It is often the big question heard at parties, dinner tables, bus stops, in hospital hallways across the province and across all demographics: “Where will I ever find a family doctor? Where can I find a new nurse practitioner? What will I do if my primary care provider moves or retires?”
Real answers and solutions require clear-eyed and bold vision from governments and health leaders. The centrepiece of any vision must first put communities at the centre of decision-making and planning for local community-based primary health care. This is essential for meaningful and transformational change, to making real progress on connecting people to the doctors, nurse practitioners and teams they need.
The appointment and work of Jane Philpott and the Primary Care Action Team are reasons to be encouraged. The recent Ontario government announcement of an increase of $1.4 billion for an overall total new investment of $1.8 billion in primary health care is positioning the system for real transformative change. Both Philpott and the Ontario government have shown that they understand a break from the status quo is required right now – and that people need to be at the centre of their own day-to-day health care and the decisions made about it.
To connect every Ontarian to primary health care over the next several years, we must continue to think differently. The needs and the barriers people face across the province are not equal, so their questions may not demand equal answers in each case. There are varying challenges depending on population, region, barriers faced, resources available. Ontario needs to transform how and where people access their family doctors, nurse practitioners, but also the other professionals who support them.
Community and locally based oversight and governance that is accountable to the people being served can have a substantive impact on increasing access to team-based, locally tailored primary health care – the foundation of the best health systems around the world. We need the best, most innovative team-based, interprofessional care available in Ontario, for everyone who needs it. And the best part is: If we can build something equitable and accessible for all, even people who face barriers, then all people in Ontario and Canada will benefit from innovation, including taxpayers.
Community governance is a way to do this. Take a look at the governance structure and strategic direction of an organization such as TAIBU Community Health Centre in Toronto, or West Elgin Community Health Centre in rural southwestern Ontario. With leadership, advocacy and direction from their boards, with lived and community experience informing their decisions, TAIBU CHC and West Elgin CHC are able to overcome barriers that both their populations face, and build strength and capacity in the community. At TAIBU, Black-led community governance means that Afrocentric principles are at the core of how health care is envisaged and delivered, by the community, for the community. In West Elgin, the CHC leverages strong volunteer participation to ensure that transportation barriers do not stand in the way of low-income seniors reaching specialist appointments that can be hours away by car.
People and communities are best positioned to be in control of their own health and wellbeing programs and services.
Community-governed boards are integral to ensuring that health care experiences meet diverse local needs. When the community itself governs the health care organization, it is about far more than “patient participation.” People and communities are best positioned to be in control of their own health and wellbeing programs and services.
The time has come for us to pivot from the provider-driven and centred health system of the past to a patient driven and centred health system of the future. When people are empowered to determine planning, accountability, improvement initiatives and oversight for the medical services and programs that matter on a day-to-day basis, results improve. And communities start to feel like the health care organization that serves their needs actually belongs to them.
We have the blueprints to do things differently. Across Ontario, health equity-driven organizations are already putting their communities, their needs and their governance direction at the centre of their work. They ensure gaps are surfaced, programs advocated for, budgets met.
The Alliance for Healthier Communities’ own research shows that health-care organizations with community-based boards have higher levels of patient satisfaction, better access for marginalized populations and improved health outcomes overall compared to other models of governance. To meet the unique challenges to accessing primary care across Ontario, we need the adaptability and responsiveness that community governance brings to organizations’ strategic directions.
It’s time to roll up our sleeves and choose to build a primary care system that can truly stand as the foundation for Ontario’s health and social systems. We have the resources, the teams and the vision. It’s time to put primary care back in the hands of Ontario communities.
Family Medicine, but now you become a slave to a community. Great idea…