On Friday, Nov. 13, the Ontario College of Family Physicians welcomed Deputy Minister Dr. Bob Bell, Ministry of Health and Long-Term Care (MOHLTC), to an Ontario Members' Forum. This year's Forum, held during the College of Family Physicians of Canada's Family Medicine Forum in Toronto, was for delegates to hear about:

• Provincial changes impacting family medicine and the vision for primary care, including the status of the Price-Baker Report;
• Funding changes that are affecting family physicians - in particular the New Graduate Entry Program; and
• How family physicians will be engaged in planning efforts.

In the last two years at the Annual Scientific Assembly, the OCFP hosted a forum where government officials provided updates of interest to family physicians. The Members' Forum is a key opportunity to connect with family physicians about what is happening in family medicine and in Ontario's health system.

Hundreds of FMF delegates attended the one-hour session moderated by Dr. Darren Larsen, Family Physician, Women's College Hospital Family Practice Health Centre, ??Clinical Teacher, University of Toronto DFCM. Newly installed Presidents Dr. Sarah Newbery, OCFP, and Dr. Jennifer Hall, CFPC, provided brief introductory remarks. Dr. Bell spoke for 20 minutes and provided the following comments that may address several misconceptions that have arisen in the absence of direct communication.

Messages from the Deputy Minister 

• There is no interest in moving to one payment model for physician services. No new funding models would be suggested for payment of physician services without consultation with the Ontario Medical Association (OMA). Dr. Bell also remarked that despite the tension that currently exists between the government and the OMA, there is a commitment to keep communication open and a recognition that the OMA is the negotiating body for physicians and a key partner.
• The MOHLTC indicated that they clearly heard that there are challenges with the New Graduate Entry Program as introduced and that there is work to be done to ensure that the provision of comprehensive care, including obstetrics, palliative and hospital care, is not negatively affected by fee-for-service limits in the program.
• The importance of clinical leadership and partnerships with organizations such as the OMA, OCFP, Association of Family Health Teams of Ontario, Association of Ontario Health Centres and others, was reinforced on several occasions. The ?Ministry needs clinical leaders to participate -- to locally plan and design the changes that are necessary for all Ontarians relevant to the local context.
• The Ministry is concerned about equity issues in the province and while great progress has been made in attachment of Ontarians to family physicians, there remain significant issues for patients to access their primary care provider when they feel they need to.
• Only 25 per cent of family physicians practise in team models (e.g. FHTs and CHCs) with funded interprofessional health resources. There is also a need to see how 75 per cent of patients and providers in the province can access the same level of resources.
• The key concept from the Price-Baker Report addressing equity and access at a sub-LHIN or geographic level for a population is currently being explored. An emphasis for this will include addressing vulnerable populations or those most in need -- this is what is being called 'risk-adjusted population-based planning'.
• The Price-Baker Report is one key input for ongoing transformation however there is other advice, including Bringing Care Home (Donner Report) and the Drummond Report (Links to all reports below). The idea is to explore better integration across settings and sectors such as primary care, home and community care, mental health and public health.

Following the overview provided by Dr. Bell, a question and answer period was held. Given the size of the audience and limited time for the session, question cards were gathered and bundled into themes. A number of key issues and questions were identified. These included concerns expressed about:

• The New Graduate Entry Program
• Impact of OMA negotiation and fee cuts
• The Ministry's plans for primary care
• Implementation of the Price-Baker Report
• Inequities across practice models
• Residency spots and succession planning
• Patient access, performance indicators and patient accountability
• Rural issues
• EMR funding cuts
• Immigration

The OCFP received over 100 questions for Dr. Bell and while most could not be answered at the ?Forum, Dr. Bell suggested that all questions be sent to the Ministry of Health and Long-Term Care to be answered. The questions are collated and accessible through the link below.

We do not yet entirely understand the future vision for primary care, however the issues being addressed, and concepts being explored are becoming clearer. So too is the need for family physicians to help lead the change. Published literature and the OCFP's recent Evidence Brief on Preparing for Devolved Population-Based Planning (link below) identify the importance of physician leadership and engagement as critical elements in high-performing health-care systems.

As the OCFP meets at various policy and planning tables on behalf of members, we will continue to reiterate the importance of engaging family physicians. We hope that you, as family physicians in Ontario will bring your experience, your wisdom and your understanding of the system and your local context to the planning tables to which you are invited. Despite the real and perceived conflicts, planning and delivery at a local or geographic level will only be successful if those on the frontline of family medicine bring their voice to the table to participate in the future. This is best summarized by the OCFP's new President Dr. Sarah Newbery, who articulated it so well in her installation speech: "All experienced paddlers know, and new paddlers quickly learn, that the fastest way to dump a canoe in difficult waters is to stop paddling. We are at a time, when the waters feel a bit uncertain, a time when it is most important to stay engaged -- to keep our paddles in water." The OCFP is here to support you.

Links and Resources

• Ontario Members' Forum - Questions for Deputy Minister Dr. Bob Bell
• OCFP's Evidence Brief: Preparing for a Devolved, Population-Based Approach to Primary Care
• Price-Baker Report - Patient Care Groups: A new model of population based primary health care for Ontario: A report on behalf of the Primary Health Care Expert Advisory Committee
• Donner Report - Bringing Care Home
• Drummond Report - Commission on the Reform of Ontario's Public Services - Chapter 5: Health