The upcoming provincial election gives each Family Health Team the perfect opportunity to build awareness about the value we deliver to our communities.  People running for office need to know (and want to know) how well their constituents are being served through their tax dollars. Why is this important?

• To make sure all candidates running in your riding know you exist, what you do, and what your work means for the people in their riding. As many FHTs have experienced, the person who becomes your MPP can be a valuable resource for the FHT.
• To build confidence in the added value generated by this model of care. AFHTO has met with the Health Minister and Health Critics for the three major parties.  All three acknowledged that FHTs are popular with their colleagues and constituents, but many politicians remain skeptical as to whether the results are “worth” the extra investment. The July 23 Petrolia Topic recently reported, “(NDP leader Andrea) Horwath said the NDP hopes the provincial auditor-general looks at the FHT model ‘…to make sure it’s value for money.’”

Many FHTs are very involved with their political representatives already. To help all AFHTO members become more active, AFHTO has developed the following tools:

• Three 3 key messages that can have stronger impact the more consistently they are used.  Family Health Teams are Ontario’s innovation in team-based care that:
  • Improves access to health care.
  • Promotes health and reduces the impact of chronic disease.
  • Has the potential to reduce the total cost of care.
• A brochure in English (click here) and French (click here), which:
  • Delivers these three messages and provides some evidence for each.
  • Contains one page for FHTs to enter their own information.
  • Allows you to print out copies as needed to hand out to candidates and campaign workers in your riding, and leave in your waiting areas.

• A list of candidates in each provincial riding and their contact information (click here).

AFHTO sent out e-mails to members by riding on Aug.31/Sept.1 and on Aug.5/6, to enable coordination within ridings. AFHTO encourages you to meet your candidates and spread the good news about your FHT and the FHT model. We hope you will find these resources helpful in your communications. As always, your feedback is welcome.

AFHTO has been working with the Ministry of Health and Long-Term Care and the Ontario Medical Association (OMA) to address concerns regarding the new FHT Funding Agreement templates. FHT Leads should be receiving from the Ministry, prior to the April 29 sign-back date, a revised agreement that addresses our key concerns with these templates. For those FHTs that requested an exemption to the requirement that “all positions funded pursuant to this Agreement shall be employees of the Recipient unless the Ministry has provided its written consent”, you will receive a separate exemption agreement. The Ministry continues to encourage all FHTs to strive to meet this goal; however, the exemption agreement gives greater flexibility regarding FHT staffing arrangements while upholding the Government of Ontario’s risk management needs. Note that the exemption agreement lists a few “as applicable” requirements. If your FHT has a concern with any of these “as applicable” requirements, you may wish to seek clarification from your Ministry consultant to determine whether they are in fact “applicable” in your case. The template agreements for all Physician-Sponsored and Mixed Governance FHTs have been revised to address the concerns regarding governance, liability and communications. AFHTO and the OMA would like to recognize the Ministry’s willingness to make these revisions to address the concerns raised by FHTs. As with any contract, each FHT is advised to carefully review the new agreement and to discuss any ongoing concerns with appropriate legal counsel and their Ministry consultant.

AFHTO has learned the Ministry is working on a framework for granting exceptions to the “employee requirement” that appears in all Funding Agreements. They expect the draft to be completed in the next few weeks. AFHTO was told that, at minimum, we would get advance notice of the content of this framework. AFHTO continues to request the opportunity to review and give feedback on the draft framework for exceptions so that problems can be identified and solved before the Agreements move into implementation. AFHTO has a very successful track record in this regard, given past work in pulling together working groups from member FHTs to give constructive feedback and attempt to solve problems with the Ministry on such issues as the move to 5-year funding, NP-SERT and the new smoking cessation program. AFHTO first notified FHTs about the potential problem with the “employee requirement” clause on March 25, and survey results indicated this would pose significant implementation challenges for many FHTs. As noted in that March 25 e-mail, the “employee requirement” was introduced with the intent to meet a government-wide directive from Ministry of Government Services (MGS) implemented last September for all transfer payment agencies. In the last few days AFHTO has discussed these concerns with the Minister’s Office (MO) and the Ontario Medical Association (OMA). We welcomed news that the MO is working with the FHT Unit and MGS to find reasonable and workable solutions to fulfil the intended purpose of the directive while minimizing the risk of destabilizing staffing arrangements and service delivery in FHTs. The OMA shares AFHTO’s concerns, and our two organizations are working collaboratively in seeking solutions. In the meantime AFHTO has learned that some FHTs have yet to receive an extension date for signing their Agreement.  Other FHTs have received a response to their specific problems in implementing the “employee requirement” with a message that says, “The Ministry realizes that there may be isolated circumstances where exemptions will require consideration. … The ministry is not encouraging exceptions and very rarely will approve unless extreme circumstances.” AFHTO continues to recommend to those FHTs who have not yet signed the Agreement:

• Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
• If the “employee requirement” poses problems for your FHT, wait to see the Ministry’s framework for granting exceptions.
• Continue to work with your Ministry consultant to seek clarification on other issues affecting your FHT.
• Seek legal advice as needed to deal with your FHT’s unique situation.
• Please continue to keep AFHTO in the loop. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

AFHTO has learned that all FHTs who requested an extended deadline to sign their Funding Agreement have received it. For some FHTs the new deadline is Friday, April 8, and others have until Friday, April 15. The FHT Unit has told AFHTO it will work with each FHT individually to resolve the issues the FHT has raised.  While the common issues were reiterated, the Ministry’s view is that each FHT’s needs and issues are unique, and each FHT has been given funding in their budget for legal assistance to help them with this. Each FHT does have unique circumstances. Some are sufficiently satisfied and have signed the agreement. Others have copied AFHTO on their letters to the Ministry specifying their FHT’s concerns. For those FHTs who have not yet signed, AFHTO suggests you:

• Continue to work with your Ministry consultant to seek clarification.
• Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation.
• Seek legal advice as needed to deal with your FHT’s unique situation.

AFHTO is continuing to monitor progress and to seek advice on the unresolved issues. We sincerely hope that all FHTs will find workable solutions; however, if your FHT should find itself reaching an impasse, please keep us informed. AFHTO remains ready to gather FHT opinions, coordinate discussion, and facilitate resolution of issues that are common among FHTs.

AFHTO has just received a copy of a review by OMA legal counsel of the FHT Funding Agreement – Physician Sponsored template.  This is posted on the OMA’s members-only website or click here to view. Some comments in the review apply to the Mixed Governance and Community Sponsored templates as well, and so this is being forwarded as a service to all FHT leaders.  The assessment of risk and liability issues may be the most pertinent for other models. AFHTO’s ED has followed up with the Ministry regarding the “employee” and the “governance” issues outlined in the March 28 e-mail below. The fact that these are issues for a large number of FHTs has been acknowledged, as has the need for a collective approach to finding workable solutions in the best interest of all. Thank you to the 62 FHTs who responded to the survey – the results were instrumental in getting the Ministry’s attention.   Please remember to e-mail a copy of your response letter to the Ministry to angie.heydon@afhto.ca , and thank you the FHTs who have done so already. These are very valuable to have for reference in our follow-up with the Ministry on the Funding Agreement.

This is a review of the what the Ontario provincial budget means for FHTs, prepared for the benefit of AFHTO members. The good news for FHTs is government’s commitment to “protect education and health care”. In documenting its record in office, creation of 200 FHTs are once again mentioned as one of the key achievements in “Better Access to Primary Care” (pages 97-98). New investments are announced to invest in a Mental Health and Addiction Strategy – starting with children and youth, enhancing the MedsCheck program, expanding breast screening for high-risk women aged 30-49, increasing funding for long-term care and community-based support to free up hospital beds, and a 1.5% increase to hospital base funding. There was no announcement of additional funding for delivery of primary care services.  There is simply the statement “More than $300 million is invested annually to support Ontario’s FHTs” (page 98). The “Managing Responsibly” section of the budget lists measures to reduce waste, eliminate duplication, strengthen oversight and find more savings. While the measures mostly focus on the public service and government agencies, as transfer payment agencies, FHTs could expect to see tightening of controls. (FHTs are already beginning to experience this with the current Funding Agreement templates.) Pages 107 – 110 point to action to manage health care costs. It states, “The government’s focus now is to manage the rate of growth in health spending to a sustainable level, while protecting front-line service delivery of quality care. In the 2010 Budget, the government set a goal of holding annual health sector spending increases to three per cent by 2012–13.The government is on track to meet this target and to maintain this rate of growth into 2013–14 after accounting for time-limited investments. It is doing so by introducing reforms that focus on providing services supported by evidence, improving quality and accountability in the sector, and increasing the value of investments in the health care system.” Government will also establish the Commission on Broader Public Sector Reform, chaired by economist Don Drummond, to examine long-term, fundamental changes to the way government works. The Commission is to report “in time to inform the development of the 2012 Budget. The Commission will not make recommendations that would increase taxes or lead to the privatization of health care or education”. Given that Mr. Drummond was co-author of a highly-publicized report called “Charting A Path To Sustainable Health Care In Ontario”, the recommendations could touch on how publicly-funded health care is organized. Full text of the budget is available at – http://www.fin.gov.on.ca/en/budget/ontariobudgets/2011/papers_all.pdf