While there are many competing voices speaking up on health care across Canada, we can certainly agree on one thing: the status quo isn’t working and needs to change.
When it comes to access to a family doctor, nurse practitioner or primary health-care team, the conversation about solutions is starting to shift – and now we need commitments from all governments to truly make primary health care the foundation of our health systems. How can we get there? What does success look like?
These days, it is abundantly clear to each and every person living in Canada who still doesn’t have a family doctor or nurse practitioner – or those who are facing losing one because of retirement or staffing shortages – that having a quarterback for your health and wellbeing isn’t a luxury, it’s a key element of being well, aging well and avoiding illness, both physical and mental. Of course, what’s even better than a reliable quarterback is having access to a whole team – that means additional family doctors and nurse practitioners to help cover vacations and parental leaves and to plan for clinicians’ retirements without interruptions of care. But it also crucially means coordinated access to the other primary health-care team members like nurses, social workers, dietitians, pharmacists, physiotherapists and health promoters. And we know from data that primary health care is often the closest (and most easily accessed) door to mental health care as well. For patients with access to team-based care, the experience can be life-changing. For providers who work in teams, this can mean spending more time on what they do best – caring for patients, in a model that integrates care around the patient themselves, and their needs.
The recently announced federal-provincial health-care funding agreement for a shared plan to improve health care in Ontario and to address immediate needs. The plan will see nearly $74 billion in shared funding over 10 years in Ontario for health-care priorities; of that, $8.4 billion is targeted to meet the commitments of a new bilateral agreement focused on the four shared health-care priority areas.
First among those priorities is “access to high-quality family health services when people need them, including in rural and remote areas, and for underserved communities.”
For many across Canada, there is a sigh of collective relief that their governments are demonstrating that they understand all people need a trusted family health provider to turn to, whether for basic health needs, to manage chronic conditions or to connect to mental-health care.
Connection to a local community health team can be the difference between life and death.
For people who face the most significant barriers to health and highest risks for chronic disease and illness, connection to a local community health team can be the difference between life and death.
Community health centres, which the Ontario health system helped introduce and has innovated in Canada for more than 50 years, deliver better outcomes for people with the most complex health and social needs, which helps all people living in Canada by avoiding additional pressures on the acute, long-term care and home-care systems.
It’s encouraging that within the recently released Ontario health care plan, $30 million is committed to expanding these types of team-based care. This is a great start. But we need to ensure we do enough to make sure no community is left behind.
With more than $8 billion in new funding to work with, Ontario needs to make a firm and tangible commitment to community- and team-based primary health care as the foundation of a health system that keeps people well and living in their homes and communities. That means supporting and expanding existing teams, and recruiting and building new ones where the needs are highest.
There’s another key element to team-based care, and that is its direct connection to health equity, ensuring that the people who face barriers to health and wellbeing, who are at increased risk of illness and chronic disease don’t fall through the cracks. What we know right now is that when people fall through the cracks, our acute-care systems, our emergency systems and the fabric of our society itself start to break down. We can and must do better. And we know how.
We know that more community-governed team-based care is what’s needed for Indigenous health, for Francophone health, for rural, remote and Northern health, for Black health, for 2SLGBTQ+ health. In Ontario, team-based care models like community health centres, Indigenous primary health-care organizations, Nurse Practitioner-led clinics and others serve patients that are 70 per cent more complex than the average person. Despite this complexity, those models save the acute system $27 million each year. Again and again, evidence shows that team-based care, taken with a culturally safe, holistic and wraparound approach, can make a massive difference – in people’s lives, for providers’ practices and for the health system overall.
The time is now to be bold in Ontario and across Canada to deliver health care better and more equitably. We need to be creative, innovative and follow the best evidence that community-based and community-led team-based primary health care can drive better health outcomes, especially for those facing barriers. We know this is what will keep more people out of the hospital, living in their communities and enjoying healthy lives longer.