Jane Philpott’s strategy to manage Ontario’s current primary care crisis is a welcome development. However, successfully implementing and sustaining such an immense system transformation requires a coordinated strategy for interprofessional education among Ontario’s robust number of universities and colleges.
The province is investing $1.8 billion dollars aimed at easing the crisis that has 2.5 million Ontarians lacking access to a family physician or nurse practitioner by creating interprofessional primary care teams that partner family physicians and/or nurse practitioners with a team of health professionals – social workers, pharmacists, dietitians, occupational therapists, physical therapists, speech-language pathologists and many more.
We are enthusiastic about Philpott’s leadership and the Ontario Primary Care Action Team’s initiative and fully support a team-based approach to repairing primary care and reestablishing it as the cornerstone of our health-care system. Interprofessional, collaborative teams have been shown to enhance patient safety, improve patient outcomes and quality care, particularly for patients with complex health conditions and socioeconomic challenges.
Education, at its best, can facilitate health-care providers’ adaptation to different ways of working together and to system-level change, including the implementation of new collaborative networks, new ways of engaging patients and their families, and collaborative approaches to supporting patients and community health. Collaborative care models are complex, and achieving successful collaborative health teams depends on preparing students with specific knowledge, skills, abilities and attitudes needed to adapt and succeed in these teams.
At a time when Ontario is experiencing a recruitment and retention crisis in the community health sector, education that inspires learners from across the multitude of programs and disciplinary backgrounds for a career in primary care is essential now more than ever. A coordinated effort to reform interprofessional health and social care education – grounded by primary care competencies and evidence-informed models of collaboration – is crucially needed.
However, three key challenges presently exist in implementing Ontario’s Primary Care Action Plan in a practical and pragmatic way.
First, the current approach to health and social care program education in Ontario is not always coordinated across professional programs, with the bulk of education being delivered in professional silos. This reality may persist despite relevant educational programs existing within the same institution, pointing to intra-institution partnerships as a crucial step. Given that not all institutions have all relevant professions, some institutions will require inter-institutional partnerships to bring together the relevant professions.
Second, Ontario’s existing landscape of primary care is inequitable and has hindered successful integration of team-based care initiatives. There are already variations and inequities in the existing models of primary care in terms of services available to patients. Using a school-board neighbourhood approach, Ontario’s plan would organize primary care based on your location, ensuring that if you move to a new city you would have access to the local health home, just as you would have access to the local school. However, not all neighbourhoods are equally resourced; a coordinated strategy to upskill existing providers through professional development must take this into consideration so as not to promote further systemic inequities. A coordinated strategy for interprofessional education and continuing professional development must actively address inequities through inclusive, data-informed design.
A third important challenge that needs immediate clarity is defining what constitutes a team as outlined in Ontario’s Primary Care Action Plan. Historically, Ontario has created primary care teams by focusing on individual providers. Achieving Philpott’s vision requires an alternative approach to defining and designing teams. Primary care needs to be about a neighbourhood of services, allowing clients to select the health-care professionals that best meet their needs, and ensuring they are supported in making informed decisions.
It is important to highlight existing successes and examples of interprofessional education upon which a coordinated strategy can be built. Led by the Centre for Advancing Collaborative Healthcare & Education (CACHE), the interprofessional education curriculum at the University of Toronto is an exemplar program that teaches collaborative competencies in an integrated manner to students across medicine, occupational therapy, physical therapy, speech-language pathology, dentistry, kinesiology, medical radiation sciences, nursing, pharmacy, physician assistant, spiritual care and social work. It does so in partnership with student, family and community partners, and with a larger practice network. Similarly, the Scarborough Academy of Medicine and Integrated Health is an emerging leader in educating nurse practitioners, physical therapists, physicians and physician assistants that aligns with community needs. The Collaborative Change Leadership and ehpic programs are guided by principles of meaningfully training health-care leaders and strive to co-create and sustain system-level changes. A final exemplar program is the Transdisciplinary Understanding and Training on Research—Primary Care that is dedicated to the education of research and quality improvement in interprofessional primary care teams.
Now is the time for a coordinated and collaborative approach to expediting reform to interprofessional health and social care education. We are eager to support Philpott and the Ontario Primary Care Action Team to prioritize a strategy that engages health and social service programs across Ontario’s universities and colleges to design and implement a coordinated education strategy. We strongly recommend that the Ontario Primary Care Action Table include educators and education scientists representing diverse interprofessional and patient perspectives. Additionally, we propose the creation of a dedicated sub-committee of educators to focus on the development, implementation and evaluation of Ontario’s primary care education strategy.
A coordinated, evidence-informed educational plan must accompany the system-wide reform, so that both future and current practitioners can thrive in and lead this change.
