Office of Health System Partnership Engages Primary Care Providers to Address the Health System's Most Pressing Needs

Primary care is the starting point for most of the health care people receive. It stands to reason, therefore, that we should involve family physicians and other primary care clinicians and scholars in making health care delivery more effective, efficient and equitable.

By Elaine Smith

The Office of Health System Partnership (OHSP) at the Department of Family and Community Medicine (DFCM) was established to bring to bear the department’s academic expertise in family medicine and primary care on the needs of the health system.

“As governments look to rebuild health systems post pandemic, there is an understanding that the foundation of these recovery efforts must be robust family medicine and primary care,” says Dr. Danielle Martin, Professor and Chair of DFCM. “We need better access, equitable services and consistent quality—all at a cost we can afford. The Office of Health System Partnership applies our department’s tremendous academic strengths to these health system challenges and provides primary care leadership at the local, provincial, national and global levels.”

It’s a large task, but Dr. Martin has assembled a stellar team to lead the work of the OHSP. She envisions a local team, deeply embedded in the health systems of Toronto and the GTA; a provincial and national group of leaders providing advice to governments and system leaders about how to improve family medicine and primary care; and a global team, working in concert with the WHO Collaborating Centre on Family Medicine and Primary Care.

One initiative of the OHSP is a local partnership with the Toronto Region of Ontario Health to model and test ways of bringing better primary care to all Ontarians, as well as enhanced health care overall.

“Dr. Martin saw the opportunity for DFCM to lead and support the formation of a co-ordinated engagement structure for primary care leadership in the Toronto Region,” says Dr. Catherine Yu, an Assistant Professor at DFCM and the OHSP’s Engagement Lead.

“The five OHSP-Toronto Region leads will try to make sense of what needs to be done to participate operationally in health system transformation; we can implement and test solutions,” says Dr. Yu, who is also chair of the board for the East Toronto Family Practice Network, a community of family physicians with a mission to create equitable access to inter-professional care for all family practices.

“We want to empower primary care. As the ‘front door’ of our public health care system, we need a scaffold to coordinate the breadth of services that primary care provides. In other words, we require regional and local strategic, administrative and operational supports, to be able to pivot when priorities shift for the populations we serve, especially for those in equity-deserving neighborhoods. These structural supports already exist in other wide-reaching public services like hospitals and public schools. We are articulating this need to Ontario Health and the Ministry of Health and working to establish a primary care network infrastructure for each of the Ontario Health Teams in Toronto. [OHTs are charged with looking after the health-care needs of the entire population in a specific geographic region.] We need the right resources to respond to the community in a co-ordinated way.”

In the Toronto region, the priorities of the OHSP include exploring care gaps in COVID recovery efforts; supporting patient attachment (the connection to a family physician or primary care provider); building a stable and responsive primary care workforce as the population increases; and engaging primary care leaders across the region, connecting them to one another so that they can work together on shared issues across the city.

The OHSP will also conduct evidence reviews to provide relevant information in a timely manner to health system decision makers and build capacity globally to support primary health care implementation through the work of the WHO Collaborating Centre on Family Medicine and Primary Care at DFCM. “Through the centre, we will assist the WHO in researching, evaluating and strengthening family medicine and primary care globally. The designation speaks to our reputation as a valued collaborator and an international leader in family medicine and primary care education and research,” says Dr. Katherine Rouleau, who is the centre’s Director, and the Global Primary Health Care Lead within the OHSP.

Primary care is a serious concern in Ontario. More than 2.2 million Ontarians are without a family doctor, according to a report released by Inspire-PHC, a health care research and policy group that is co-led by DFCM Professor Rick Glazier.

“We want to look at how we as a department can help alleviate this issue, learning from best practices internationally as well as across Canada,” says Dr. Avnish Mehta, who is the OHSP’s Attachment Lead. “The initial step has involved a review of international jurisdictions with high attachment rates, as well as local work interviewing key leaders across Ontario who have tried innovative approaches. We feel confident that we can learn from the very best.”

Dr. Mehta, who is also chief of family medicine at Scarborough Health Network, says family physicians in his neighbourhood are working at capacity, so the solution isn’t simply to assign more patients to each doctor.

“One key is to find a variety of ways to expand their capacity, such as interdisciplinary teams,” says Dr. Rouleau. “Through our global networks we can explore the macro-, meso-, and micro-level approaches to expanding capacity, such as the contributions that community health workers can make in primary care.”

Engaging busy family doctors in system work isn’t easy when they are all working at capacity. Dr. Yu has put together a leadership table of the primary care leads for each of the eight Ontario Health Teams (OHTs) based in Toronto to explore approaches to making access to high-quality care more equitable in Canada’s largest city. Integration efforts at the OHT level are part of that journey. Building partnerships, not only among family physicians but with hospitals, specialists, social service organizations and beyond, takes time and effort, but the team is eager to contribute.

“The implementation science behind breaking down siloes in health care is a growing field. In fact, many primary care champions among our own faculty members have been contributing to this body of knowledge for decades,” says Dr. Yu. “The OHSP seeks to gather and spread the learnings from existing models, so that integration across our health care system can be scaled quickly.”

“The most important changes we can make to the health care system aren’t complicated, but they do require an investment in sustained structures and processes to enable change management of a large community of service providers,” says Dr. Noah Ivers, who is the OHSP’s Scientific Lead. Critical to these reforms is an inclusive and integrated data system. “We need to harness the power of data to drive evidence-based, patient-centred improvements in health care,” he adds.

Both Drs. Mehta and Yu can point to successful examples from their own experiences that might someday become templates for networks of family care practitioners.

At the Scarborough Health Network, there is a cancer screening pilot project that allows patients to call in, speak to a physician and get signed up for ongoing screening. It is based on the VaxFacts program rolled out by the Network during the COVID-19 pandemic that allowed people to call in for a one-on-one, judgment-free consultation with a physician to get the most accurate information about vaccines and treatments for diseases like Monkeypox and COVID-19, childhood vaccines, flu vaccines, and preventative health counselling.

“The percentage of vaccine-hesitant people who went on to get vaccinated was very high,” says Dr. Mehta.

Meanwhile, Dr. Yu puts forth the work of the East Toronto Family Practice Network during the pandemic as an example of a successful way of organizing primary care providers and physicians to partner with an OHT to advance integrated care and population health. During the pandemic, Michael Garron Hospital, Family Health Teams, Community Health Centers and the East Toronto Primary Care Network and other health care and social service providers collaborated to ensure that vaccines were available throughout the catchment area in an equitable fashion that required co-ordination and outreach.

“We’re all part of the solution,” Dr. Yu says. “We’re gathering what works and hoping to produce generalizable knowledge to share and support locally fit solutions for our health care system.”