Dr. Eric Hoskins, Ontario's Minister of Health and Long-Term Care launched the next phase of Patients First, with a proposal to strengthen health care in the province. The paper, Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario was distributed on Dec. 17, 2015, and described the need to improve access to primary care, reduce structural and integration issues that create health inequities, and better link population health and public health services to improve patient care, particularly of vulnerable populations.

While the timeline for response to the paper was limited, the OCFP was actively engaged in collecting feedback from our membership. We consulted with our Board of Directors and members, attended the Maternal Child Health Summit, a Ministry Consultation with stakeholders, and also had the opportunity to participate in many LHIN primary care physician engagement meetings across Ontario. The OCFP's goal was to coordinate a response through direct feedback from members that accurately reflects the realities and challenges family physicians are facing practicing in communities across Ontario.

Over the past two months, we received excellent input from our members, despite the difficulty in engaging at a time when there is no Physician Services Agreement between the Ontario Medical Association and the Ontario government. Several key themes emerged in the engagement sessions:

The majority of patients in Ontario are seen by family physicians who care deeply about delivering high-quality care for patients and families throughout their lifetime.

Family physicians are uniquely placed across the healthcare system, working in a variety of clinical settings such as primary care practices, hospitals, long-term care facilities and in patients' homes. This gives family doctors a distinct perspective of the opportunities and challenges for better integration across settings of care. This system view should be tapped more effectively by the Ministry and LHINs to help build effective, evidence-based solutions.

Family physicians provide leadership in their clinical practice settings, with interprofessional colleagues through teams and primary care networks, and by teaching and mentoring their peers. Family doctors want to be part of the actual planning and implementation and not just consulted on an ad hoc basis.

Members also reinforced the importance of streamlining the transition of patients between hospital and primary care by:

Better linking specialists with family physicians.

Building stronger relationships across family practice models and walk-in clinics so that continuity can be preserved and strengthened.

Providing family physicians outside of FHTs and CHCs with access to social workers, nursing care coordinators and psychologists as well as other health professionals.

The mal-distribution of resources is leading to inequities of access to care for patients and needs to be addressed under the LHIN planning.

Much of the feedback received from family physician members in LHIN meetings focused on the lack of detail around planning, implementation and accountability, the purpose of the sub-LHINs, and the role of the LHIN in performance management, monitoring and governance. Additionally, the issues of access (to whom and for what) and the need for public education and patient accountability were frequently mentioned as requiring more transparent discussion and planning.

In addition to the lack of detail in the Discussion Paper, the OCFP highlighted major gaps that require more attention before further steps should be taken by the MOHLTC or the LHINs. In the OCFP's response, we described these gaps as the following:

More detail is required regarding how to address gaps in mental health and addictions services, particularly for adolescents and young adults.

Priorities around maternal and child health and the role of the family physicians in obstetrics - notably in rural and remote communities - need to be addressed.

Further detail is required about how to address the growing health crisis and immediate needs for First Nations, Inuit and Metis Populations. This includes addressing the impact of social determinants of health on Indigenous population health outcomes.

The fundamental role of care coordination in primary care to ensure comprehensiveness and continuity of care must be recognized.

More usable data, interoperability of information systems to support care pathways, and relevant metrics to measure performance are needed.

Health Human Resources planning needs to be based on available resources in communities and informed by family physician practices, not just a "headcount" approach.

A more detailed description of what is meant by clinical leadership and how family physicians will be supported to engage in system change is needed.

The OCFP provided comments on the four key proposals outlined by the MOHLTC. Member input was collated over the last two months and is reflected in the OCFP's response to the MOHLTC.

As with any new strategic direction, the OCFP recognizes that the devil will be in the details. The OCFP is committed to staying actively engaged around policy tables and with the MOHLTC to ensure the family physician voice is being heard and to support family physicians in the community during this period of health system change. We also hope you will continue to participate in LHIN meetings to bring forth innovative solutions. We thank you for the rich and constructive feedback we have been able to gather from you during this challenging time. We strongly encourage you to read the OCFP's full response to Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario and encourage you to provide feedback to us on the response directly. The OCFP will continue to keep you informed as new details emerge on the Patients First agenda.

Links and Resources

• OCFP Response to Patients First - Feb. 29, 2016
• Pulse on Family Medicine: A Proposal for the Future of Health Care in Ontario and a Role for Clinical Leadership - Dec. 17, 2015
• Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario - Dec. 17, 2015
• OCFP's Evidence Brief: Preparing for a Devolved, Population-Based Approach to Primary Care - Oct. 16, 2015