Access to care: 5 principles for action on primary health-care teams

Primary care is in crisis. Recent estimates indicate 6.5 million Canadians, including 2.5 million Ontarians, .

Interprofessional primary care teams include a range of health professionals in addition to a family doctor or nurse practitioner, and are a key solution to improve access to primary care.

As of Dec. 1, 2024 family physician and former federal cabinet minister Jane Philpott is leading Ontario’s new . Philpott states, “Our goal will be for 100 percent of Ontarians to be attached to a family doctor or nurse practitioner working in a publicly funded team, where they receive ongoing, comprehensive care.”

Her book articulates a vision of primary care, or what is being described as a “health home,” which would guarantee every person access to a primary care team close to where they live. The Primary Care Action Team has announced its plans to achieve this goal within five years.

A is the front door to the health system and includes a team of primary care providers that supports an individual’s health and wellness; co-ordinating care across the system and through every stage of their lives. Each health home would ensure you could receive primary care services based on where you live; ensuring that if you move to a new city you would have access to your local health home, just as you would have access to your local school.

A doctor helping a young patient who is accompanied by a guardian.

There are currently no evidence-based guidelines, minimum standard complement or ratio of patients to team members to ensure primary care teams are resourced to meet their local needs. (Adobe)

Principles are needed to achieve these goals. These principles should build on successes and address historical challenges. Our team, comprised of primary care researchers and a community partner, has focused our work on understanding how primary care teams can support access and better outcomes.

Collectively we propose the following five principles for the Primary Care Action Team to consider, which emerged from our at the 2024 on Oct. 25, 2024.

1. Primary care teams with minimum standard team members

All Ontarians should have access to a primary care team with a minimum composition of a family physician and/or nurse practitioner (NP), dietitian, nurse, occupational therapist, pharmacist, physiotherapist and social worker.

There are currently no evidence-based guidelines, minimum standard complement or ratio of patients to team members to ensure primary care teams are resourced to meet their local needs. The health professionals listed above are the most frequently included in , according to findings of a conducted by one of the authors of this story (Catherine Donnelly) and occupational therapy students Maryjune Duggan and Thea Babalis. This review included 187 , the in Ontario, and identified over 60 different types of providers who offered almost 1,500 different programs.

2. Direct patient access to team members

People must have direct access to all primary care team members. Direct access means people can directly book an appointment with any team member. Currently, for the , how people access team members beyond doctors and NPs is highly variable. Our review of Family Health Team websites found that some people can book directly, others require a referral; some can book online, others must call.

Older gentleman stretching alongside a rehabilitation expert.

Direct access means people can directly book an appointment with any team member, such as a physiotherapist, without first making an appointment with a doctor in order to get a referral. (Adobe)

Direct access to the broader team empowers patients, full scope, and increases primary care capacity by reducing physician or NP visits associated with appointments booked to get a referral to another team member.

First-contact physiotherapy roles in the National Health Service in the United Kingdom provide an example of how direct access can improve access to primary care and reduce health system costs. People in the U.K. with a musculoskeletal condition such as back pain or osteoarthritis are able to book directly with a physiotherapist. Recent care and physician-led musculoskeletal care in the U.K. resulted in similar health outcomes, but the physician-led care costs about 2.5 times more.

This is just one example of how direct access to team members can improve the quality, patient-centredness, and efficiency of primary care.

3. Infrastructure to support health neighbourhoods

People and teams must have the infrastructure to communicate across their health neighbourhood. The includes care providers and services within and beyond a person’s primary care team. Currently, teams are ill-equipped to communicate and collaborate across organizations. For example, patients may access , physiotherapists, occupational therapists or mental health counsellors who don’t share an electronic health record (EHR) with the primary care team.

As a starting point, providing people with access to their own EHR would allow them to connect their primary care home with their “health neighbourhood”. Evidence indicates that patient access to their EHR can in one’s health care and .

4. Data collection on care by all team members

Data must be collected on care provided by all primary care team members. After , FHTs for collecting data related to visits, care provided, experiences and outcomes of care provided by non-physician team members. Further, data from visits with non-physician team members isn’t found in health administrative databases because it is not billed to the Ontario Health Insurance Plan (OHIP).

Healthcare professional consulting with a patient.

Data must be collected on care provided by all primary care team members, including non-physician team members who may not bill through the Ontario Health Insurance Plan (OHIP). (Adobe)

Our health system must systematically collect the data necessary to implement accountability structures for the investment in team-based primary care and to facilitate continuous quality improvement. This data must include visits, care provided, experiences and health outcomes for care provided by all primary care team members, not just services billed to OHIP.

— an interprofessional primary care model that has a specific focus on populations that face additional barriers to accessing services such as geographic isolation or cultural or language barriers — through their EHR and have linked this data to other health administrative data to assess the impact of their teams on the health system, demonstrating this is feasible.

5. Shared team leadership structures

Primary care teams must have shared leadership structures. Currently, , compared to 100 per cent of Community Health Centre boards.

Primary care teams are expected to be accountable to the communities they serve. Governance must reflect this. Further, inclusion of patients and families within decision-making is critical to achieving the primary care principle of .

Additionally, primary care leadership structures and decision-making processes will benefit from diverse health professional perspectives and expertise, including representation from the core professions that currently work on teams.

The identifies shared leadership as a core competency for all health professionals. We need governance and leadership structures that involve team members sharing accountability for decision-making. The Primary Care Action Team is an excellent opportunity to demonstrate the value of interprofessional decision-making to move from goal to action.

Achieving the Primary Care Action Team’s mandate will take new ways of thinking and working together to ensure broader access to teams for Ontarians — and these five principles provide clear actions to avoid the status quo. More than ever we need to create strong teams with community leadership, data access for decision-making and accountability to broader communities.

* This story was co-authored by:

Clare Cruickshank, Patient Advisor, , Patient Expertise in Research Collaboration.
, Assistant Professor, Leslie Dan Faculty of Pharmacy, ;
, Associate Professor, School of Rehabilitation Therapy, ,
, Associate Professor, Factor-Inwentash Faculty of Social Work,

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