On Feb. 26, Minister of Health and Long-Term Care Christine Elliott announced upcoming changes to our healthcare system.

How family doctors will fit in to these reforms is not yet clear. What is clear: family doctors must play a meaningful role in the changes ahead, both in system design and care delivery - family doctors are at the heart of the system that the government seeks to improve and ultimately central to success.

As outlined in Bill 74, The People's Health Care Act, 2019, and assuming the legislation passes, "Ontario Health Teams" will coordinate local health service providers (primary care, home care, hospitals, long-term care, etc.) that come together voluntarily with the aim of streamlining access. LHINs and multiple provincial agencies will be integrated into a single agency called "Ontario Health".

Family doctors will need to connect to these Ontario Health Teams, and this will vary depending on the way the physicians in the region practice.

1. What's changing?

Creation of a new agency called "Ontario Health" and geographic/population-based entities with health service providers called "Ontario Health Teams" coordinating care across settings for patients.

Ontario Health will include Cancer Care Ontario, Health Quality Ontario, eHealth and HealthForce Ontario. It will also collapse the LHINs and other agencies.

2 . How will these changes impact family doctors?

How family doctors will fit in to new Ontario Health Teams is currently unclear. The proposed legislation enables government to make primary care physicians accountable to the new agency, a measure that has faced resistance by doctors in the past. The Ministry noted that there are many high performing FHT/FHO relationships that would be well positioned to lead the OHT in their region, and they are hopeful that family physicians will want to be part of the early OHTs (for example, a local hospital taking the lead for the OHT in their region). Yet, few details were revealed about how this would happen.

Ministry briefings indicated the OMA would be engaged in the details affecting physicians. The OCFP looks forward to working with stakeholders including the OMA, Section on General and Family Practice, Association of Family Health Teams of Ontario, Council of Ontario Faculties of Medicine: Family Medicine Chairs, and others to ensure that the unique value of the family doctor role in transformation efforts is recognized.

Many family doctors are already leading change in their regions and these colleagues must be kept engaged. They know the realities and challenges of accessing and coordinating care - this knowledge is critical to getting it right.

3. Tell me more about the Ontario Health Teams

As we understand, in each OHT, health service providers will govern themselves as one coordinated team, directly funded, and offering patients seamless and coordinated care. At maturity, there will be 30+ local OHTs serving about 300,000 patients each.

The example used in a briefing was a school board, yet there is no current mandate for merging governance of the current structures. The focus for now is on collaborative governance, but a move towards integrated governance is not out of the realm of possibilities (i.e., each organization could keep its own board versus organizations merging in to one big board). OHT providers will share clinical and fiscal accountability for each patient journey, tied to outcomes.

The specific structure of these teams is not detailed in the draft legislation. Included in an OHT must be at least three of the following:

• Hospital services
• Primary care services
• Mental health or addictions services
• Home care or community services
• Long-term care home services
• Palliative care services
• Any other prescribed healthcare service or non-health service that supports the provision of healthcare services

Components include:

• Patients will have a single point of contact
• Comprehensive continuum of care
• Communication and information sharing
• Virtual care with digital access
• Single point of clinical and fiscal accountability
• Single budget
• Detailed performance model allowing risk and gain sharing, with performance publicly reported
• Defined patient population (e.g., complex pediatric care)/geography

The government is not prescribing more than this - they will assess proposals from prospective OHTs, will help fund the process of change, and will rigorously evaluate early adopters.

4. What do we know about timelines?

Given the scope and scale of changes, it is expected that there will be a phased approach over the next three years. What is known to date:

The Act:

Bill 74, The People's Health Care Act, 2019 passed First Reading and is expected to be rushed through the House in March, with its first provisions coming into effect July 1, 2019. The Bill undoes many of the changes in the previous government's Patients First Act, which became law in 2016.

The intent of the proposed changes is to create a more coordinated and seamless patient experience, and improve access to services, supported by digital tools.

Ontario Health Teams:

In mid-March 2019, the Ministry anticipates launching an Expression of Interest process along with guidance documents outlining how groups can apply to become early OHT adopters. The OCFP will share what we know about keys to success learned in Ontario and in other countries to help inform the Expression of Interest guidelines through the broader rollout.

Early OHT adopters are expected to be in place by the summer; based on rigorous evaluations, more OHTs will be added over time.

Ontario Health:

The integration of provincial agencies in to Ontario Health is expected to be gradual. The LHINs, for example, may be in existence for up to three years managing home and community care until those health service providers are transferred to Ontario Health Teams (OHTs).

5. How should family physicians get involved?

The guidance document coming out soon should provide some further direction.

Speak to other family physician leaders in your community about some of the activity already underway. Talk to your Primary Care Physician LHIN lead or your sub-region lead. Connect with Academic Family Health Team physician leaders in your community. Email the OCFP ([email protected]) and we can help make a connection.

6. What are the OCFP's views?

We need a better integrated system. We struggle to pull the pieces of our patients' care together. We need equity in access to necessary healthcare providers for all Ontarians. We have been talking about the Patient's Medical Home/Neighbourhood since 2010 whose vision is coordinated, comprehensive, high-quality care with family physician leadership.

So, we agree that the vision of these changes is laudable - the devil will be in the details, and it is critical that physicians are at the planning tables. Family doctors have stepped up across the province over the years, and they are ready to lead with solutions in their communities. Our Evidence Brief from 2016 noted the ingredients for successful transformation and these still hold true; primary care and family physician leadership are foundational to successful reform.

Let us know what you think

We'll advocate for you to have a role in shaping reform, based on your frontline experience and with many of you who took on clinical leadership roles in your communities. Along with the OMA, Section on General and Family Practice and the Association of Family Health Teams of Ontario, we're working to amplify a strong, shared voice for family medicine and primary care.

We'll keep you updated as we learn more in the weeks and months ahead and as the transformation agenda becomes clearer.

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 the OCFP can more fully represent the needs of family doctors and primary care.