not only current and future compensation, but also those aspects of collective agreements that enhance productivity and facilitate public sector transformation.” It also states, “Where agreements cannot be negotiated that are consistent with the plan to balance the budget and protect priority services, the government is prepared to propose the necessary administrative and legislative measures.” For FHTs that are able to offer the HOOPP or any other public sector pension plan, note that pension changes will be introduced to reduce employer obligations to fund pension deficits or otherwise add to employer and taxpayer expense, beyond what has already been agreed.
AFHTO’s Operational Issues Working Group met yesterday (March 6) with Mary Fleming, Director of Primary Health Care Branch; Richard Yampolsky, Program Manager, FHT Implementation; Gayle Barr, Senior Program Consultant; and Erin Weinkauf, Program Analyst. Flexibility in Operating Plans and Budgets The need for greater flexibility, consistency and transparency in budgets was the central theme throughout the meeting. The Ministry confirmed:
The Ministry is open to considering a more sustainable approach to funding IT hardware replacement. AFHTO has committed to looking at methods used in other sectors and developing a proposal. Additional volunteer assistance is welcome. Ministry Policy Priorities: Integrating Primary Care into LHINs: MOHLTC continues to confirm there will be consultation as this process unfolds. MOHLTC has not yet named a lead branch for this initiative. After hours care: The Ministry is not releasing results to date from the first 3 years of the 5-year FHT evaluation study, however we are told they indicate significant improvement needed in delivering after hours care. The comments may have been prompted by the just-released ICES study – Comparison of Primary Care Models in Ontario by Demographics, Case Mix and Emergency Dept Use. It found that FHTs, FHNs and FHOs had patient populations with higher-than-expected ED visits, whereas FHGs and CHCs had lower-than-expected ED visits. AFHTO will be examining this question more closely. House calls: Increasing house calls was part of government`s campaign promise, and FHTs are expected to do their part. A number of Toronto FHTs are part of the `Bridges` pilot to test implementation models. The issues of travel support and reduced number of client visits have been identified to date. AFHTO will be monitoring. Additional updates: NPAR: Evaluation is expected to be completed in late May. No further expansion will take place till after that date. Streamlining quarterly data collection: FHT Unit is committed to doing this and will consult with the relevant associations in the near future. Post comments on ED Collaborative Space: FYI – Briefing notes presented at this meeting are posted on AFHTO’s ED Collaborative Space. (FHT EDs received a username and password on February 24. Contact info@afhto.ca if you need help.) Use this space to ask questions and compare notes with your peers. AFHTO collaboration on operational issues with the AOHC CFHT group: AFHTO is committed to strengthening the voice for all FHTs – 93% of which belong to our association today. A number of community-governed FHTs belong to both AFHTO and the Association of Ontario Health Centres. With AOHC support their CFHT group has tackled a number of operational issues with the FHT Unit. AFHTO`s Operational Issues Working Group and the AOHC CFHT group have come together to meet jointly with the Ministry to deliver well-developed, consistent messages. The briefing notes posted on AFHTO’s ED Collaborative Space (see above) are the result of our combined work. Through AFHTO’s CFHT rep, Michelle Karker (contact info below), CFHTs will receive an update on discussions regarding the Blended Salary Model in the near future. Thank you to AFHTO`s Operational Issues Working Group The Operational Issues Working Group members volunteer their time and leadership on behalf of all FHTs. Each one is the “point person” for a group of AFHTO members and is interested in hearing from you through the ED Collaborative space or via e-mail.
Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement. Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary. Primary care recruitment and retention: Letter to Premier and Finance Minister The Ontario Government has not yet declared whether it will extend the Public Sector Compensation Restraint Act beyond its current expiry date of March 31. As part of our joint advocacy to address the challenges in recruiting and retaining qualified staff in primary care, AFHTO, in partnership with the Association of Ontario Health Centres and the Nurse Practitioners Association of Ontario, has sent a letter to Premier McGuinty and Minister Duncan urging Government to avoid extending this freeze on compensation and for immediate action to enable the HOOPP pension plan to be offered to primary care staff. Click here to read the letter. Support for 2012-13 Operating Plan development On Friday FHT EDs received a link, username and password to an online platform for FHT EDs to raise issues, ask questions of their peers and discuss potential solutions in a safe and secure environment. You are welcome to provide input for AFHTO’s March 6 meeting with the Ministry’s FHT Unit on common operational issues. This is an initial pilot to support FHTs in the Operating Plan submission process. As we learn from this collaborative space the approach will be fine-tuned and spread to support communication and collaboration among all team members across Ontario’s FHTs. Click here for a brief video (under 2 min.) on how to make the most of this collaborative space. If you are a FHT ED and did not receive your username and password please contact Sal Abdolzahraei at info@afhto.ca. New resources to help FHTs implement AODA Click here for templates, a checklist and additional resources to assist FHTs in meeting requirements of the Accessibility for Ontarians with Disabilities Act, 2005 (AODA). Template documents may be edited to match individual FHT branding and accessibility requirements. As of January 1, 2012, FHTs must comply with the first standard – Customer Service. (If you require your login information for the Member’s Only website please contact info@afhto.ca) Health Equity: tools and resources for program development If your FHT is doing strategic planning and/or program development, the following resources may be helpful. The Health Equity Impact Assessment (HEIA) tool is one part of the repertoire of equity-driven planning tools. It analyzes the potential impact of service, program or policy changes on health disparities and/or health-disadvantaged populations. It can both help to plan new services, policy development or other initiatives or assess existing programmes. The Wellesley Institute has health equity resources available on their website focused on operationalizing health equity strategies. Resources include a Health Equity Impact Assessment Tool, evidence based planning tools, sample equity strategies from LHINs, and more. Feedback survey on Provider Education Tools of the Ontario Breast Screening Program Cancer Care Ontario (CCO), in partnership with the Centre for Effective Practice (CEP), developed Provider Education Tools for healthcare providers (family physicians, nurse practitioners, genetic counsellors, radiologists) to support the changes to Ontario Breast Screening Program (OBSP). The CEP is conducting an online survey to evaluate the Provider Education Tools. This survey will take approximately 7 minutes to complete. All individual responses will remain confidential. The survey results are analyzed in aggregate only, such that you cannot be identified in any way. Please complete the survey here: https://www.surveymonkey.com/s/OBSP If you would like more information or have any questions, please contact Mary Clelland-Dube at 416 260-7885 or mary.clelland-dube@effectivepractice.org. AFHTO membership renewal invoices will go out March 1 For FHTs that may have funds remaining in their general overhead budget, AFHTO membership renewal notices will go out on March 1. If you want to use funds remaining from other overhead lines to pay for your FHT’s membership renewal, the FHT Unit has confirmed you must speak to your Ministry Rep first.
The Ontario Government has not yet declared whether it will extend the Public Sector Compensation Restraint Act beyond its current expiry date of March 31. As part of our joint advocacy to address the challenges in recruiting and retaining qualified staff in primary care, AFHTO, in partnership with the Association of Ontario Health Centres and the Nurse Practitioners Association of Ontario, has sent a letter to Premier McGuinty and Minister Duncan urging Government to avoid extending this freeze on compensation and for immediate action to enable the HOOPP pension plan to be offered to primary care staff. Click here to read the letter.
Advancing a Performance-Oriented Model for Primary Care One of AFHTO’s strategic directions is to build evidence of FHT performance and value to patient health is. Key to this is the capacity of FHTs to make the IT/IM investments needed to capture and report data consistently and reliably, and to use it for improvement. Consistent with the direction of the Drummond Report, performance in quality outcomes, practice capacity, and health system costs must be tracked and improved. AFHTO recently submitted a proposal to the Premier’s Office for a pilot project to support primary care teams to do this, and to assess the resulting improvements. Click here to read the proposal summary.
Outcome of AFHTO-AOHC-NPAO meeting with ADM on primary care recruitment & retention This morning representatives of our three associations met with senior Ministry staff to review the findings and recommendations of our joint report – Toward a primary care recruitment & retention strategy for Ontario. (See details below). Ministry attendees included three members of MOHLTC’s Health Human Resources Strategy Division – Suzanne McGurn, ADM; Jeff Goodyear, Director, HHR Policy; and Debra Bournes, Provincial Chief Nursing Officer – as well as Phil Graham, Manager of the FHT Unit in Negotiations and Accountability Management Division. The ADM and Ministry staff were receptive to the report. They welcomed the information it contained, saying it validated a number of issues being looked into by the Health Human Resource Strategy Division. They particularly appreciated seeing the three associations representing all interprofessional models of primary care delivery working jointly on this issue, and doing so from the perspective of strengthening all of these primary care organizations. Two statements from the ADM stand out – “there is no disagreement with the principles in the report” and “timing is the big issue”. The key constraint is the province’s need to rein in spending. While the Drummond report does not endorse a continuation of public sector wage restraint (it suggests that broader public sector employers and bargaining agents should be responsible for bargaining outcomes and bear responsibility for delivering value for public money), there remains the possibility that public sector compensation restraint could be continued past March 31. The Ministry representatives clearly understand that the inability of primary care organizations to offer both the HOOPP pension plan and reasonable benefits creates significant disadvantage in competing for staff with other parts of the health system. While the likelihood of funding increases for compensation in the next fiscal year is very small, the Ministry has agreed to look into the idea of giving greater flexibility to allow primary care organizations to go beyond the 20% cap for pension and benefits, within their current overall budgets. Immediately after this meeting we briefly touched base with Shawn Kerr, Policy Advisor for primary care in the Minister’s Office and will meet with him in the near future to discuss more fully. As always, we will keep our members informed. For further information, please view past AFHTO, AOHC and NPAO message to members:
The Association of Family Health Teams (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners’ Association of Ontario (NPAO) are pleased to share our joint report with our members.
It has been a challenge for primary care organizations to recruit and retain the skilled and compassionate staff needed to deliver accessible, high quality, patient-centred primary care. Our three associations – representing all of Ontario’s interprofessional primary care organizations – teamed up in September to gather the facts and create the solid case to address the issues. About half of the 295 organizations – 10 aboriginal health access centres (AHACs), 73 community health centres (CHCs), 186 family health teams (FHTs) and 26 nurse practitioner led clinics (NPLCs) – responded to our survey. This information, together with data from salary studies by the Hay Group, has been combined to make the compelling case. Our joint report was finalized this week and sent to the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division in advance of our meeting on Feb.22. The meeting had been scheduled for Feb.9 but was postponed due to personal circumstances. The report makes the case that:
The investigation found:
Please click here to read about the outcome of the joint meeting. 
The Minister made two presentations today, an early-morning prelude for a healthcare audience and the lunchtime launch of Ontario’s Action Plan for Health Care hosted by the Board of Trade. Below you’ll find links to the full plan and related communications pieces, as well as a bullet-point summary of the Action Plan. The general direction of the Action Plan is consistent with the content of AFHTO’s presentation to the Drummond Commission (http://www.afhto.ca/news/afhto%E2%80%99s-submission-to-drummond-commission-on-broader-public-sector-reform/ ). In particular, the Action Plan points to the critical role of primary care as the “natural anchor for patients in our health system”, a focus on quality in primary care, and the need for more formal connections between primary care organizations and other entities to coordinate care. In our Drummond submission AFHTO went further to identify the need to support the critical enablers required for primary care to play its full role in the health system: leadership, team based care, information systems and clinician involvement. FHTs are well-positioned, and with some evolution and support, could play a key role in advancing health system transformation at the local, regional and provincial levels. Of these enablers, “information” is the one that is the least well-developed – FHTs need sufficient support to collect, manage, analyze and act on data to improve access, improve outcomes, and deliver better value for money. Details for implementing the Action Plan remain to be developed. To get a read on this, I had the opportunity to compare notes with leaders from a number of other health associations, have a follow up meeting with the primary care lead in the Minister’s Office, and exchange a few words with the Minister. Despite the Toronto Star’s report that “Matthews hopes to achieve this by placing the provinces’ 200 family health teams under the control of Ontario’s 14 local health integration networks,” the Minister’s Office confirmed that the processes, accountability and funding relationships would be developed with key stakeholders such as AFHTO, to meet the goal of creating a more seamless journey for patients through the LHINs. For the most part FHTs have developed their own LHIN-based networks – AFHTO will be tapping into these networks for advice, direction and assistance as this implementation goes forward. Other areas that AFHTO will be monitoring include the implementation plans around access, house calls, funding reform, and the concept of “Care Coordinators” for seniors recovering after hospital stays to reduce readmissions. Having touched base with colleagues at the Ontario Association of CCACs, it’s not yet known whether the Care Coordinator is seen to be a role within a CCAC, hospital or primary care. AFHTO’s overall assessment of the Action Plan is posted at http://www.afhto.ca/news/afhto-welcomes-ontario%E2%80%99s-focus-on-family-and-community-care/ . We are pleased with the general direction, and look forward to collaborating with the Ministry and others to work out the details that will lead to sustainable improvement. Links:
Quick summary of Action Plan (Courtesy the Minister’s Office) Faster Access and a Stronger Link to Family Health Care
Right Care, Right Time, Right Place
Keeping Ontario Healthy
Media reports on public sector salaries may be stirring up concerns among staff at your FHT. To help you respond, this e-mail gives you a brief summary of what’s being reported, and what AFHTO is doing about concerns over inequity in compensation. Headlines on the Toronto Star and National Post websites this evening (Jan. 24, 2012) leave the impression that public sector salaries are at risk in the upcoming budget. This is following from Premier McGuinty’s speech today to the Canadian Club. Spurred by PC Leader Tim Hudak’s comments to the press last Thursday, on Friday, CBC radio and other on-line reports fuelled speculation that the current freeze could be extended. To date government has not committed one way or the other. FHT staff and managers are very concerned about inequities in compensation across health care. This fact emerged quite clearly in last fall’s survey of interprofessional primary care organizations (FHTs, Community Health Centres, Aboriginal Health Access Centres and Nurse Practitioner-Led Clinics), conducted jointly by their representative bodies – AFHTO, the Association of Ontario Health Centres and the Nurse Practitioners Association. Over 85% of EDs of primary care organizations identified lower compensation as one of the 3 main reasons potential candidates turn down job offers, and about half report this as being one of the 3 main reasons for staff leaving the primary care organization. Our three associations have been raising this issue at various levels in the Ministry and the Minister’s Office. We are scheduled for a joint meeting on February 9 to review the findings from our study with the ADMs of Negotiations and Accountability Management Division and Health Human Resources Strategy Division. Once we have reviewed the findings with the ADMs, the three associations will share the report with our respective members. While media reports are raising a lot of speculation, the key message for FHT staff is that it is only speculation at this stage. AFHTO continues to give priority to advocate for compensation funding to recruit and retain the staff needed to deliver interprofessional primary care. The current economic situation means that achieving equity in compensation will be an incremental process.