“Many moving parts”: update from May 19 PHC Branch meeting

Discussion at the May 19 quarterly meeting of AFHTO and MOHLTC Primary Health Care Branch covered:

1. Parameters and next steps for developing new contract templates, given the ministry’s intent to:
   1. Conduct a review of all interprofessional primary care models
   2. Move toward “comprehensive regionally governed, population-based primary health services for Ontarians”
   3. Implement policy directions emerging from sources such as the Expert Panel on Primary Care (Price Report)
2. Next steps regarding performance reporting and the schedules in the contract
3. Commitment to improve Schedule A as a tool for meaningful program planning and reporting
4. Re-purposing funds (e.g. for telemedicine programs)

1.  Developing new contract templates amidst the “many moving parts”

AFHTO has been keeping members informed on what is emerging about the province’s policy direction for primary care. (Click here and here for past reports.) The ministry’s desire to move toward a “comprehensive regionally governed, population-based primary health services for Ontarians” is given – implementation questions include how this will affect the organization of primary care, how it is resourced, and what will be the reporting relationships. The review of interprofessional teams can be expected to inform these decisions; however AFHTO anticipates it will be well over a year before there are any results since the details of this review are under development. We understand this review will look at performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). Meanwhile, the current 5-year FHT contracts expire at the end of this fiscal and to that end work to redevelop the contract templates will proceed. Because of these “many moving parts”, the contracts could potentially need further updates going forward. Members may feel unsettled by this uncertainty – understandably so.  Keep in mind the province is well aware that:

• Quality patient care must continue.
• Ontario needs AFHTO members – the innovators and leaders in improving comprehensive primary care – in order to succeed in whatever direction the ministry may want to take with primary care.
• AFHTO members have a very strong voice – through their collective work in this association – and must be engaged in finding the workable solutions for moving forward.

Next steps:

• AFHTO has pressed the need for the leaders of our member organizations to receive more information about the direction the province is taking. We have been told the Expert Panel report will be shared, possibly in a few weeks’ time.
• As reported in the ED Advisory Council news, a work group of AFHTO members will begin the process of reviewing the contract, guided by the principles identified by FHT and NPLC leaders last fall, to identify issues that need to be addressed and begin strategizing.

2.   Performance reporting and the schedules in the contract

As reported in the most recent ED Advisory Council news, PHC Branch has agreed to recommendations from AFHTO to:

• Retain Schedule A – program planning and reporting. (Improvements are required – see the next section below.)
• Eliminate reporting that is not meaningful, i.e. activity reporting found in Schedule E. (The current contract states Schedule E is required. Contract needs to be changed, but given this direction, AFHTO anticipates compliance is unlikely to be pursued.)
• In place of Schedule E, leverage work of D2D and to select 6-10 meaningful measures to be included in the next contract agreement.  Ministry priorities would also add:
  • One or two chronic disease measures (AFHTO thinks this is doable in the next iteration of D2D)
  • 7-day follow up (Adopted in the D2D 2.0 list as developmental, since AFHTO Indicators Working Group identified a number of current limitations in this measure that need further refinement)
  • Avoidable ED use (AFHTO Indicators Working Group had concluded this is not a good measure as it is right now. This needs further investigation.)

3.   Commitment to improve Schedule A as a tool for meaningful program planning and reporting

All agree that Schedule A has the potential to promote stronger program planning, coordination and evaluation; however many FHT/NPLC EDs have called for improvements to the Schedule A template, instructions and education. Next steps: PHC Branch and AFHTO will put together a joint working group to:

• Improve Schedule A as a useful tool for program planning and reporting.
• Do a joint presentation at the AFHTO conference on how to do effective program planning and evaluation, ministry needs for reporting, and how to use Schedule A effectively.

4.   Re-purposing funds

AFHTO followed up on a question from our previous meeting with PHC Branch regarding funding to replace telemedicine equipment. The response was that, for everyone who had asked, the ministry was able to help the FHT/NPLC identify existing funds to re-purpose to purchase replacement equipment. PHC Branch reps said this was also true for those who asked to re-purpose funds to cover sessional costs for these telemedicine consults. We were told that, for the past fiscal year, there are still some FHTs and NPLCs returning unspent funds to the Province. Next steps:

• As reported from the Nov. 21 AFHTO-PHC Branch meeting, FHTs and NPLCs are encouraged to request reallocation of approved budgets to meet needs.
• When it comes to telemedicine programs, AFHTO has reminded PHC Branch of the need to address the policy question as to how this need can be supported in a sustainable fashion.

Participants in the May 19, 2015 meeting AFHTO was represented by:

• Randy Belair (AFHTO President and ED, Sunset Country FHT, Kenora)
• Sean Blaine (AFHTO Vice President and Lead MD, STAR FHT, Stratford)
• Ross Kirkconnell (Secretary + QIDS Steering Committee Chair and ED, Guelph FHT)
• Kavita Mehta (ED Advisory Council Chair and ED, South East Toronto FHT)
• Angie Heydon (AFHTO Executive Director)

MOHLTC’s PHC Branch representatives were:

• Nadia Surani (Senior Manager, Interprofessional Programs Unit, PHC Branch)
• Fernando Tavares (Program Manager, Interprofessional Programs)
• Debbie Lora (Senior Program Consultant)