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Primary Care Leaders Urge Canada’s Premiers and Federal Government to Strike a Deal That Focuses on Expanding Team-Based Primary Care Including Access to a Primary Care Provider
TORONTO, Feb. 6, 2023 /CNW/ – The Primary Care Collaborative (PCC) is encouraging Premiers across the country, and the federal government, to strike a new Canada Health Transfer agreement that will focus on expanding team-based care and ensure that every Canadian has access to a family doctor or nurse practitioner within an interprofessional team.

At this critical time, political leaders across the country can make a real impact on Canada’s ongoing healthcare crisis. Research shows that high-performing healthcare systems are based on a strong foundation of comprehensive primary care. But millions of Canadians from coast to coast, including the Indigenous peoples and communities of Canada, are currently unable to access the care they deserve.

That is why the Premiers and Federal Government need to ensure that team-based models of care are at the centre of a renewed Canada Health Transfer Agreement. Doing so will ensure that we are building a cost-effective healthcare system where people can access better, more integrated, more accessible and continuous care.

In team-based models of care, patients can access primary care from a family physician or nurse practitioner, but the benefit to the patient and the system comes from the larger team, which also includes interprofessional healthcare providers, including nurses, social workers, dietitians, pharmacists and many others. These healthcare providers work as a team to meet patients’ health and social needs, including their mental health needs.

A special focus should be placed on Canada’s Indigenous communities, many of which do not have access to Indigenous Primary Health Care. Access to culturally appropriate and safe care is critical to ensure that Indigenous Peoples and communities are supported and able to thrive.

With primary care at the foundation, the Primary Care Collaborative’s 2023 Ontario Budget submission lays out what is needed to help build a healthcare system where people can access better care. With increased funding from the Canada Health Transfer Agreement, we are recommending that the Ontario government:
- Makes team-based primary care available to more Ontarians through an investment of an additional $75 million per year for 10 years;
- Addresses the health human resource (HHR) crisis in primary care through the creation of a primary care HHR table; and
- Invests in primary care for Indigenous Peoples.
About the Primary Care Collaborative (PCC):
We are a coalition of primary care organizations collectively representing 14,000 family doctors, 1,000+ primary care nurse practitioners, 286 primary care teams, 28 Indigenous primary care teams, including northern, rural, and remote teams. This alliance of comprehensive primary care organizations joined together for a common purpose to build on the collaborative work during the COVID-19 pandemic as we move towards recovery in a time of health system transformation. The PCC provides a collective and cohesive voice with the purpose of advancing equitable person-centred primary care in Ontario and is focused on influencing policy by creating a unified voice towards resolving barriers or challenges that prevent comprehensive primary care from being the foundation of the health system. Learn more about the PCC here.

Click here for the full article

SOURCE Primary Care Collaborative

For further information: Kavita Mehta, Chief Executive Officer, kavita.mehta@afhto.ca

French Translation below

Les responsables des soins primaires exhortent les premiers ministres des provinces et des territoires et le gouvernement fédéral à conclure une entente portant sur l’expansion des soins primaires dispensés en équipe, y compris l’accès à un fournisseur de soins primaires

TORONTO, 6 février 2023 /CNW/ – Le Groupe collaboratif de soins primaires (Primary Care Collaborative – PCC) invite les premiers ministres des provinces et des territoires et le gouvernement fédéral à conclure une nouvelle entente de Transfert canadien en matière de santé portant sur l’expansion des soins dispensés en équipe afin que chaque Canadienne et Canadien ait accès à un médecin, une infirmière praticienne ou un infirmier praticien au sein d’une équipe interprofessionnelle.
En cette période critique, les dirigeants politiques canadiens peuvent avoir une incidence réelle sur la crise des soins de santé qui perdure au pays. Les études montrent que les systèmes de soins de santé très performants sont fondés sur des soins de santé primaires complets. Cependant, des millions de Canadiennes et Canadiens d’un bout à l’autre du pays, y compris les peuples et les communautés autochtones, sont incapables d’avoir accès aux soins auxquels ils ont droit.
C’est pourquoi les premiers ministres des provinces et des territoires et le gouvernement fédéral doivent s’assurer que les modèles de soins dispensés en équipe sont au cœur d’une nouvelle entente de Transfert canadien en matière de santé. Ainsi, il sera possible d’établir un système de soins de santé ayant un bon rapport coût-efficacité au sein duquel les personnes peuvent recevoir des soins continus meilleurs, plus intégrés et plus accessibles.
Dans les modèles de soins dispensés en équipe, les patients peuvent recevoir des soins primaires d’un médecin de famille, d’une infirmière praticienne ou d’un infirmier praticien; cependant, les avantages pour le patient et le système proviennent de l’équipe élargie, qui comprend des fournisseurs de soins de santé interprofessionnels, notamment du personnel infirmier, des travailleurs sociaux, des diététistes et des pharmaciens. Ces fournisseurs de soins de santé travaillent en équipe pour satisfaire aux besoins des patients en matière de soins de santé et de services sociaux, y compris leurs besoins en matière de santé mentale.
Une attention particulière devrait être accordée aux communautés autochtones du Canada, dont plusieurs n’ont pas accès à des soins de santé primaires à l’intention des Autochtones. L’accès à des soins respectueux des valeurs culturelles est essentiel afin d’aider les peuples et les communautés autochtones et de leur permettre de s’épanouir.
Reposant sur les soins primaires, le mémoire du Groupe collaboratif de soins primaires pour le budget de l’Ontario de 2023 précise ce qui est nécessaire pour créer un système de soins de santé au sein duquel les personnes ont accès à de meilleurs soins. Grâce au financement accru provenant de l’entente de Transfert canadien en matière de santé, nous recommandons au gouvernement de l’Ontario les mesures suivantes :
•   Améliorer l’accès aux soins de santé primaires dispensés en équipe pour les Ontariennes et Ontariens grâce à un investissement additionnel de 75 millions $ par année pendant 10 ans;
•   S’attaquer à la crise des ressources humaines du secteur de la santé quant aux soins primaires par la création d’une table sur les ressources humaines en santé à ce sujet;
•   Investir dans les soins primaires pour les peuples autochtones.
À propos du Groupe collaboratif de soins primaires :
Nous sommes une coalition d’organisations offrant des soins de santé primaires, qui ensemble, représentent 14 000 médecins de famille, plus de 1 000 infirmières praticiennes/infirmiers praticiens, 286 équipes prodiguant des soins primaires, 28 équipes de soins de santé primaires autochtones, y compris des équipes en milieu nordique, rural et éloigné. Cette alliance d’organisations offrant des soins de santé primaires complets s’est formée dans le but commun de tirer parti du travail collaboratif accompli au cours de la pandémie de la COVID-19 alors que nous nous dirigeons vers le rétablissement en période de transformation du système de santé. Le Groupe collaboratif de soins primaires forme une voix commune et cohérente ayant pour but d’améliorer les soins de santé primaires équitables axés sur la personne en Ontario, et il tente d’influencer les politiques en faisant front commun afin d’éliminer les obstacles et les difficultés qui empêchent les soins de santé primaires d’être le fondement du système de santé. Pour en lire davantage sur le Groupe collaboratif de soins primaires, cliquez ici.
SOURCE : Groupe collaboratif de soins primaires

Pour de plus amples renseignements : Kavita Mehta, directrice générale, kavita.mehta@afhto.ca
February 6, 2023
AFHTO’s 2023 Pre-Budget Submission

On February 6, 2023 AFHTO submitted our recommendations to the government for their 2023 budget. Recommendations 1 and 2 of our 2023 pre-budget submission was done in collaboration with partners in the Primary Care Collaborative and recommendation 3 and 4 are two other recommendations AFHTO is advocating for.
With primary care at the foundation, our submission lays out what is needed to help build a province where people can access better care, more integrated care, and more accessible and continuous care.

Our recommendations are broken into four sections:

1. Make team-based primary care available to more Ontarians through an investment of an additional $75 million per year for 10 years.

Every Ontarian deserves access to comprehensive and equitable care where and when they need it. It’s time for Ontario to commit to ensuring access to a comprehensive interprofessional primary care team for every person who needs it. This would be achievable with a commitment to invest $75 million per year for the next 10 years in team-based care.

2. Address the health human resource (HHR) crisis in primary care through the creation of a primary care HHR table.

In addition, we need to attract healthcare providers to care for our aging and increasingly complex patients. The retention and attraction of healthcare workers in primary care is a challenge we cannot face alone. We are proposing to create a primary care HHR table for future HHR and capacity planning that includes all PCC partners, the Ministry of Health and Ontario Health.

3. Provide mental health and addictions services and home and community care in coordination with primary care.

We need a health system that is truly integrated. Care coordination and system navigation is a key function of primary care and should be foundational in realizing the vision of OHTs. To be most effective, critical mental health and addictions and home and community care supports must be embedded in primary care—the most effective setting to facilitate seamless transitions in care and offer patients a single point of contact in their health care journey.

4. Provide resources to support the implementation of primary care networks (PCNs) and recognize PCNs as the organizing model for primary care.

PCNs will enable horizontal integration, enhancing the capacity of primary care physicians and nurse practitioners to support each other and their patients while facilitating local care planning with their respective OHTs. PCNs will benefit all primary care physicians and nurse practitioners practising under all funding models by streamlining supports and available resources.

Our 2023 Pre-Budget submission can be read here.

The PCC Pre-Budget submission can be read here.

February 6, 2023
Strengthening mental healthcare delivery in primary care
The OMA and the Primary Care Collaborative have released a joint policy paper with recommendations to strengthen mental healthcare delivery in primary care.

The rate of new mental health and addiction diagnoses is increasing, exacerbated by the ongoing impacts of the pandemic. Approximately three-quarters of Canadians rely on their primary care provider to address their mental health needs, but there are longstanding system gaps that must be addressed to enhance the ability of primary care doctors to deliver mental health care.

In a paper, titled Strengthening the delivery of Mental Health and Addiction Services in Primary Care, the Ontario Medical Association and the Primary Care Collaborative have identified the following policy actions that are necessary to ensure greater support for primary care providers and improve care in this crucial area:
- Enhance primary care’s capacity to offer treatment locally by funding and establishing interprofessional care teams with expertise in treating moderate to severe depression and anxiety
- Improve the ability of primary care providers to connect their patients who have moderate to severe depression and anxiety to local services by leveraging and expanding the navigation service, Health Connect Ontario
- Expand access to harm reduction services, such as supervised consumption and treatment sites
- Implement an Indigenous-led mental health and wellness strategy
The paper was released on October 3, 2022.

The full news release can be read here.

About The Primary Care Collaborative
The Primary Care Collaborative is an alliance of primary care organizations that joined together to collaborate on strengthening primary care as we move toward recovering from the pandemic. It is made up of the Association of Family Health Teams of Ontario, the Indigenous Primary Health Care Council, the Alliance for Healthier Communities, the Nurse Practitioner-Led Clinic Association, the Ontario College of Family Physicians, and the OMA’s Section on General and Family Practice.
October 6, 2022
Letter to Minister Elliott – Scheduled lifting of public health measures
April 21, 2022

Hon. Christine Elliott
Minister of Health
777 Bay St., College Park, 5th Floor
Toronto, ON M7A 2J3

Dear Minister Elliott,

As associations representing interprofessional primary healthcare teams, we are concerned about the projected impact of what both Chief Public Health Officer of Canada, Dr. Theresa Tam, and our Chief Medical Officer of Health, Dr. Kieran Moore, have confirmed is the sixth wave of COVID-19.

With hospitalizations related to COVID-19 surpassing the 1,600 threshold for the first time since mid-February, we are seeing more individuals in ICUs being treated for COVID-19. While vaccinations and some immunity from prior infection are helpful, being “fully vaccinated” (only 2 doses) or having had the virus does not stop a person’s ability to carry and transmit it to others or to become reinfected.

We ask that you do not end any of the public health measures that are scheduled to be lifted on April 27, especially mandatory masking in all healthcare settings – including primary care clinics – and public transit.

Please also consider reinstating masks in indoor public settings as we know masks reduce spread. At minimum, require their use in essential settings that vulnerable people must go to, such as grocery stores and pharmacies.

We need to support healthcare providers and prioritize prevention measures. Decisions based solely on hospital capacity do not keep in mind how precarious our health human resources are – particularly in primary care, where people get care that can prevent them from being hospitalized. In addition, delayed surgeries due to healthcare providers being sick or inundated with COVID-19 cases will continue to hurt Ontarians. We have never seen as many healthcare workers off with COVID-19 as in this wave. This is putting health system capacity and the wellbeing of many Ontarians at great risk. It is critical not to lift any more prevention measures and to protect the scant HR capacity that we currently have.

Thank you for considering our input. We wish you all the best in your future endeavors.

Sincerely,

Kavita Mehta, Association of Family Health Teams of Ontario

Sarah Hobbs, Alliance for Healthier Communities

Caroline Lidstone-Jones, Indigenous Primary Health Care Council
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April 22, 2022
AFHTO’s 2022 Pre-Budget Submission

On February 10, AFHTO submitted our recommendations to the government for their 2022 budget. Our 2022 pre-budget submission was done in collaboration with our five partners in the Primary Care Collaborative.

With primary care at the foundation, our submission lays out what is needed to help build a province where people can access better care, more integrated care, and more accessible and continuous care.

Our recommendations are broken into four sections:

1. Address the HHR crisis and system capacity

Recruitment and retention of healthcare workers is a challenge that the pandemic is exacerbating. Issues like burnout, illness, and lack of acknowledgement and support, such as the enforcement of Bill 124, are impacting the HHR needed to get through and recover from the pandemic; to care for its long-term impact; and to continue to deliver preventative care and care for acute and chronic conditions. We provided four recommendations.

2. Integrate health care across Ontario

The pandemic shone a spotlight on the fragility of Ontario’s healthcare system. Ensuring integrated and continuity of care will be key; however, integration cannot occur unless there is capacity in the systems that need to integrate. We provided five recommendations.

3. Prioritize digital and data equity

The pandemic has exacerbated social isolation, highlighted barriers to accessing healthcare, and emphasized that digital equity is a driver of health equity. Primary care requires funding to support our leading work on digital and data equity – providing safe and trusted health and social services to people who face barriers getting online through broadband and digital devices. We provided four recommendations.

4. Create a culturally safe healthcare system that addresses health inequities

Many people have faced and continue to face discrimination and disadvantage, which leads to inequitable health outcomes. Primary care serves populations who face the most barriers: Indigenous Peoples, Francophones, Black populations, people with disabilities and mental health challenges, other racialized groups, recent immigrants and refugees, people who are 2SLGBTQ+, and people living in northern, rural, and remote areas. We provided nine recommendations.

Our 2022 pre-budget submission can be read here.

February 11, 2022
Letter to Minister Elliott on Public Health Measures – January 27, 2022
January 27, 2022

Hon. Christine Elliott Minister of Health
College Park, 777 Bay St., 5th floor Toronto, ON M7A 2J3

Dear Minister Elliott,

We commend the government for expediting vaccinations last month and for beginning the fourth dose for the most vulnerable people. Returning to a modified step two of the “Roadmap to Reopen”, while challenging for many people, was also a good step in managing the spread of the virus.

We are concerned with the recent announcement to ease these public health measures. In-person school has just returned for children, surgeries have not resumed in hospitals, and ICU numbers and COVID-related deaths continue to rise. Healthcare workers remain inundated with COVID-related cases – those who are even well enough to work. They cannot afford to see demand continue to rise.

It is too early to relax public health measures. We ask the government extend step two until we have seen at least two weeks of steady decline in COVID-related ICU admissions.

In addition, we want to reiterate the importance of additional measures to protect people in Ontario from this highly infectious variant. We ask the following:

1. Repeal Bill 124 to address the shortage of critical healthcare workers and show that they are valued and respected
- Ontario needs to deliver a comprehensive health human resources strategy to address the strained healthcare workforce and address the severe gaps in health care workers.
- Healthcare workers have worked tirelessly, often putting themselves and their loved ones at risk. They are tired, frustrated, and leaving in numbers that are irreplaceable.
- This Bill is impacting the health human resources needed to get through this pandemic, to care for its long-term physical and mental health impact on people in Ontario, and to continue to deliver needed care for acute and chronic conditions.
- Healthcare workers are critical for our wellbeing and our recovery, and they must be recognized for this. Putting strict limits on their compensation does the opposite.
2. Amend Directive #6 to make COVID-19 vaccinations mandatory across all healthcare workers
- By not having a vaccine mandate, the risk to employees’ and patients’ health from COVID-19 outbreaks and the risks to staffing shortages if staff become sick are significant and unpredictable.
- The risks posed by a vaccine mandate, while a one-time challenge, are more predictable and less likely to impact patient care.
3. Increase sick days to 10 days
- We must ensure that all people in Ontario are protected and that we do not create additional hardships on those who cannot afford to be sick.
4. Access to testing and appropriate PPE
- Access to PCR, rapid antigen tests, and appropriate PPE, including KN95 or N95 masks, must be made easily available for all residents of Ontario, and the importance of using them clearly communicated. As examples, they should be provided free of charge at pharmacies, primary care clinics, schools, and high-traffic areas, like transit stations.
- While children are lower risk in terms of severity, they are high risk to older and vulnerable people with whom they have contact, including their loved ones. Regular tests for them should be prioritized.
5. Access to oral antiviral medication
- Ensure this is distributed to all primary care offices, once ready, so that there is immediate access for treatments. Please ensure a distribution plan is underway now.
- It is important to ensure that the distribution plan includes equity strategies so that we do not create further health disparities.
6. Redefine “fully vaccinated”
- Advocate to Heath Canada to change the definition of “fully vaccinated” so it encompasses the three-dose vaccine regimen, proven to be more effective than two doses.
- The current terminology gives a false sense of security and lowers incentive to get a booster. It is also misleading when looking at the number of “fully vaccinated” people in hospitals, which can incite worry on the effectiveness of vaccines.
- Update the vaccine passport to require three doses for access to the relevant services.
These measures can help avoid future waves and lessen the pandemic’s impact on all sectors. If COVID-19 cases, hospitalizations, and deaths continue to rise with no appropriate public health measures in place, if preventative care is not prioritized, if diagnoses get delayed, and if hospitals are unable to provide needed care for non-COVID related illnesses, many people in Ontario will pay the price.

When the sector is overwhelmed with addressing COVID-19 and where there are still mitigation measures the government can use to help, we call on you to act on them.

Sincerely,

Sarah Hobbs, CEO Kavita Mehta, CEO
Alliance for Healthier Communities Association of Family Health Teams of Ontario

Caroline Lidstone-Jones, CEO Katie Hogue, President
Indigenous Primary Health Care Council Nurse Practitioner-led Clinic Association

cc.
Dr. Catherine Zahn, Deputy Minister, Ministry of Health
Dr. Kieran Moore, Chief Medical Officer of Health, Ministry of Health
Patrick Dicerni, Assistant Deputy Minister, Ontario Health Insurance Plan (OHIP), Pharmaceuticals and Devices Division
Nadia Surani, Director, Primary Health Care Branch, Ministy of Health

See Full PDF Here
January 27, 2022
Inequities in Ontario’s online health card renewal system must be addressed so marginalized people are not left behind

MEDIA STATEMENT
December 7, 2021

The Alliance for Healthier Communities (Alliance), the Association of Family Health Teams of Ontario (AFHTO), the Indigenous Primary Health Care Council (IPHCC), and the Nurse Practitioner-led Clinic Association (NPLCA) call on the government to address the inequities in the online health card renewal system.

“The ability to renew the Ontario health card online is only available to people who hold a driver’s licence. This needs to change to include those with an Ontario photo card,” says Kavita Mehta, CEO of AFHTO. “There are a number of people who do not or cannot drive, including those with medical conditions. Like those with a licence, they need the same ability to renew online.”

The Ontario driver’s licence and the Ontario photo card are government-issued cards that show proof of identity and proof of residency, and they are both accepted for in-person renewal. The government does not accept the Ontario photo card for online renewal.

“This is concerning at any time, and it is particularly concerning during a pandemic,” says Sarah Hobbs, CEO of the Alliance. “One group that could be disproportionately affected by this practice are people with disabilities. People made more vulnerable by the pandemic, and at higher risk, are also faced with inequitable access to this system. These populations should not be treated differently or be limited to only being able to access in-person ServiceOntario renewals. We call on the government to step up and make the online OHIP renewal system equitable and accessible for all people living in Ontario.”

Katie Hogue, nurse practitioner and chair of the NPLCA, echoes this concern. “There are many medical circumstances that can prevent people from driving, such as mobility challenges, vision impairment, dementia, and epilepsy. There are also conditions like rheumatoid arthritis, which can keep a person from driving while also making them immunocompromised. The system is not considering these people or their needs.”

The CEO of the IPHCC, Caroline Lidstone-Jones notes this concern across the healthcare system. “The pandemic has highlighted inequities in our healthcare system. We must prioritize those who are vulnerable and at-risk. This discrimination is one example of an inequitable system but this one has a quick solution: allow people with a photo card to renew their health card online, the same way those with a driver’s licence can.”

The associations represent family health teams, community health centres, nurse practitioner-led clinics, Indigenous primary healthcare teams, and other interprofessional models of primary care in Ontario.

For further information: Beth MacKinnon; 647-234-8605 x1201; beth.mackinnon@afhto.ca

December 7, 2021
Truth and Reconciliation Day Statement from the Primary Care Collaborative

On the inaugural National Truth and Reconciliation Day being recognized today across Canada, the Primary Care Collaborative values the opportunity and responsibility to acknowledge some of the actions that can help support better understanding of colonization, the trauma of residential schools for Indigenous people and communities, and the ongoing impacts of systemic racism, and the steps to create safer spaces and change for Indigenous health and wellbeing.

For our collaborative group of primary health care associations, ensuring our staff have the tools they need to support improving Indigenous healthcare experiences and outcomes, is an essential step towards truth and reconciliation. Through the Indigenous Cultural Safety (ICS) Program, offered by the Indigenous Primary Health Care Council, our associations are committed to taking concrete steps towards the respect and understanding at the core of de-colonization work. The ICS Program will help us to better understand our roles as individuals in supporting primary care providers to decolonize health care, and also in organizational change both within our associations and among the partners we work with.

Through a series of moderated and facilitated sessions, the program facilitates a deeper level of understanding of how colonialism is embedded in health systems and services, and how to motivate change at the organizational levels. The ICS Program also explicitly connects the impacts of racism and discrimination on the health and wellbeing of Indigenous people and communities, with real-world examples of how these impacts play out in people’s lives. Importantly, this program also includes follow-up steps for organizations and providers and offers tools to deepen the learning of the initial program. Ultimately, the ICS Program supports a practical understanding of the truth of colonization for Indigenous people’s experiences, and then some paths for how to support reconciliation.

The Primary Care Collaborative believes that collective commitments to actions such as mandating Indigenous cultural safety training for public service organizations is what will ultimately change the culture and the mindset of individuals and organizations. Increasing awareness of both historical context and connections to the current environments and conditions that Indigenous people face in health care is an essential foundational step to moving forward together, and to ensuring that Indigenous people’s voices, concerns and trauma are heard and heeded within organizations, policy-making circles and governments alike.

The Primary Care Collaborative, therefore, remains committed to our own journey of Truth and Reconciliation this year, and on this inaugural day, by committing all of the staff at our associations to undertake ICS Program training, and to engage with other programs such as the University of Alberta’s Indigenous Canada program, or resources and modules from Cancer Care Ontario. In doing so, we also challenge and call on the wider public and government sectors across all of Ontario, who have also engaged with the ICS Program, to set out your organizational plans and commitments to ongoing learning and the steps being taken to promote organizational transformation.

Taken as a whole, it is these actions, which will outlast Truth and Reconciliation Day that will enable us to start moving on a path where Indigenous people and communities will be able to lead safer, healthier and happier lives, with lowered risk of violence and trauma from colonization’s impacts.

About the Primary Care Collaborative (PCC):
We are a coalition of primary care organizations collectively representing 14,000 family doctors, 1,000+ primary care nurse practitioners, 286 primary care teams, 28 Indigenous primary care teams, including northern, rural, and remote teams in Ontario. This alliance of comprehensive primary care organizations joined together by common purpose to build on the collaborative work during the COVID-19 pandemic as we move towards recovery in a time of health system transformation. The PCC provides a collective and cohesive voice with the purpose of advancing equitable person-centred primary care in Ontario and is focused on influencing policy by creating a unified voice towards resolving barriers or challenges that prevent comprehensive primary care from being the foundation of the health system.

See the pdf version here.

September 30, 2021
Directive 6 Must Apply To Patient-Facing Team-Based Primary Care Providers During COVID-19

To: Hon. Doug Ford, Premier
Hon. Christine Elliott, Deputy Premier, Minister of Health
Cc: Dr. Kieran Moore, Chief Medical Officer of Health, Ministry of Health
Matthew Anderson, CEO, Ontario Health
Helen Angus, Deputy Minister, Ministry of Health (outgoing)

Re: Directive 6 must apply to patient-facing team-based primary care providers during COVID-19

September 3, 2021

Dear Premier and Deputy Premier,

First, we want to take the opportunity to thank your government for the leadership you’ve shown with the
introduction of the vaccine certificate and Directive #6, which requires the implementation of a mandatory
vaccine policy for employees, staff, contractors, volunteers and students in certain health care settings. As
associations representing team-based primary care providers and other front-facing health professionals in every
community of Ontario, we see Directive #6 as integral to protecting as many people as possible while giving
options to our providers to mandate policies that work best for their organizations’ environments.
Directive #6 is also an approach that allows us to take seriously and respond empathically to concerns about
mistrust in the health system from populations and communities who’ve faced discrimination in the health
system, while still making it clear to Ontario health care workers that getting vaccinated is a top priority in keeping
health care settings safe for everyone. Every serious illness and death we can prevent, every outbreak we can
prevent, every ICU admission we can prevent – will bring us closer to the end of the pandemic.

So we’re writing to you today to ask you to expand Directive #6 to include team-based primary care settings that
include our organizations – community health centres, family health teams and nurse practitioner-led clinics.
Premier, Deputy Premier, as you know, our organizations deliver primary health care and social services to many
of the populations most vulnerable to COVID-19 and its related impacts. Our members’ staff do outreach, both in
shelters, urban areas and to isolated seniors; we provide harm reduction services and supports, often meeting
people where they’re at; and our providers are also on the front lines of testing, community supports and
vaccination rollout efforts. Simply put, providers at our member organizations are face to face with the virus,
working with people most vulnerable to it, on a daily basis.

Our members stand ready to implement Directive #6 and its guidance on how to encourage staff and related
workers to get a COVID-19 vaccine. Many are ready to use their authority as laid out by the Chief Medical Officer
of Health to, like University Health Network, go beyond the minimum requirements of the Directive. Your
leadership can help enable this vital path of actions to get key Ontario health care settings to the highest levels of
vaccination possible, and to protect more vulnerable Ontarians.

We hope to hear back from you as soon as possible about the inclusion patient-facing primary care providers in Directive #6, and we are ready to meet to address any concerns or questions.

Sincerely,
Sarah Hobbs, CEO, Alliance for Healthier Communities
Katie Hogue, President Elect, Nurse Practitioner-led Clinic Association
Kavita Mehta, CEO, Association of Family Health Teams of Ontario (AFHTO)

See Full PDF Here

September 21, 2021
Need for Indigenous Cultural Safety Training and Education for all public servants

To: Hon. Christine Elliott, Deputy Premier, Minister of Health
Hon. Sylvia Jones, Solicitor General

Cc: Hon. Greg Rickford, Minister, Indigenous Affairs
Matthew Anderson, CEO, Ontario Health
Dr. Kieran Moore, Chief Medical Officer of Health, Ministry of Health
Helen Angus, Deputy Minister, Ministry of Health

Re: Need for Indigenous Cultural Safety Training and Education for all public servants

August 3, 2021

Dear Deputy Premier Elliott and Minister Jones,

The leaders representing the Ontario Primary Care Collaborative across the province write to you today urgently about the ongoing crisis facing Indigenous people and communities due to systemic racism and trauma rooted in colonization. Throughout the pandemic, the challenges of COVID-19 have intersected with other public health challenges and emergencies and we’ve seen that racism can create and maintain barriers – to vaccinations, to people getting the services and care they need, and to healing. The impacts of racism, intolerance and lack of understanding contribute to ongoing trauma experienced by Indigenous people and communities.

Deputy Premier and Minister, we all know systemic racism is itself an emergency that impacts health. It’s why we’ve seen governments at all levels talking the talk on addressing anti-Indigenous racism in the last several months, particularly as Canada has started to reckon with the full truth and ongoing trauma of residential schools. Walking the walk of addressing anti-Indigenous racism requires bold leadership and courage, however, and taking practical steps with foundational policy shifts that can truly change the systems, organizational structures, cultures and actions that perpetuate and sustain systemic racism against Indigenous people and communities.

We need to work together to create truly safe spaces (physical and virtual), environments, and the ability for Indigenous people to interact with Ontario’s systems with a reduced risk of racism and violence, and to increase access to health and social care and services across the board. To do it, Ontario needs to mandate and fund Indigenous cultural safety training for all decision-makers and all branches of government whose services and programs interact with and serve Indigenous communities. We need meaningful training opportunities that are created and led by Indigenous people and communities, and which broker the conversations and connections needed to create conditions for healing, safe spaces and active reconciliation. It is also essential – while we support behavioural changes for individuals through Indigenous cultural safety training opportunities – that we also simultaneously work to create change at organizational levels, so the health system not only supports, but encourages and fosters change of practices and policies.

The Indigenous Primary Health Care Council (IPHCC) is in the process of modernizing a made in Ontario Indigenous Cultural Safety approach to health care that will aim for individual behavioural change through Foundational ICS, but which will also work to support organizations within the health system on their journey towards creating culturally safe spaces through implementation of culturally appropriate policies, procedures and practices. The IPHCC Indigenous Cultural Safety approach is focused on supporting Indigenous Health transformation as part of the overall health and social service systems transformation underway in Ontario. We are strongly recommending that you learn more about this program and make this available to your staff.

By now, we are all acquainted with the stories of Joyce Echaquan, Brian Sinclair, and many others, which speak to the worst-case scenario of racism seen in Canada’s health systems. At that higher level, we also see through occurrences with the recent evacuation efforts in Northern Ontario and reported living conditions that the need for Indigenous cultural safety is as great as ever. Ontario has the capacity to improve how all of the province engages with Indigenous leaders, organizations and populations when action and coordination are needed to help people. We can and must do better, and we know you agree we can.

Changing minds, hearts and attitudes long term is what many governments have professed to in the wake of the discovery of mass and unmarked graves across Canada. We believe the Ontario government has an opportunity to lead with concrete actions that will truly change behaviours and make an impact with safer, fairer and more just spaces, services and organizations serving Indigenous peoples. Together, we can make a tangible impact in addressing systemic anti-Indigenous racism and showing others the path forward, but we need your support to do it.

We look forward to hearing from you very soon, and we’re available to meet or answer any questions you might have on next steps.

Sincerely,
Leanne Clarke, CEO, Ontario College of Family Physicians
Katie Hogue, Nurse Practitioner-Led Clinic Association
Sarah Hobbs, CEO, Alliance for Healthier Communities
Caroline Lidstone-Jones, CEO, Indigenous Primary Health Care Council
Kavita Mehta, CEO, Association of Family Health Teams of Ontario
Allie Kinnaird, Executive Director, Ontario Medical Association, Section on General & Family Practice

See the pdf version here.

August 4, 2021