One year ago, the government of Ontario passed landmark legislation that puts primary care – the care most often delivered by family doctors – at the foundation of the health-care system.
The Primary Care Act was shaped by wide public consultation and sets out an ambitious vision: that every person should be able to build a relationship with a family doctor or another primary care clinician for timely, inclusive care that responds to community needs and gives patients easy online access to their personal health information.
The Primary Care Act builds on the promise of the Canada Health Act: that medically necessary care should be provided without charge to everyone.
Every province and territory should follow Ontario’s lead.
The boldness of the Primary Care Act arises from the contrast between what it promises and the current reality. Results from the 2025 OurCare survey of nearly 17,000 Canadians suggest that around 5.8 million adults in Canada are without primary care.
The survey also highlights that those who do have primary care often are unable to access that care in a timely way. Only 37 per cent could get a same or next day appointment when they had an urgent concern and only 45 per cent could get an appointment when their doctor was away. Only 56 per cent could access lab tests and only 31 per cent could see a list of their medications online.
Perhaps most striking is how much access to primary care in Canada depends on where you live.
In Ontario and Manitoba, nearly 90 per cent of residents reported access to a source of primary care compared with just 63 per cent in Prince Edward Island and 64 per cent in the Northwest Territories. And although Ontario compares well, it still has more than 1.5 million adults without primary care.
Those without primary care are forced to turn to emergency departments and walk-in clinics – settings not designed to manage ongoing, complex issues or promote well-being. Some forgo getting any care at all.
Moving from the current reality to a future where everyone has access to primary care won’t be easy. We know there are not enough family doctors to serve everyone, at least not the way family doctors work today. Partly for this reason, Ontario is investing in teams made up of different health professionals. The hope is that when doctors work together with nurses, social workers, pharmacists and others, each doctor can take care of more patients.
Many other countries have shown that it’s possible for everyone to have primary care. In the latest episode of the Primary Focus podcast, I take listeners to Spain, one country where every resident has access to primary care in a system that works like public schools do in Canada.
Every community in Spain has a primary care centre – sign-posted on the highways in the same way a big “H” sign tells drivers in Canada that there’s a hospital nearby. Every resident knows they can get care at the centre anytime from 8 a.m. to 8 p.m. – whether or not they have registered in advance. There is no question about whether the centre will “accept you” as a patient.
Anyone who registers at a clinic in Spain is assigned both a doctor and a nurse. Nurses manage people with more routine and straightforward issues – whether that’s someone with a sore throat or stable diabetes. Doctors handle more complicated situations. Teams also include a social worker, dentist, midwife and physiotherapist. And you don’t have to show up at the clinic to receive care – people who find it difficult to leave their homes, or who live in nursing homes, are also cared for by the same primary care teams.
Crucially, the teams are centred in the community. Teams work with epidemiologists to understand how their local population is changing. They host focus groups – sometimes together with the local municipality – to understand the health priorities of their community and evolve their services to match. The government monitors growth in the population and resources the teams accordingly.
The system is not perfect with some centres strained to provide care for everyone. But at the end of the day, no person is turned away from care.
It’s time for us to dream bigger in Canada. It’s time for every province and territory to pass legislation that commits to primary care for all.
