To: Leaders in all AFHTO member organizations In the words of Dr. Sean Blaine, chair of AFHTO’s Physician Leadership Council (PLC), the three key points from the March 29^th PLC meeting of are:

1. Despite the recent breakdown of MOHLTC / OMA negotiations and the imposition of unilateral action by government, we as physician leaders in FHTs know there is more work to be done to guide the continued transformation of the primary care system. As champions of innovation in primary care, we want to help lead these changes.
2. There is a need for demonstrating and assuring value in primary care – AFHTOs D2D project has helped to make this more attainable for the broad range of FHTs in the province.  Choosing Wisely Canada is another initiative that has many merits and deserves our attention.
3. The impending release of the Price Report (Expert Panel on Primary Care) will likely have profound implications for primary care and the possible transition to a more regional/geographic population-based approach to primary care through organized accountable networks. We are ready to lead once these announcements come our way.

This e-mail summarizes PLC’s discussion:

• What’s ahead for Team-Based Primary Care
• PLC’s Priority Objectives
• Demonstrating & Assuring Value
  • Advancing Manageable, Meaningful Measurement: Role of Physician Champions
  • Choosing Wisely Campaign
  • Optimizing Team Capacity
    • Access to Team Based Care
    • Physician Entry Restrictions
    • Harmonization
    • Strengthening Governance & Leadership

What’s Ahead for Team-Based Primary Care

PLC members reviewed recent Ministry announcements and key messages, including an email summarizing Associate Deputy Minister Susan Fitzpatrick’s meeting with the AFHTO board on March 3, and a summary of what’s ahead for primary care in Ontario based on a March 5^th meeting between AFHTO’s representatives and the PHC Branch. The following 3 key messages were highlighted:

“Comprehensive regionally governed, population-based primary health services for Ontarians.”

This statement has appeared on slides used by both the Deputy and the Associate Deputy Ministers – the intent is clear, but not much more is known at this time.  In his March 9 speech, the Deputy emphasized the critical need for a strong foundation of primary care, and went further to speak of a “possible move to Accountable Care Organizations as our primary care system strengthens.”

Review of primary care team models

AFHTO’s March 3 email also reported the ministry will be reviewing the team-based models from the perspectives of performance and accountability, funding, and use of interprofessional teams (recruitment and retention, ratios of team members, opportunity to leverage these resources). The ministry is developing terms of reference for this review, and is considering the range of team-based models to be included. One of the ministry’s drivers is to ensure that Ontarians who could benefit most from team-based care have access to this. The review is still in early development but the PHC Branch confirmed that AFHTO and related associations will be involved to inform the review process.

Process for determining “high needs” areas / replacement of FHO+FHN physicians

The ministry has communicated changes to primary health care physician payments, such that, “effective June 1, 2015 and onwards, monthly registration into these models will be limited to 20 physicians per month in areas of high need.” By end of March, the ministry is aiming to have the criteria and process in place for determining “areas of high need”. LHINs will be playing a key role.

PLC Priority Objectives

In light of the recent Ministry announcements and direction, members agreed on the following 3 priorities for their work:

• Demonstrating & Assuring Value
• Optimizing Team Capacity
• Strengthening Governance & Leadership

Demonstrating & Assuring Value

1. Advancing Manageable, Meaningful Measurement – The Ministry’s recent announcement to review interprofessional primary care models puts new emphasis on providing solid evidence of the value of FHTS/NPLCs and team-based care. The Deputy’s consistent messaging regarding the need to improve performance measurement / management in primary care will also be a strong influencing factor in the development of new MOHLTC-FHT contracts. Physician participation is critical to making the case that the investment in team based care pays off by, among other things, optimizing total health system costs. PLC members spoke about the need to broaden the reach of physician involvement in manageable, meaningful measurement and the need to champion the work of D2D as the vital platform to demonstrate FHT value and drive quality improvement efforts. PLC encourages physician leaders to consider participating in D2D 2.0 and to stay informed – sign up for the bi-weekly D2D ebulletin.
2. Choosing Wisely Canada (CWC) – CWC is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. PLC members endorse the concept of system stewardship / appropriate use of resources and encourage MDs and NPs to learn more about the Choosing Wisely Initiative. There are a number of early adopter health care organizations across Ontario that are beginning to implement CWC recommendations; HQO, OCFP and CFPC are also all actively involved. AFHTO will conduct further outreach to determine the value and applicability of the CWC initiative for our members and depending on what is found, consider measures related to Choosing Wisely recommendations for future iterations of D2D.

Optimizing Team Capacity

Deputy Minister Dr. Bob Bell has publicly stated that all Ontarians who would benefit from team-based care should have access to teams. Associate Deputy Minister Susan Fitzpatrick announced the review of interprofessional primary care models will include review of the use of interprofessional teams and the “opportunity to leverage these resources”. The recent FHT Evaluation report points to opportunities to improve team functioning and capacity. There are many facets to addressing this issue – including:

1. Physician participation in teams – PLC members discussed ways that physician participation in primary care teams could be broadened and the potential issue of allowing physicians from outside of teams to refer to interprofessional health providers inside teams. PLC reps agreed to form a smaller working group to focus on approaches to maximizing resources/capacity to improve access to team based care and to identify potential risks, mitigation strategies and funding implications.
2. Physician entry restrictions – There is understandable concern about the ministry’s new policy regarding managed entry into FHO and FHN models. The policy allows for replacement of positions vacated by an existing member of that FHO or FHN, outside of the “managed entry” process; however this is on a one-to-one basis – it does not allow for two physicians to divide the roster. AFHTO will continue to assist members and advocate for resolution of problems. PLC members also agreed it would be prudent for FHTs to work with their LHIN in identifying potential pockets of underserviced areas in their geographical region if they want to position themselves to meet the criteria of “high need”.
3.  Improving team capacity through greater harmonization of FHT and FHO/FHN – PLC members briefly discussed the need and possible approaches to harmonize working relationships and practices for effective and efficient teamwork. AFHTO will look at developing a better understanding of the approaches FHTs are taking and at establishing a repository of tools, resources and/or frameworks that have been developed to support FHT-FHO/FHN relations and to drive the development of high performing teams.

Strengthening Governance & Leadership

There is a clear need to ensure that team-based primary care is rich with strong leaders and champions to lead the way for the sector as the ministry and stakeholders work to transform the health system. Given the Ministry’s upcoming review of primary care team-based models, the Ministry-FHT contract renewal, and the new requirements for FHTs/NPLCs outlined in the Governance and Compliance Attestation – this is a timely opportunity for FHT leaders to reflect on their own internal governance and leadership practices and for AFHTO to determine from a provincial perspective, opportunities to support ongoing governance and leadership development. PLC will continue to look at ways to support knowledge translation, improve collaborations/communications and strengthen physician leadership at the local level, including the development of FHT physician networks. The next meeting of the Physician Leadership Council will be held in late May / early June. Click here for the list of members. For further information, please contact: