Just like the public-school system: Mandated rostering among the ideas heard in health-teams session

Canadians want the primary-care system to move towards team-based care, and many would like to see their provinces introduce rules such as automated rostering of patients based on residence, or to provide both general practitioners and specialists with incentives—like subsidized overhead—to enter team-based care. These were among the findings shared on Aug. 17 at a Canadian Medical Association Health Summit session on team-based. “In order to reduce provider burnout and provide more access to comprehensive care, the Ontario public wants the primary-care system to move away from solo providers towards models for team-based care,” Dr. Tara Kiran, a family doctor and primary-care researcher at the MAP Centre for Urban Health Solutions—which is part of Unity Health Toronto—read from a report drawn from a “priorities panel” of 35 Ontarians, each picked randomly to represent the demographics of the province. The Ontario panel was one of several priorities panels conducted across the country, in addition to a nationwide online survey of more than 9,000 Canadians that asked questions ranging from whether they had a family doctor or nurse practitioner to their use of an app or website to retrieve their medical information. A number of survey questions about team-based practices elicited overwhelming agreement. For example, when asked if health teams should accept any patient who lives near their office, close to 85% said they agreed, either strongly or somewhat. A question about willingness to see any family doctor or nurse practitioner—even if that meant not seeing the same health professional consistently—got a nod from 75% of respondents. In her CMA Health Summit presentation, Dr. Kiran noted that the priorities panels in Ontario and British Columbia were “particularly enamoured” with community health centre models, which are typically interprofessional and governed by the local community. “Actually many of the physicians there are employed and on salary . . . that’s something that new grads in particular are looking for,” she said. Read: New poll shows Canadians think healthcare system is ‘undeniably declining’ Dr. Kiran called out some “really interesting” recommendations from the Nova Scotia panel, including providing incentives for healthcare professionals to join health team. These incentives could come in the form of clinic overhead subsidies or cost-sharing. “And they actually want to incentivize specialists to join primary-care teams so that patients receive all the care in one place,” added Dr. Kiran. One of the boldest recommendations came from Ontario: Change the rules to ensure that every Ontarian has access to a primary-care home, in the same way every child in the province has access to a public-school education. This would mean a move towards automatic rostering—similar to how it’s done in public-school districts—so that health teams are mandated to accept any patient from their catchment area. “And (the panel) went on to describe how . . . if the patient moves neighbourhoods, they still have the option of staying with their old health team,” said Dr. Kiran. “But fundamentally, what they really wanted was to move away from this awful situation that people are in right now, where they’re having to fight to get on a waiting list to see a family doctor—any doctor—to even fight to get into a walk-in clinic.” Breakout groups at the end of the presentations by Dr. Kiran and Teri Price—executive director of Greg’s Wings, a Calgary-based non-profit organization focused on health projects—also yielded a number of recommendations from the physicians in the group. Read: Newfoundland hospitals grapple with patients admitted because they have nowhere to go One group underlined the importance of choosing health-team members who are accountable and respectful of their colleague’s competencies. Clear and open communication is critical, the group said. “That's a very another important quality in order to avoid working in silos,” said the group’s spokesperson. “We have to share, to have good communication. If communication is bad, every member of the team will be working separately and we won’t have gained anything by calling it a team.” Widening the spectrum of care in the team to include professionals such as psychotherapists and social workers was another idea put forward by this group. Having an administrative to support the team would also go a long way towards easing the massive burden of paperwork physicians must face each day. “We know that family doctors spend some 10 hours a week doing paperwork,” noted the group. “So if we had a support there, then those are hours that could be spent providing care, seeing patients.” Another group brought up an important question: Who will be responsible for funding these health teams? “We can't expect it to come via physician remuneration,” said the group’s spokesperson. “We can't expect a physician to be making a decision between getting new windows for their house versus hiring a team—that’s not reasonable. We need to have funding that goes straight towards the teams.” Read: A reflection on progress and challenges for Canadian healthcare

Just like the public-school system: Mandated rostering among the ideas heard in health-teams session

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