The Ministry template for FHT Funding Agreements has serious implications for FHTs, therefore this message is being sent to all FHT leaders, AFHTO members and non-members alike.  This message follows up on an e-mail sent to all AFHTO members on March 25 and a related message sent to non-members on March 26. The AFHTO board of directors met this evening (March 27) to review the results of the membership survey on the Funding Agreement (53 responses since Saturday) and outcome of discussions today with Phil Graham, with two different lawyers working with FHTs on this issue, and with various FHT leaders. The key messages for all FHT leaders are: 1. Do not rush into signing the Agreement until your FHT is comfortable with the requirements and the timeframe for implementation. Our survey results tell us over 60% of responding FHTs cannot meet the deadline. The Ministry’s FHT Unit has said it is looking for “best efforts for sign-back” and will consider requests for extensions, as long as the FHT is specific in identifying the additional issues that need to be addressed. 2. Review the problems with the template agreements listed below, and seek legal advice as needed to deal with your FHT’s unique situation. Our survey results show that the “all funded positions shall be employees” clause will create significant hardship for the majority of FHTs. Additional issues identified to date in the three template agreements (one for each of the three governance models) are identified below. 3. In a letter to your Ministry consultant, indicate very clearly the clauses in the Agreement that are of concern. In sending the letter, your FHT could append the signed Agreement, having first struck out and initialled all of the problematic clauses in the agreement. 4. E-mail a copy of your cover letter to AFHTO — angie.heydon@afhto.ca. AFHTO is ready to gather FHT opinions and coordinate discussion. Our goal is to facilitate resolution of issues that are common among FHTs. Concerns with the template agreements ·         “All funded positions shall be employees” clause: From the survey response, this is a problem affecting pharmacists in about 1/3 of responding FHTs, admin staff and social workers in about 1/4 of these FHTs, RNs and dieticians in 15% of these FHTS, and NPs in just under 10%. Among the 19 FHTs who reporting having psychologists, 11 FHTs would be challenged in converting them to employees.  Twenty-eight FHTs reported having mental health workers; 9 of these FHTs would have the same conversion challenge. AFHTO acknowledges that a government-wide directive on “transfer payment accountability” has led to inclusion of this clause, and that the clause allows for exceptions. From discussions Friday and today, it is clear that each requesting FHT will have to go to inordinate lengths to prove they cannot fill these positions with employees, and very few exceptions would be granted in the end.  While AFHTO believes it will be possible to find solutions that uphold government’s principles for transfer payment accountability, without jeopardizing patient care, the FHT Unit has indicated they are not prepared to discuss it further. ·         Governance problems in “Mixed Governance” and “Provider-led” templates: For Mixed Governance FHTs:  the requirements are highly prescriptive (and include some errors, e.g. a FHT cannot be a member of itself) and will generate costs to amend and implement the resulting bylaw changes. For Provider-led FHTs: their governance is undermined by the lack of any reference to the FHT board as the governors, and gives authority for the contract to the “Lead Physician and Associate Lead Physician as designated or redesignated under its Physician Services Contract”. ·         Other concerns to note: AFHTO members have also flagged concerns about: –          the process by which payment could be reduced or suspended –          the restrictive bands on compensation levels –          liabilities for the physician group if the FHT is wound up –          the requirement to consult with the Ministry before participating in media communications and publications. AFHTO will continue to work on behalf of members to identify and work to resolve common issues.  We will provide updates and share solutions with AFHTO members as they emerge. For those who are not yet members of AFHTO, this is an excellent time to join. Go to www.afhto.ca for more information.

The cover letter for all of the funding agreements MOHLTC has sent to FHTs contains a paragraph called “Requirement that all funded positions be employees”.  This post: ·         Summarizes specific issues AFHTO has collected to date, from e-mails and phone calls with EDs & lead physicians over March 24-25, 2011. ·         Reports on outcome of an initial conversation with Phil Graham, Manager of the FHT Unit (i.e. this requirement results from a government-wide directive) ·         Asks you to complete a brief survey so AFHTO can identify the depth and breadth of these issues, found at http://www.surveymonkey.com/s/MCCLLMZ . ·         Asks for potential volunteers who can be called on to form an AFHTO working group to find workable solutions on behalf of all FHTs, if needed. Requirement, as stated in the letter: 3 Requirement that all funded positions be employees To ensure consistency and alignment with enhanced accountability requirements, the following clause has been incorporated into the new Funding Agreement: “The Recipient acknowledges and agrees that all positions funded pursuant to this Agreement shall be employees of the Recipient unless the Ministry has provided its written consent for the use of an independent contractor. In no case, shall any portion of the Funds be transferred by the Recipient to any other person, corporation or entity for the purpose of paying for a position Funded pursuant to this Agreement, unless otherwise agreed to in writing by the Ministry.” Why has this requirement been introduced? This is to meet an Ontario government-wide directive implemented last September that applies to all government-funded transfer payment agencies. I requested a copy to get clarity on the scope and intent of this directive, and the criteria for the Ministry to determine exceptions. Apparently the document cannot be shared, but further background may be forthcoming in another week. Key problem areas identified by FHT leaders: ·         Barriers to recruiting community pharmacists, psychologists, dieticians who generally working in private practice and are contracted to work x hours per week in the FHT. Prescribed pay rates are below what they earn in their other roles. They appear to meet Canada Revenue Agency’s test for “independent contractor”. Conversion to an employment contract means payroll taxes will reduce their income further. ·         Contracts with outside agencies to provide services, e.g. mental health: in a number of communities, this was found to be the most cost-effective way to provide quality services to FHT patients. ·         Contracts for physician staff to fill part-time roles: where some roles are less than .5 FTE, some FHTs have found it more efficient to combine the role with one in the physician organization to create a full FTE position. Other issues raised by FHTs regarding the Funding Agreements: ·         The specific content of the schedules. These are unique to each FHT – each FHT will need to make sure they are accurate and negotiate the content with your MOHLTC consultant individually.  Keep in mind that this is your FHT’s “base” funding and activity for the next 5 years. Each year your FHT can apply for additions to your base or for one-time funding required to meet specific objectives in your annual operating plan. ·         Amount of time needed for full review with board and legal counsel. MOHLTC’s letter says “This Agreement must be signed and returned to the ministry by March 31, 2011 in order for the ministry to process the April 2011 payment.” Some FHTs received their Funding Agreements yesterday. ·         Time needed to implement changes to comply with the agreement. MOHLTC consultants have said FHTs would be allowed 6 – 8 months to transition to the new requirements (e.g. ensuring equal access to IHPs, implementing public complaints process, ensuring the FHT comprises all physicians contracted under a Physician Services Agreement). Next steps: Please click here to complete the brief survey – http://www.surveymonkey.com/s/MCCLLMZ . AFHTO’s Executive Director will continue to work on getting clarity regarding the scope and criteria for granting exceptions to the employee requirement. Your response to the survey will help in this matter. AFHTO will continue to keep you informed, and we appreciate your help in keeping the AFHTO board and me informed of developments as well.

Click here to access AFHTO’s notes on the questions and answers discussed during the two teleconferences on NP-SERT hosted by MOHLTC on March 11, 2011. Click here to to access the Q&A document e-mailed by MOHLTC on February 1, 2011.