Dr. Eric Hoskins, Ontario's Minister of Health and Long-Term Care released Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario describing the need to improve several aspects of our health-care system. Included in the discussion paper are the need to improve access to primary care, reduce structural and coordination issues that create health inequities, and better link population health and public health services.

The paper is structured around proposals that describe the current situation, the need for change and elements to be considered. Details will be informed through discussion and there are several questions noted to seed these conversations. The OCFP understands there will be a two to three-month consultation period and more details are to follow.

Here are the areas of focus for integration in Ontario based on the MOHLTC's paper:

• Local Health Integration Networks (LHINs) will have greater responsibilities and accountabilities for all health service planning and performance, including working with providers on planning at the sub-LHIN level (or smaller geographies). This will include more alignment and integration between primary care and home and community care.
• LHINs will work with family physicians and inter-professional providers on primary care planning and measuring performance. Importantly, health human resource planning and improving access to inter-professional teams for patients who need it most will be part of the planning mandate.
• LHINs will be given direct responsibility for service management and delivery of home and community care. This is being transferred from the Community Care Access Centres (CCACs), and as a result, the CCAC Boards will be dissolved. CCAC employees supporting clients will move to the LHINs and home care coordinators will be focused at the sub-LHIN level. These coordinators may be deployed into community settings such as community health centres (CHCs), family health teams (FHTs) or in hospitals.
• LHINs will also have a more formalized relationship with public health units, with Medical Officers of Health working with LHINs on population health services and planning.

Based on an initial review, this is what the OCFP understands is not changing for family physicians:

• The goal that every patient who wants a family physician should have one.
• The importance of the centrality of the patient/physician relationship is supported, and existing relationships between physicians and patients will not change.
• The focus on improving access to same day and after-hours service in support of continuity and high-quality care delivery remains.
• The Ontario Medical Association's representation rights remain, and the ministry will continue to negotiate physician compensation and primary care contracts through the OMA. The OCFP continues to support the need for the OMA and the government to resume negotiations. It is important to ensure that there are no barriers to support family physicians to engage in local planning.

The OCFP is encouraged that primary care is acknowledged as the foundation of any high performing health-care system and that the importance of clinical leadership is identified. Family physicians are well placed to understand many of the "pain points" within the health system and can identify the local challenges they face caring for patients and families. Family physicians have identified and struggled with many of the gaps discussed in the report including challenges in delivering effective home care, and the "silos" between the primary care sector and the public health sector. The Patient's Medical Home is referenced in the paper. Primary care should be the "medical home" for patients, providing comprehensive, continuous and coordinated care.

The proposal provides more clarity about the future of primary care planning and the role the LHINs will be undertaking to seek greater alignment between primary care, home and community care, and population and public health. Working at a sub-LHIN level should allow for better planning that considers the local context with the input of family physicians and other health-care providers. Better integration of other sectors with primary care has the potential to make the system easier to navigate and work more efficiently for patients and their health-care providers. With family physicians uniquely placed across all health sectors - primary care, long-term care and home care, hospitals, and public health - leadership in family medicine needs to be meaningfully engaged and supported.

The OCFP will be reviewing the proposal further and will work with the Board of Directors to identify questions and concerns that are important for us as comprehensive family physicians in practice, as well as those of us who work in focussed practice. The questions of our learners and those who will be new to practice in the coming years are also of particular importance.

As with any new strategic direction, the OCFP recognizes that the devil is in the details. The need for family physicians to participate and provide input into the details of the planning will be critical to ensuring that the health-care system evolves in a way that continues to build on its strengths in family medicine and primary care. We hope you will provide us with your input, identify the support you need from the OCFP, and share your ideas for local solutions, so that your College can ensure that the voice of family physicians is part of the consultation process with the government. We also encourage you to participate in local system planning opportunities through your LHINs.

Links and Resources

• Patients First: A Proposal to Strengthen Patient-Centred Health Care in Ontario - December 17, 2015
• MOHLTC Health Bulletin - December 17, 2015
• Patient's Medical Home
• OCFP's Evidence Brief: Preparing for a Devolved, Population-Based Approach to Primary Care - October 16, 2015