A system-wide problem needs a system-wide solution, and pharmacists have one

There’s a lot of hope riding on the current call for proposals to expand interprofessional primary care teams (IPCTs) in Ontario. The government’s commitment to attaching every person in the province to primary care is admirable, and the funding is significant. But the question on many minds is: how exactly will we achieve “net new” attachment in a system that isn’t expanding its pool of providers?The Primary Care Action Plan outlines an investment in 80 new or expanded IPCTs this year, with a goal of attaching 300,000 more Ontarians to a regular primary care provider. Proposals are expected to focus on “net new” patient attachment in postal codes with the highest rates of unattached individuals. But here’s the rub: the timeline for readiness (operational by summer 2025) doesn’t support adding new physicians or nurse practitioners in the short term. So where will these magical new patient slots come from?Family physicians have been clear for years: they’re tapped out. They don’t have room for more patients. Burnout is rampant and administrative burden continues to climb. If they’re full, how can we expect them to sign up for more patients, regardless of how well-funded the team is around them?That brings us to the second principle of the IPCT expansion plan: “Connected.” The idea here is to empower every health professional to work to their full scope to support the team and improve access. And yet, we continue to ignore the fact that pharmacists are stuck working under scopes of practice that are years behind their training and the needs of the communities they serve.Pharmacists in Ontario have training that prepares them for much more than what they are legally allowed to do. We are medication experts with diagnostic training (yes, it’s true) and the ability to manage common ailments, chronic diseases, and even help triage urgent care issues. The Pharmacy First model in the UK has demonstrated what can happen when pharmacists are fully integrated into the primary care system. There, pharmacists manage minor ailments, prescribe when appropriate, and reduce the pressure on both family doctors and emergency departments. And they’re not doing it in silos, they’re part of the connected team.Imagine this scenario in Ontario: a patient with diabetes presents to the pharmacy with their BG monitor, showing progressively increasing BG readings. The patient recently lost their family physician. The pharmacy can preform an (unfunded) A1c check as the last was >6 months ago. Maybe the pharmacist can adjust a dose of a medication if it’s not already maxed out. But that’s where the legal limit ends. Despite the fact that the pharmacist has the training to initiate new medication, review labs and preform comprehensive care, the patient may very well be directed to an emergency department. How on earth is this appropriate for the patient, for the system, for anyone. Imagine if pharmacists had full scope, including ordering labs, prescribing, and following up, then the patient could receive complete care at the pharmacy, no ED needed.This isn’t hypothetical. Pharmacists have proven their ability to deliver excellent care, especially in chronic disease management. We have studies that show pharmacists provided care is on par with, at minimum, traditional primary care providers when managing hypertension and diabetes. Many other studies show strong evidence of pharmacists acting as antibiotic stewards, another critical priority in today’s healthcare environment.So if the government is serious about building a system that is “connected,” we have to move beyond rhetoric and into real, structural change. That means giving pharmacists the scope to do what we’re trained to do and embedding us fully into team-based care models. Let’s stop treating pharmacy as a side quest and start integrating it as a core solution. And again, team-based doesn’t mean co-located. It means all practitioners working as a team on the care of a patient. Ontario’s health care challenges are not isolated to one profession or one region. The problem is system-wide. That means our solutions need to be just as broad. We need to ask ourselves: are we building proposals that put the burden of unattached patients to already overloaded physicians, or are we truly designing something new? Something that includes pharmacists, social workers, dietitians and others at the centre of patient care?Team-based care only works if the entire team is empowered. A hockey team doesn’t win by asking only the winger to score all the goals. We win when every player is on the ice, working to their full capacity. It’s time pharmacists were on the ice… not sitting on the bench waiting for someone to allow us to play the game we’re already experts in.As proposal teams race to submit by the May 2 deadline, let’s build something that will still make sense five years from now. Let’s build something sustainable. Because patients don’t just need to be “attached,” they need to be cared for. And pharmacists are ready, willing but still waiting to be part of that solution.

A system-wide problem needs a system-wide solution, and pharmacists have one

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