Unpacking the how of a ‘guarantee of access’ for primary care

Congratulations to Dr. Jane Philpott and her team on the recent major announcement on primary care in Ontario—$1.8 billion in funding, a legislative commitment and a “guarantee of access.” Appointed in late 2024, Dr. Philpott moved quickly, securing this reform just before the provincial government entered caretaker mode with the election writ drop. A sense of urgency never hurts.Of course, magic like this takes years of dedication and hard work. Dr. Philpott has long been a champion of primary care reform, most recently in her book Health for All: A Doctor’s Prescription for a Healthier Canada. Her work built on and was reinforced by Dr. Tara Kiran and the OurCare team, who developed the case, provided data and depth through research and engaged Canadians in discussions that struck at core values. A hard-working but largely anonymous team at Ontario Health also played a critical role. Under CEO Matt Anderson’s leadership, they had solutions ready for years but lacked the investment and political backing to act. This time, they seized the opportunity. The result: a substantial agreement.Read: Universal primary care access by 2035The $1.8 billion package includes $400 million in previously announced funding and $1.4 billion in new spending over four years. The plan aims to create and expand 305 additional interdisciplinary teams to connect approximately two million people to primary care, addressing a worsening doctor shortage. The number of Ontarians without a family doctor rose to 2.5 million in 2023, up from 1.8 million in 2020. The government has also pledged new legislation to set primary care standards, report on performance metrics like same-day or next-day access and cap wait times at 12 months for those on the Health Care Connect list.Critics will point out that Premier Doug Ford has had seven years and two full terms to act and only moved at the last moment, just as the election campaign began. That’s undeniably true. But that’s not Dr. Philpott’s problem—it was her opportunity, and she took it.Exploring model optionsA guarantee of access is a bold promise, but execution matters. And there is urgency. Two models have been floated by Dr. Philpott in her writings and by the team in their international travels and associated social media posts:The education-based model: In this approach, primary care is funded like the school system, ensuring universal access without fee-for-service billing or the business burdens of running a private clinic. Physicians and teams would be salaried, with funding distributed per capita based on patient needs, similar to how public education is structured.The Dutch model: The Netherlands uses universal patient rostering, where every citizen is assigned to a primary care provider, with regional oversight ensuring fair distribution of patients and resources. This model promotes continuity of care, data-driven planning, and equitable funding for practices, ensuring no one is left without access. It relies on an insurance backbone for funding allocation.Other jurisdictions provide possible additional inspiration or cautions:The Quebec PREM model: Quebec uses a regional physician allocation system (PREM—Plans régionaux d’effectifs médicaux), limiting where new family doctors can practice to ensure “fair” distribution. While this prevents clustering in urban centres, critics argue it restricts physician choice and may discourage retention in under-serviced areas.The Danish model: Denmark assigns primary care responsibility to municipalities, allowing local governments to recruit, fund and organize family medicine services at the County Council level. This decentralized approach ensures services are tailored to local needs, with municipalities incentivized to invest in preventive care to reduce hospital demand.Renfrew, Ont.’s Municipal-Backed Family Health Team: Renfrew has pioneered a new model of family health team (FHT) that integrates paramedics into both virtual and in-person MD-led teams. This has allowed an expanded team capacity in this hard to serve municipality.Virtual-first models in Atlantic Canada: Provinces like Nova Scotia, New Brunswick and Newfoundland and Labrador have been testing virtual-first primary care to bridge gaps in access. Patients are assigned to telemedicine physicians, who collaborate with local providers for in-person needs. While promising, critics worry about continuity of care and the lack of a stable physician-patient relationship in a fully virtual system.Expanding 300+ FHTs is a great start, but how will we ensure access to all corners of the province in an equitable way? What will we do in areas where there are no physically present care teams. Models that blend regional oversight, virtual care and municipal involvement could be key to making this work.One other concern arises immediately: physician and other clinician recruitment. The plan acknowledges that primary care is struggling to attract young doctors, with many opting against traditional office-based, cradle-to-grave family practice. The government has promised new medical schools, expanded grants and easier licensing for internationally trained doctors, but those efforts will take years to bear fruit. As Ontario Medical Association president Dr. Dominik Nowak noted, “The best time to do this would have been years ago. The next best time is now.”Dr. Philpott and her team have a unique opportunity during the quiet period provided by the provincial election. They have committed funds regardless of who wins the election. The challenge now is making sure this investment leads to real, lasting change. Will Falk is an executive in residence at Rotman School of Management and a CD Howe Institute senior fellow.

Unpacking the how of a ‘guarantee of access’ for primary care

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