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Tag: Members Only News

  • Letter from AFHTO board re MOHLTC-OMA negotiations

    FYI — The letter below from the AFHTO  Board of Directors was sent this morning, Friday, May 18, 2012, to Susan Fitzpatrick, Assistant Deputy Minister of MOHLTC’s Negotiations and Accountability Management Division, and to Dr. Doug Weir, President, Ontario Medical Association.

    ……………………………………………………….

    May 17, 2012

    Ms. Susan Fitzpatrick Assistant Deputy Minister Negotiations and Accountability Management Division Hepburn Block 5th Flr, 80 Grosvenor St Toronto ON M7A1R3 Dr. Doug Weir, President Ontario Medical Association Ontario Medical Association 150 Bloor Street West, Suite 900 Toronto, Ontario, M5S 3C1

    Dear Ms. Fitzpatrick and Dr. Weir,

    The Association of Family Health Teams of Ontario is all about the TEAM in primary care. Our mission is to work with and on behalf of our members as the advocate, champion, network, and resource center for family health teams, to support them in improving and delivering optimal interprofessional care.

    The question of the Physician Services Agreement is a matter between the Ministry and the OMA, and therefore AFHTO’s position has been to remain neutral. With our mission clearly in mind, AFHTO has also been watchful as to the potential impact on the ability of FHTs to deliver optimal interprofessional care.

    The AFHTO board has reviewed the current situation in its meeting this week. In the interest of maintaining productive working relations among the Ministry, physicians and all members of primary care interprofessional teams, we encourage a return to fair and honest negotiations between government and the OMA regarding physician compensation.

    Looking at broader questions in the evolution of our health system, AFHTO is ready, willing and able to help shape further development of interdisciplinary primary care in Ontario. With 20% of Ontarians as patients, existing FHTs have created a critical mass of leadership and organization that can be leveraged to support planning and improvement in primary care delivery.

    With the cost and funding pressures facing the province of Ontario, the AFHTO board would also encourage government and all stakeholders to engage in a broad-based exploration of strategies to achieve, consistent with the Excellent Care for all Act:

    • Control of cost, and
    • Establishment of capacity such that there is the choice of primary care practice for every person in province, and
    • Assurance of quality to the expectations of the people of the province of Ontario.

    We offer best wishes to both the Ministry and the OMA in reaching an agreement that will serve patients well, and will be satisfactory to both parties. We look forward to participating with you and others to improve Ontario’s health system.

    Sincerely,

    Kavita Mehta, President

    Angie Heydon, Executive Director

     

    Copy to: AFHTO members

  • AFHTO’s EMR survey – March 2012 survey results

    The EMR survey was completed by 160 respondents from 121 FHTs (65% of all 186) in the period April 10 – 30, 2012. Thank you to all who took the time to respond.

    Click on the links below to find:

    Findings from responses indicate:

    • 93.7% of respondents use only 1 EMR system in their FHT, with 6.3% using 2 or more.
    • Almost half of FHTs (49%) use Practice Solutions Software (PSS) and account for 52.5% of all EMR users.
    • The next most-frequently used EMRs are OSCAR and Bell EMR (formerly xWave) with about 12% of FHTs for each, then HealthScreen and P&P Data Systems with about 6% of FHTs each.
    • Looking at aggregate scores for the 9 EMRs rated by more than one FHT:
      • 3 EMRs received average or good ratings in all evaluation questions (OSCAR, Jonoke and Accuro(R))
      • 3 EMRs receive average or poor ratings in all evaluation questions (Nightingale, HealthScreen and York-Med)
      • The remaining 3 had ratings ranging from poor to good (PSS, Bell and P&P)
    • About 91% of FHTs report their physicians and other staff are using the full range of functionalities (ie. scheduling, billing & patient charting), and 97% of FHTs have a messaging function for internal communication.
    • 95% of FHTs have remote VPN connection to the EMR, but only 46% can access the EMR via WiFi during hospital rounds and/or LTC visits and/or home visits.
    • Over 93% of FHTs use desktops in exam rooms, but only 39% use tablets or laptops during patient encounters.
    • Patient access to a Patient Portal or Patient Health Record is still in early stages, with about 15% of FHTs who have this in place. About 70% have printers in patient rooms.

    Respondents who had indicated an interest in being part of a user groups for their EMR received contact information of all others who had signed up for the same EMR user group.  Having been linked in this way, user groups are encouraged to act as resources for one another to learn how to get the most from their EMR, and join together as needed in working with their vendor.

  • First time release of data from 5-year FHT evaluation study

     

    The first set of data from the Ministry-sponsored five-year FHT evaluation study was released last week to 118 FHTs. These FHTs had participated in at least one of three 2009 surveys – facility, patient, and provider – conducted by the Conference Board of Canada evaluation team.

    In 2009, the 134 FHTs in waves 1 – 3 were invited to participate in these surveys. Last week all 134 received a request to complete the follow-up Facility Survey and to distribute the Provider Survey to everyone in the FHT who provides direct patient care.

    The 118 FHTs who had participated in at least one of the 2009 surveys also received a summary of those results – for their individual FHT and the aggregate for all responding FHTs.  The Conference Board researchers confirmed that individual results have been distributed solely to the respective FHT; the Ministry receives only aggregate data.

    The report combines responses from several questions to provide scores in the domains of access, comprehensiveness, teamwork, coordination, quality and chronic disease prevention and management. Almost all scores are expressed on a scale of 0-100. There is no cutoff between “good” and “bad”, but the ideal is to score 80 or above.

    The following report gives AFHTO’s observations on this first set of data.  The Ministry is currently compiling a more detailed report on the full set of results from the first three years of the FHT evaluation.

    Median scores – the middle number with an equal number of responses above and below – indicate the following for FHTs overall in 2009:

    • Patients report the median wait for minor health problems was 0.5 days and they generally have little or no difficulty accessing care (median score of 81). However, the overall median patient score for accessibility of care was 73.
    • Overall, providers report that several critical aspects of teamwork are in place, with median scores of 82 for the way in which team members communicate and interact, 78 for collaboration with members of their immediate team, and 74 for collaboration among all providers in the FHT.
    • When it comes to coordination and quality, both providers and patients gave relatively high scores for factors internal to the FHT. Examples include median patient scores of 90 for their experience of interaction with their health care provider and for care coordination within the FHT, 94 for satisfaction with their providers and care, 84 for cultural competency, and 79 for family-centredness. Providers seem to be somewhat harsher in looking at themselves in these same domains, with median scores of 80 for care coordination within the FHT, for satisfaction with their role and FHT team; 74 to 76 on their interactions with patients and family-centredness, and 65 for their cultural competency.
    • Related to the operation of their FHT, providers gave a median score of 80 for the extent to which their FHT has key governance-related policies in place, 73 to the extent to which their FHT uses data to support patient services and care, and 56 to the extent to which they are participating in quality improvement activities.
    • Patients gave relatively high scores related to some aspects of chronic disease prevention and management (CDPM) – median score of 82 for satisfaction with the services they receive for their chronic diseases and 85 for their level of confidence in self-management. In addition 93% of patients with the relevant chronic conditions reported their blood pressure was under control, and 83% said likewise for blood sugar. The lowest median score in the whole report, however, was 31 for questions related to services received to manage their chronic disease (e.g. lists, reminders, treatment plans). One would expect this score to improve with time as FHTs have further developed and strengthened CDPM programs since the early days of setting up multidisciplinary programs.
    • External linkages are also expected to strengthen as the FHTs mature. Median scores were relatively low in these early days, with an overall median score of 55, presumably since FHTs were focused on getting their teams up and running. Patients gave an aggregated median score of 46 on questions related to their FHT’s community orientation. Providers gave a median score of 63 to their experience of patient care coordination with external providers; interestingly though, patients gave this a median score of 95.
    • The results also point to room for improvement when it comes to discussions about health and well-being (e.g. diet and exercise, medications, preparation for aging). Median score from the patient survey was 66, and 71 in the provider survey.

    Outside of the few areas listed above, median scores are above 70.  While FHTs overall may be performing relatively well, the scores for individual FHTs range from 25 to 100 for most items.  FHTs that received these individualized reports may find some additional areas for improvement.

    Three years later the three surveys are being repeated.  The results will be valuable in showing how FHTs as a whole are developing over time.  Participating FHTs will have the added advantage of seeing how their individual performance is evolving.

    FHTs that have received the 2012 facility and provider surveys are encouraged to complete them.  If you require the link to the survey or have any questions, please contact the evaluation team through Garry Armitage at 1-888-689-1847 or g.armitage@malatest.com .

    BACKGROUND

    MOHLTC contracted the Conference Board of Canada to conduct an evaluation of the FHT initiative over the period from Dec. 2008 to Nov.2013. The study has included key informant surveys, site visits, patient focus groups and administrative data analysis, in addition to the two rounds of facility, provider and patient surveys in 2009 and 2012. Comparative data is also being collected from Community Health Centres and Family Health Groups. The evaluation domains are:

    • Access
    • Comprehensiveness of care
    • Coordination and continuity of care
    • Information management systems to support quality and coordination
    • Interprofessional team functioning and effectiveness
    • Quality and appropriateness of care
    • Health promotion and chronic disease prevention and management

    In 2009, all FHTs were invited to participate in facility and provider surveys. As well, randomly selected FHTs were invited to participate in site visits and patient surveys. In total: 84 per cent of FHTs responded to the facility survey; over 800 FHT providers, including physicians, registered nurses, mental health workers, nurse practitioners, dietitians, pharmacists, and others responded to the provider survey; and more than 2,600 FHT patients shared their views about the care they receive at their FHTs through the patient survey.

     

  • 2012 Ontario Budget: Highlights for FHTs

    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 key sections for FHTs are “Transforming Health Care” and “A LONG-TERM PLAN FOR PUBLIC-SECTOR COMPENSATION”.  FHTs may also be affected by the push for more “Collaborative Purchasing in the Broader Public Sector” and the move for full cost recovery in a number of user fees such as the Hazardous Waste Fee (see “Non-Tax Revenues”). Transforming Health Care

    This section of the budget reiterates the key themes of Ontario’s Action Plan for Health Care.   The budget states specific plans to:
    • Cap health care expenditure growth to 2% per year.
    • Maintain total physician compensation at current levels through the next Physician Services Agreement with the Ontario Medical Association.
    • Hold growth in hospitals’ overall base operating funding to zero per cent in 2012–13, while continuing to increase investments in the community care sector by an average of four per cent annually.
    • Restrict seniors with net incomes over $100,000 from access to free drugs.
    • Phase in a patient-centred funding model over three years such that hospitals, long-term care homes and Community Care Access Centres will be funded “based on the types and volume of services and treatments they deliver, at a price that reflects the best practice and complexity of patients and procedures, while encouraging efficiency without compromising service and access”. (There is no reference to primary care regarding this point.)
    • “Keep Ontario Healthy”, with a panel set up to develop a Childhood Obesity Strategy, increased fines for those who sell tobacco to children, continued expansion of comprehensive cancer screening programs, and individual access to an online Personalized Cancer Risk Profile that will use medical and family history to measure cancer risk and then link those at higher risk to prevention supports, screening or genetic testing.

    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.

  • Updates from meeting with MOHLTC Primary Health Care Branch

    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:

    • It is moving toward more broadly defined `buckets` of funds to give greater flexibility.  The FHT Unit hopes to confirm what these are by July, possibly sooner.
    • FHTs do have some flexibility in determining the mix of IHPs in the team in circumstances such as unfilled positions. The request to change will need approval as would be expected. The line item for this will be associated with the benchmark of the requested IHP.
    • The Ministry benchmark for funding IT connectivity has been judged to be adequate by OntarioMD and eHealth Ontario. DSL is the standard.  Unique circumstances could be discussed, but the benchmark will not be altered. Concrete examples of issues directly related to connectivity are useful to make the case for operational needs.
    • It is looking into the issue of relief funding to backfill reception and nursing positions to cover operating commitments, within government funding constraints and where physicians are not the ones obliged to cover these costs.

    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.

    • For FHT EDs in LHINs 1-4 and 12 (Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant, North Simcoe Muskoka) and all CFHTs across the province:
    • For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
    • For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
    • For FHT EDs in LHINs 13-14 (North East, North West)
      • Randy Belair, ED Sunset Country FHT,  AFHTO Secretary
      • E-mail:  rbelair@kfht.ca
    • For FHT Clinical Leads:
      • John McDonald, Lead Physician PrimaCare Community FHT, AFHTO Past President
      • E-mail:  john.mcd1@sympatico.ca

  • Updates on AFHTO support for members

    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.

  • Outcome of Meeting with ADM on Primary Care Recruitment & Retention

    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:

  • Toward a Primary Care Recruitment & Retention Strategy for Ontario

    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 full compensation package – salaries, pensions and benefits –must be addressed to make working in primary care sufficiently attractive to recruit and retain competent staff in this sector.  Recognizing current economic constraints, it is well understood that reaching a competitive compensation level will need to be phased in over a few years.
    • As an immediate first step, the barrier to labour mobility must be removed to enable all primary care organizations to offer the HOOPP pension plan and reasonable benefit package.  This entails a 2.5% increase in compensation funding, for a total of $10.36M.
    • Since staff are required to contribute a minimum of 6.9% of gross earnings toward the pension, a matching increase of 2.5% should be added for all staff to defray their reduction in take-home earnings.  This would bring the total investment across all of primary care to $19.48M.

    The investigation found:

    • The biggest vacancy rates appear among the largest staff groups, e.g. 19% for Nurse Practitioners, 14% for dietitians, 10% for RNs, and 5-12% for administrative managers.  Add to this an 18% vacancy rate for pharmacists, and the result is a serious gap in skills to provide the full scope of primary care, particularly chronic disease prevention and management.
    • Factoring in turnover rates and the time needed to fill each type of position, roughly 6-7% of overall staff service capacity is lost each year due to turnover.
    • The most troubling finding is that the majority of staff who leave are then lost to the primary care sector – only 1/3 move to other primary care settings, but about 1/2 go to work in hospitals and other health care settings.
    • While Ontario’s Action Plan for Health Care calls for placing “Family Health Care at the Centre of the System,” there are barriers to attracting health providers to primary care and keeping them in this part of the health system.
    • There is overwhelming evidence that compensation packages are the root cause. Independent review found salaries to be 5 – 30% below market. Lack of the HOOPP plan makes it hard to compete with the other health sectors that do offer it.
    • Growing inequity in compensation is creating conditions for rapid expansion of unionization in this sector, beyond the 10% of PCOs who currently have staff under collective agreements.

    Please click here to read about the outcome of the joint meeting.

  • Ontario’s Action Plan for Health Care: Highlights for primary care

    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

    • Family Health Care at the Centre of the System:  Through the LHINs, we will hold the entire health system accountable for substantial progress towards fewer hospital readmissions.
    • Faster Access: More patients will have access to same-day and next-day appointments and after-hours care. This means better care for our patients and less strain on other areas of our health care system.
    • House Calls: We will be expanding access to house calls from health care professionals, like doctors, nurses, and occupational therapists. We will also be improving access to online and phone consultations.
    • Local Integration of Family Health Care: We will integrate family health care planning under the LHINs. Together, we will identify a model that brings planning and accountability for the full patient journey. However, the Ministry of Health and Long-Term Care will continue to have a funding role with Ontario’s doctors.
    • A Focus on Quality in Family Health Care: We will expand our focus on quality improvement to family health care, and ensure that all family health care providers are equipped to integrate the latest evidence based care into their practice.

    Right Care, Right Time, Right Place

    • High Quality Care: Evidence will drive our decisions and it will drive our funding. IF there is evidence to support a new procedure or test, we will fund it. We will also continue to find ways to fully maximize the potential of our range of health care professionals.
    • Timely, Proactive Care: We will implement our mental health strategy starting with children and youth, including getting mental health nurses into our schools, supporting people with eating disorders, and smoothing the transitions of people between mental health care providers.
    • Seniors Strategy: We will launch a Seniors Strategy with an intense focus on supporting seniors to stay healthy and stay at home longer, reducing strain on hospitals and long-term care homes. It will include:
      • An expansion of house calls
      • More access to home care through an additional 3 million Personal Support Worker hours
      • Care Co-ordinators that will work closely with health care providers to make sure the right care is in place for seniors recovering after hospital stays to reduce readmissions.
      • The Healthy Homes Renovation Tax Credit, which will support seniors in adapting their home to meet their needs as they age, so they can live independently at home, longer.
      • Empower LHINs with greater flexibility to shift resources where the need is greatest, such as home or community care.
    • Moving Procedures into the Community: We will shift more procedures out of hospital and into non-profit community-based clinics if it will mean offering patients faster access to high-quality care at less cost. We will not compromise on quality, oversight, or accountability.
    • Funding Reform: Funding must follow the patient. We will accelerate the move to patient-based payment, as patients move through our health care system.

    Keeping Ontario Healthy

    • Childhood Obesity Strategy: We will take on the challenge to reduce childhood obesity by 20 per cent over five years. Success on this front will require partnership, so we will bring together a panel of advocates, health care leaders, non-profit organizations, and industry to develop the strategy to meet our target.
    • Online Cancer Risk Profile: All Ontarians will have access to an online Personalized Cancer Risk Profile that will us medical and family history to measure risk of cancer and then link people at higher risk to screening programs, prevention supports, or genetic testing.
    • Expanded Screening: We will expand our comprehensive screening programs for cervical, breast and colorectal cancer to notify and remind participants when they are due for their next screening.

  • Responding to staff about media speculation on public sector salaries

    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.