The quarterly meeting between AFHTO and the MOHLTC’s Primary Health Care Branch was held on November 21^st 2014. The meeting focused on:

• Process to revise Ministry contract templates and schedules
• Recruitment and retention
• 2014/15 funding, reporting & budget reallocation
• 2015/16 Operating Plan process
• Funding envelope for interprofessional primary care

Process to revise Ministry contract templates and schedules

Following from the AFHTO membership’s work to develop a common direction — Toward the next ministry contract: Principles and guidance for moving forward –  AFHTO and PHC Branch have begun to map out a path to put in place new contract templates before the current Ministry-FHT contracts expire on March 31, 2016. With this comes the opportunity to develop more mature and meaningful contracts that will support interprofessional teams to continue to deliver high-quality primary care and improve the health of the people in the communities served. While these discussions focus on FHTs, AFHTO retains a clear focus on the needs of, and implications for, our NPLC members. Discussion with PHC Branch focused on the process to review and renew the contract template, which identifies the terms and conditions of funding in addition to some programmatic elements. The Ministry is looking to our members to provide recommendations on possible amendments to the contract template that will support FHTs in achieving their objectives. Discussion also focused on the process to determine the performance measures to be reported under Schedule A of the contract. Members have agreed that:

• Financial and clinical reporting should minimize duplication in data collection and reporting.
• Accountability should be defined in terms of collectively agreed upon measures that reflect value delivered.
• Reporting requirements should place more emphasis on the work of the team to achieve outcomes and less on individual member activities and patient encounters.

The ministry is looking to AFHTO, in collaboration with other relevant stakeholders, to recommend performance measures aligned with the ministry’s focus on enhancing access/integration and supporting quality and sustainability in primary care.  We are well-positioned to do this, by leveraging our collective work on the next iteration of Data to Decisions  (D2D 2.0) and continuing to engage our members and other stakeholders (ICES, HQO, AOHC, OMA). Ministry representation will be added to the process.  As a collective, we will continue to identify manageable and meaningful measurement and demonstrate the value and impact of interprofessional primary care as we work towards the next ministry contract.

Recruitment & retention

Recruitment and retention remains the most significant challenge for FHTs and NPLCs. This issue is well-recognized in the PHC Branch. AFHTO members:  This issue can only be addressed at the political level of government. We understand planning work is underway, and are encouraged by support that has emerged from the opposition parties – seen in a question in the Legislature from the NDP Health Critic (Oct.28) and a Member’s Statement from the PC member from Huron-Perth riding this past week. The best thing AFHTO members could do at this point is continue to meet with MPPs – this is the political pressure that will be the most effective at this point. To help you in this work– click here for:

• A brochure, key messages and a powerpoint you can use in MPP meetings.
• AFHTO-AOHC-NPAO joint report and recommendations on recruitment and retention in primary care

2014/15 funding, reporting & budget reallocation

All budget letters have been mailed out to the FHTs; NPLC letters are in the approval process. For FHTs that requested funding for physiotherapy, these letters are separate and should be sent out over the next few weeks. The need for transparent letters that clearly identify funding increases versus reinstatement of funds was noted. Ministry representatives accepted the feedback but noted that the letters are based on standard ministry templates they are required to use. The approved funding for QIDSS positions was also reviewed. While we are pleased to see some increase in QIDSS positions, MOHLTC was able to fund only 3.5 FTEs out of the 13 requested. The ministry signalled the commitment to continue with performance measuring and maintaining a strong focus on quality yet stressed the limitation of working within confined budgets. There is a need to develop more clear expectations for host sites of QIDSS; AFHTO will work with our host and partner sites to develop advice for the ministry accordingly. While funding is tight there is room for flexibility in use of budgets.  PHC Branch noted there are still dollars being returned at the end of each fiscal year. FHTs and NPLCs are encouraged to request reallocation of approved budgets to meeting needs.  This includes requests to move funds for current vacant positions (clinical or admin) to a QIDSS position. For the quarterly reports, the ministry noted that there is no expectation for FHTs to backfill data for Q1 or Q2, the expectation is that data will be provided for Q3 only.

Accountability Reform Initiative

Now that budget letters have gone out, this will be the next focus for the ministry. Stay tuned for ARI approvals and information on the next cycle of applications. AFHTO’s Fundamentals of Governance guidebook, videos and toolkit is available to help members take the steps needed to meet the requirements.

2015/16 Operating Plan

AFHTO conveyed members concerns regarding the challenge of meeting reporting deadlines and then waiting 8 months for approvals. We acknowledge that much of the approval process takes place beyond the control of PHC Branch, but both sides are interested in continuing to find ways to improve the process that takes place within the branch. Ministry staff are currently working on  process and timelines for the 2015-16 operating plan and budget submissions. Draft material will be shared in the next couple of weeks; the ED Advisory Council will review during their December meeting and provide feedback. As the process unfolds, AFHTO will work closely with our members to support them in completing the submission requirements.

Funding envelope for interprofessional primary care

The current budget allocated for Interprofessional Programs (FHTs, NPLCs and AHACs) has pretty well reached the limit.  The message to AFHTO members is:

• Your association will continue to use all available evidence to make the case for investment in interprofessional primary care.
• In order to do this, we must collectively demonstrate and document the value to health and the health system from Ontario’s investment in interprofessional primary care.
• Our collective work to advance manageable and meaningful measurement, aligned with the Starfield principles, is a fundamental key to accomplishing this.

In the current fiscal climate, it will be challenging to expand the budget envelope.  As we approach the next cycle of operating plans, we must all be prepared for no new money, and find ways to make optimal use of available funds.

AFHTO met with MOHLTC’s Primary Health Care Branch to discuss questions around funding for FHTs and NPLCs.  From this we can provide the follow advice for members:

• Funding approval process:  The process for approving any one-time funding or increases to base is still underway in the ministry. Meanwhile, FHTs and NPLCs can be confident in planning for and using their base budgets.

• Definition of “base budgets”: While many teams experienced adjustments in their base funding last fiscal, PHC Branch has not recommended any further adjustment this year. Base budget is equal to what you currently received each month, times twelve.

• Make full use of available funds: The ministry reports that a large number of teams are still returning unspent funds, and at the same time, requesting additional funding in their yearly budget submission.
  • FHTs and NPLCs have the right to request re-allocation of funds as needed during the fiscal year.
  • Q1 recoveries are coming soon – plan ahead and make your requests to re-purpose funds for other needs.
  • To make a request, EDs are encouraged to submit an accurate budget forecast in their quarterly financial reports, along with a request to re-purpose funds, supported by the justification for the request.
  • Ministry consultants are to collaborate with EDs to ensure that relevant program needs can be met within current budget by allowing flexibility in allocation of existing funds.
    • Example: Funding for OTN replacement equipment. OTN funding came through eHealth Ontario, and funding is no longer available. Primary Health Care Branch does not fund OTN equipment, however, they have worked with groups to re-allocate existing budgets to cover the cost.

• Physiotherapy funding requests are still in process:  Funding for approved PT positions will be added to base. As a result, notice of approval for these positions should come just before the FHT/NPLC funding letters.

  Reminder:  Registration is still open for Leadership and Governance events

• For board chairs, Lead MD/NPs and EDs
• Take place immediately before AFHTO Conference at the Westin Harbour Hotel, Toronto
• NO COST to participate.
• Effective Governance for Quality workshop, October 14 from 10:30 am to 4:30 pm.
• Leadership Session – Towards the next Ministry contract – on October 15 from 10 AM – 12 noon
  • Session will be informed by results of a survey sent out to board chairs, Lead MD/NPs and EDs. Please respond by Sept.26.

Primary objective of the meeting of FHT Directors (representing AFHTO and AOHC members) and MOHLTC’s FHT Unit concerned operating plan submissions and cash flow challenges in first half of next fiscal. Click here for the full report. One topic was staff compensation. AFHTO, together with AOHC and NPAO, is continuing to advocate at political levels on the challenges to recruiting and retaining the staff needed to fulfill government’s commitment to deliver interprofessional primary care.  (Click here to see the joint report and recommendations.) Recruitment and retention will also be a key message in AFHTO’s upcoming pre-election work – more on this to come.

• Your help is needed to reinforce this message in your operating plans.  Section 5.1 of the submission package asks, “Is there anything else the Family Health Team would like to communicate to the ministry regarding their planned activities for 2014-2015?” If your FHT is facing recruitment and retention challenges, please use this as the opportunity to tell the Ministry about your concerns, and illustrate with specific stories. For example, point out:
  • vacancies you have experienced and their impact on the FHT’s ability to deliver care
  • better-paid positions that staff members have left to take
  • likelihood of losing staff in the next year (e.g. is there recruiting in other sectors in your community that’s threatening to draw staff from the FHT)
  • We have gained some traction on this issue, and your reinforcement with real-life illustrations will help. After entering it into your plan, please send a copy of your stories to info@afhto.ca so we can draw from them in our on-going work.

Other topics covered in the full report include:

• Funding for additional QIDS positions and overhead costs for QIDS employers
• Clarification of what the funding priority — “Innovative low cost expansion opportunities” — means
• Restitution of specialist sessional funding
• Guidance for FHTs incorporating Diabetes Education Programs
• Funding, cash flow and audit requirements Health Link leads
• Accountability Reform Initiative
• And more … click to read the full report

In the course of a meeting of with the Ministry’s FHT Unit yesterday, we learned the target distribution date for the 2014-15 operating plan packages is in early January. FHTs would have two months to complete their plans for submission in early March. This meeting was the next step in our work toward achieving greater flexibility in FHT budgets, as agreed in the most recent quarterly meeting of AFHTO, AOHC and the Ministry’s FHT Unit.  (Click here for meeting report.) The purpose was to review:

• Draft criteria to assess readiness to govern and manage a more flexible budget, developed through AFHTO’s ED Advisory Council, and
• The FHT Unit’s initial ideas to move toward more meaningful accountability reporting.

The FHT Unit will do further work on a number of questions raised in the course of the meeting. Over the next number of weeks AFHTO and AOHC will receive drafts of templates for readiness assessment, quarterly reporting and the annual operating plan submission for review and comment. Thank you to the FHT EDs who worked on drafting the readiness criteria, the ED Advisory Council for their comments and support.  Thank you as well to those who participated in yesterday’s meeting:

• MOHLTC: Phil Graham (Manager, FHTs and Related Programs), Fernando Tavares (Acting Program Manager), and Johlen Jordens (Acting Senior Program Consultant)
• FHT EDs: Randy Belair (Sunset Country FHT in Kenora), Michelle Karker (East Wellington FHT), Keri Selkirk (Thames Valley FHT in London)
• Association staff: Angie Heydon and Clarys Tirel (Association of Family Health Teams of Ontario), Leah Stephenson (Association of Ontario Health Centres)

FHT Directors representing AFHTO and AOHC members met with the FHT Unit on Wednesday. To access the full report, please click here. The main focus of the meeting was the discussion on budget flexibility and accountability. The FHTs presented the position proposed by the Executive Director Advisory Council at their meeting of August 28, which was to achieve:

• A global budget divided into two envelopes, one for HR and the other for operations, such that:

• The HR envelope should allow for complete flexibility in determining the positions.
• A provincial salary grid for each position should continue to be enforced to avoid unproductive competition for staff (with movement toward a more competitive primary care compensation structure, as advocated in the Compensation Structure for Ontario’s Interprofessional Primary Care Organizations report from AFHTO, AOHC and NPAO.)

The EDAC position was approved by the AFHTO board and is supported by the AOHC C-FHT Executive Directors. (To access the briefing note on this position, please click here.) The MOHLTC FHT unit agrees that, given the current fiscal constraints and the stage of development of some of the FHTs, moving towards increased budget flexibility and reviewing the accountability framework is the right direction.  All parties agreed that a staged approach that would be developed with a goal of moving a number of FHTs to a hybrid global budget for the next fiscal year, contingent on final ministry decisions. All have committed to collaborate on the first two steps to move this forward:

1. Readiness assessment: Through EDAC, AFHTO will prepare initial draft of criteria for assessing FHTs in terms of their readiness to govern and manage a more flexible budget.
2. More meaningful accountability reporting:  MOHLTC will share their initial work to review the reporting structure as a starting point for further discussion on changing the accountability framework.

There remains the need to find ways to ensure decisions about the size of budgets can remain consistent with changing demands and conditions over time. The meeting also provided the opportunity to review with the Ministry the process to address current budget pressures. The Ministry re-affirmed its commitment to ensure that the budget reductions do not impact negatively on patient care.  The Ministry coordinators have been instructed to be flexible and to work with FHTs on a case-by-case basis to free up funds within the approved FHT budget, or if necessary consider other measures. The Ministry provided updates on a number of issues identified by EDAC:

• Status of the BSM review
• Sessional fees
• Transfer of rostered patients
• Quality Improvement Plans
• QIDSS Program
• IHPS in non-FHT models
• Physiotherapy in FHTs

Representatives from AFHTO’s Operational Issues Working Group and the AOHC’s CFHT Executive met with the MOHLTC FHT Unit on September 20.The main objectives were to receive updates from the FHT Unit on budgets and other operational matters and to highlight “good news” from FHTs.  The following is a summary of the discussions. a) Recovery of unspent funds

• Recovery of unspent funds currently applies only to vacant position salaries and benefits. The focus is currently on surplus HR funding from the Q1 time period.
• Background: a significant amount of surplus funds are recovered each year from FHTs.  Due to the timing of audited statements, these funds have been recovered in the following fiscal year.  By reconciling on a quarterly basis, it provides more in-year flexibility, either to re-invest funds or to contribute to the government’s deficit reduction commitments.
• Process: based on review of hiring reports and Q1 financials, FHT Unit and FHT will come to agreement on amount to be recovered; following monthly payments will be adjusted accordingly.  Amount recovered is salary + 20% for benefits. This will have no impact on the approved budget for the FHT.
• FHT Unit is open to discussions about re-profiling positions that remain vacant for long periods (as long as the interdisciplinary nature of the team remains intact and the re-profiling is revenue neutral) or addressing in-year pressures. These issues need to be discussed with ministry contact.

b) Plans for funding existing/new Physician Assistants (PAs)

• Existing PAs (funding ends Mar 2013): Health Human Resources Strategy Division manages the PA program, but work is underway on a long-term strategy to support the integration of PAs into targeted areas of Ontario’s health care system.
• Regarding FHTs specifically, although PAs are not currently included in the list of approved interdisciplinary health providers in FHTs, there appears to be a strong case for making this happen. The permanent integration of PAs into FHT’s is one of the areas of focus for the long-term work currently underway.
• The FHT unit is currently working with the Health Human Resources Strategy Division on how this could work. The goal is to communicate this before March 2013.
• It was noted that support from the MOHLTC for a FHT-PA Community of Practice would be appreciated.
• Approvals to hire New PAs: Deadline for hiring is Oct 31. The FHT Unit is in process of finalizing approvals for recruitment.  FHTs should be notified in the next couple of weeks about the status of their application.

ACTION: FHT Unit to send AFHTO & AOHC list of FHTs with existing Physician Assistants. c) Funding for Relief positions

• Lack of relief funding, in particular for reception and RNs, continues to pose significant problems for some FHTs, including patient services, impacting workload and health and safety of providers when an absence creates a scenario where someone is left to work alone.
• Smaller FHTs, rural/remote, and community FHTs may be more greatly impacted by this.
• The FHT Unit will consider a number of options for addressing this issue, including a standard percentage increase for relief funding on a per-request basis, reallocation of unspent salary dollars or 3^rd party revenue to offset cost of relief.  FHTs are encouraged to discuss this problem with their primary consultant.
• Any change in relief funding would not be in effect until 2013/14 fiscal year.
• The question of BSM physician job-sharing was raised. The FHT Unit identifies this as an issue for FHT management to address/implement as appropriate.

d) Association Membership Fees

• The group thanked the FHT Unit for support for association membership fees.
• The FHT Unit confirmed that these funds are specifically earmarked for association fees, and cannot be reallocated if not used for that purpose.
• The expense needs to be reported as a separate line item under general overhead and will be monitored to ensure it is going towards AOHC or AFHTO dues.

e) Preparing for next budget cycle / annual planning

• The earlier start to the budget cycle was noted as a positive change for FHTs.  FHT Unit would like to start 2013/14 budgeting process even earlier.
• FHT Unit analyzed 2012/13 annual plans and will be issuing a provincial snapshot in the next FHT To Print newsletter.  FHT Unit will follow up with each FHT individually about how they compare with other FHTs in their LHINs.
• FHT Unit is reviewing reporting requirements with the eye to streamlining and reducing the burden of reporting.  May include new quality improvement measurements (see (f) Quality  Improvement Planning in FHTs)
• Process: FHT Unit will aim to have a draft revised annual plan template by end of Nov 2012, for input from a small working group of FHTs gathered by AOHC and AFHTO.  The goal is to have the revised plans to FHTs by mid-Dec 2012, with a submission deadline of Feb 28, 2013.
• A request was noted that the measurements related to HealthCare Connect be reviewed with feedback from FHTs, with an eye to improving program processes and related measurements.

ACTION: AFHTO & AOHC to identify working group for Annual Plan review. f) Quality Improvement Planning in FHTs

• Primary care has been identified as the next sector to which the principles of the government’s Excellent Care for All strategy will apply. Family Health Teams will feature strongly in this.
• Although work is underway, this at a minimum will include a requirement for FHTs to undertake quality improvement processes, including the development and implementation of a Quality Improvement Plan.
• The Quality Improvement Plan for primary care is likely to include the following three Quality attributes: Accessible, Integrated and Patient-Centred. The specific quality indicators are currently under development.
• Planning is underway to ensure supports are in place for an enhanced focus on quality improvement, including templates, guidance documents, governance training and other assistance provided by the ministry and Health Quality Ontario.
• The details of the roll-out are still in the planning phase, but more details will be communicated through AFHTO and AOHC shortly.
• Work is underway by the ministry to streamline the reporting burden on FHTs in anticipation of new expectations for quality improvement. The ministry’s intent is to reduce administrative reporting on a quarterly and annual basis so as to free-up capacity to focus on quality improvement planning and implementation.
• The first year of implementation will be a transition year to support FHTs in embedding quality improvement in their on-going activities, with the intent to progressively advance the program in out-years.

ACTIONS

• Kavita Mehta and Ruth Kitson to send FHT Unit sample patient satisfaction surveys.
• AFHTO & AOHC to identify working group for review of draft QI plans.

g) Data Management Support in  FHTs

• The need for data management/analysis support in FHTs was reiterated, especially given the planning for QI.
• FHT Unit is investigating the possibility of implementing a regional data support model. This may be feasible to implement under the umbrella of NPAR (see (k) NPAR: update on evaluation and roll-out plans for more information).

h) Update on plans to integrate primary care with LHINs

• The MOHLTC continues to assess a number of proposals/models that were submitted on restructuring primary care.
• There are legislative barriers that may prevent moving primary care into the LHINs, and other alternative models are being considered that do not require legislative reform.
• In the meantime, FHTs should continue fostering and building local partnerships to enhance service integration and collaboration.

i) Compensation

• The AOHC/AFHTO/NPAO compensation review being developed by the Hay group is scheduled for release at the end of October.
• The FHT Unit regrets that with continued austerity measures in place, there is no news on addressing funding inequities within FHTs and lack of parity across FHTs for similar positions funded through different funding streams.

j) Adding Physicians to Existing FHTs (Patient Enrollment Models)

• There has been managed registration of new physicians in certain patient enrolment models (including those eligible to affiliate with FHTs) to 25/month while a review of the registration process takes place.
• The current interim process is to register 25/month through a needs-based assessment and consultation with LHINs.
• The ministry will consult with relevant stakeholders before finalizing the process.

k) NPAR: update on evaluation and roll-out plans

• The MOHLTC has committed to removing the $1 per service encounter. In order to do this a consent form will be developed to allow interdisciplinary health providers (IHPs) and FHTs to share service-level information with the ministry.
• FHT Unit is looking at options to roll out NPAR to other IHPs.  This will take time, as support for additional NPAR licenses was also identified as a need if it is rolled out to other IHPs.
• Included in this work will be options to re-profile the $1/encounter allocation to support data management and analysis support.
• It was emphasized that different skill sets are required for data entry and data management/analysis.
• FHT Unit will issue a communication to FHTs on the status and evaluation of the program in the next few weeks.

l) Point of Care Testing

• The group shared how point of care testing (eg INR) can be done more cost-efficiently through FHTs than by other providers in the system, such as hospitals or labs, using existing provider resources in the FHT. While the FHT Unit has already approved the one-time equipment costs, there is an ongoing funding need to cover the cost of additional supplies.
• This is an innovative way of reallocating health system funds to enhance services to clients and client experience.
• The FHT Unit affirmed that FHTs can use General Overhead funds to cover the cost of supplies.  Requests for additional funding for supplies will be considered, but individual FHTs need to first demonstrate or estimate the volume of testing being / that will be performed, and the financial need, before additional funding will be approved.
• The FHT Unit will also consider requests to reallocate unspent operating line items (outside of General Overhead) to cover these costs.

m) FHT Good News Stories: areas of priority to showcase

• AFHTO will be issuing awards to 16 FHTs at their upcoming conference, and will share details with the FHT Unit after the event.
• For FHT to Print, the FHT Unit is particularly interested in stories pertaining to quality, access, integration, peer modelling, and the patient experience.

Meeting participants

• MOHLTC: Phil Graham, Acting Manager of the FHT Unit and Richard Yampolsky, Program Manager, FHT Implementation.
• FHT EDs: Randy Belair (Sunset Country FHT in Kenora), Mark Ferrari (Windsor FHT), Ruth Kitson (Community & Primary Health Care FHT, Lanark, Leeds & Grenville) Kavita Mehta (South East Toronto FHT).
• Association staff: Sophie Bart (Association of Ontario Health Centres) and Angie Heydon (Association of Family Health Teams of Ontario).

Do you have input on operational issues for the next quarterly meeting? Please contact:

• 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:
  • Michelle Karker, ED East Wellington Community FHT
  • E-mail:  michelle.karker@ewfht.ca
• For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
  • Kavita Mehta, ED South East Toronto FHT, Working Group Chair, AFHTO President
  • E-mail:  kavita.mehta@setfht.on.ca
• For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
  • Joyce Phillips, ED Kingston FHT
  • E-mail:  jphillips@kfhn.net
• 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

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:
  • Michelle Karker, ED East Wellington Community FHT
  • E-mail:  michelle.karker@ewfht.ca
• For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
  • Kavita Mehta, ED South East Toronto FHT, Working Group Chair, AFHTO President
  • E-mail:  kavita.mehta@setfht.on.ca
• For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
  • Joyce Phillips, ED Kingston FHT
  • E-mail:  jphillips@kfhn.net
• 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

FHTs want to deliver optimal interprofessional care to their patients and communities, and face many day-to-day challenges along the way.  Some of the operational issues we deal with require collaboration with or assistance from the MOHLTC’s FHT Unit. To help FHTs become much more effective in raising and resolving these operational issues, AFHTO has established an Operational Issues Working Group, supported by a continuous process to engage FHTs in identifying issues and potential solutions. The FHT Unit has agreed to meet quarterly with this Working Group. The first meeting was held today to review plans for the 2012/13 budget process. Four main topics were discussed:

• 2012-13 budget process:
  • AFHTO Working Group expressed appreciation for the Unit’s on-going work to improve budget processes and tighten up response time.
  • For next round, AFHTO Working Group has asked for a 2 month window to prepare submissions and get FHT board approvals, as well as the opportunity to receive feedback on previous submissions.
  • FHT Unit will communicate information about the budget process in the next “FHT to Print” newsletter, to be distributed in next week or so.
• Need for greater flexibility in budgets:
  • FHT Unit is seeking internal approvals to introduce greater flexibility among some FHT budget lines.  If approved, FHTs would still be required to report on a line-by-line basis but would be able to shift funding among specific groups of budget lines to meet needs.
• Sector-wide funding pressures:
  • AFHTO Working Group presented two key issues: need for funding to recruit and retain staff and for IT.
  • While acknowledging government’s goal to limit expenditure growth to 1%, AFHTO Working Group pressed the urgent need to address compensation as the Public Sector Compensation Restraint Act comes to a close. AFHTO, in partnership with the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners Association of Ontario (NPAO) is seeking a meeting at the ADM level to review findings and recommendations from our joint research on recruitment and retention in primary care. (Report will be shared with members of all three associations in the new year.)
  • For IT, FHT Unit has agreed to develop some guidelines for a “life-cycle” approach to planning and funding IT, and AFHTO has offered assistance in doing so.
• FHT reporting and evaluation:
  • AFHTO and the FHT Unit share a common interest in revamping reporting so that it conveys more useful information about quality and performance. FHT Unit will arrange consultations with AFHTO, AOHC and Health Quality Ontario. Meanwhile the AFHTO board has set up a Performance and Sustainability Working Group to look into questions such as indicators and data needs.
  • NPAR pilot, involving 40 FHTs, will be evaluated in April/May. Decisions about further implementation will take place after the evaluation is complete.

AFHTO’s Executive Director will continue to maintain on-going contact and follow up on these and other issues between the quarterly meetings. Engaging FHTs in raising and resolving operational issues Each member of the Operational Issues Working Group is the “point person” for a group of AFHTO members:

• For FHT EDs in LHINs 1-4 and 12 (Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant, North Simcoe Muskoka):
  • Michelle Karker, ED East Wellington Community FHT
  • E-mail:  michelle.karker@ewfht.ca

• For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
  • Kavita Mehta, ED South East Toronto FHT, Working Group Chair, AFHTO President
  • E-mail:  kavita.mehta@setfht.on.ca

• For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
  • Joyce Phillips, ED Kingston FHT
  • E-mail:  jphillips@kfhn.net

• 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

We will be developing additional communication tools via social media, SurveyMonkey and the AFHTO members only website to support the goal to raise and resolve operational issues.  We look forward to the progress we can make for all through this collaboration.

In the past few days AFHTO has had meetings with the Ministry’s FHT Unit, the Ontario Hospital Association (OHA), the Ontario Medical Association (OMA) and the Association of Ontario Health Centres (AOHC). In all cases primary care is recognized as key to improving quality of care for patients and sustainability of the health system.  FHTs are recognized for their potential to significantly advance both quality and sustainability. With the FHT Unit we examined how we work together to support FHTs in achieving these ends.  In particular we focussed on how to progress in strengthening FHT governance, recruitment and retention, and capacity to get the full benefit from EMRs and data for quality care. Getting traction requires stepping forward in bite-size chunks:

• To develop governance capacity, the FHT Unit is developing an RFP as the first step in response to AFHTO’s detailed proposal for web-based learning modules on the core set of knowledge and skills required for governance, strategic planning and risk management.
• The framework for FHT governance is likely to be shaped by the Ministry’s “Strengthening Primary Care” initiative. AFHTO has been participating in the working groups, along with a number of other stakeholders.
• With recruitment and retention, the next step is to understand the patterns and drivers underlying vacancy rates.  AFHTO has struck a working group that will look into questions such as time to recruit, turnover, and reasons for leaving. Working in partnership with AOHC and HOOPP, AFHTO has compiled comparative data on compensation packages.
• Supporting use of EMRs and data is a more complex undertaking. AFHTO has exchanged ideas with some thought leaders from within the FHTs and from key organizations such as the Canadian Institute for Health Information (CIHI), the Institute for Clinical Evaluative Sciences (ICES), and Health Quality Ontario (HQO).  This may crystallize into another proposal in 6 – 9 months’ time.

The FHT Unit continues to look to AFHTO to assemble small groups of FHT volunteers to provide feedback on implementation issues such as the revised NP-SERT program (renamed Nurse Practitioner Access Reporting or NPAR)  and the new SRI templates replacing WERS. With the OHA our focus was on what our respective associations could do to foster greater understanding and collaboration among hospitals, primary care and other key components such as CCACs. With the OMA and AFHTO we discussed a number of ideas for working together to strengthen primary care. This exploration will continue in a meeting with NPAO in a few weeks, and other associations over the course of the summer. Ideas are percolating. Some will result in highly stimulating content for the 2011 AFHTO Conference on Oct. 25-26. Other interesting collaborations are likely to emerge. Stay tuned.