To fix health system, find every Canadian a family doctor or nurse practitioner, report urges

Shoring up Canada’s struggling health-care system requires crucial reforms to primary care to ensure every Canadian is connected to a family doctor or nurse practitioner.

That’s the argument put forward by health-care leaders in a new report that calls for targeted reforms to how most Canadians access the health system — including scaling up what’s described as team-based primary care.

The report from the Public Policy Forum, entitled Primary Care for Everyone: An Urgent To-Do List for Reform, lays out 10 steps policymakers must take to expand access to family doctors or nurse practitioners and make it much more equitable.

Released Wednesday, the report comes with a striking set of figures: More than 6.5 million adults in this country — or more than one in five Canadians over 18 — do not have a primary care provider.

Its authors, which include some of the country’s top health leaders, say increasing access to primary care — and transforming how it’s delivered — will not only improve patient outcomes and ease the burden on practitioners, but also bolster the country’s health-care system.

“No amount of investments in wait times for surgery or mental health services or access to diagnostic imaging will matter unless we solve access to primary care,” said Dr. Danielle Martin, one of the report’s authors and chair of family and community medicine at the University of Toronto.

“We cannot have a high-functioning health-care system unless every single person is connected to primary care.”

In Canada, primary care is usually delivered by family doctors or nurse practitioners. It includes everything from well-baby visits and administering childhood vaccinations to checkups for viral infections to scheduling screening tests, such as mammograms and colonoscopies.

Patients without access to primary care are more likely to land in the ER and are less likely to get routine care, such as annual flu shots, affecting their individual health and adding further stress to the system.

“Not having access to primary care puts your health at risk, it puts your longevity of life at risk, it puts you at greater risk of becoming more ill and needing more health services because (medical conditions) aren’t caught soon enough,” said Beth Cowper-Fung, a nurse practitioner, report author and clinic director of The Georgina Nurse Practitioner-Led Clinic, in Georgina, Ont.

“We know there’s lots of care being given in emergency departments … that could be done by a primary care provider.”

The federal government’s recent deal for health spending highlights primary care as a priority area. And Health Minister Jean-Yves Duclos has said the federal government has provided enough money to ensure every Canadian has access to family medicine.

Dr. Alika Lafontaine, president of the Canadian Medical Association, said while new funds are welcome it would also “be a mistake” to see money as the sole solution to primary care challenges.

He called the new report “timely” because it offers specific solutions — and points to the policymakers and health-care leaders responsible for implementing such solutions.

“The number one issue for patients across the country, regardless of where you look, is access to care. And the number one issue for providers across the country is unhealthy working environments,” said Lafontaine, one of the report’s authors. He notes primary care is “suffering the most” in both these cases.

The report makes the case for scaling up team-based primary care, meaning patients are connected to interdisciplinary teams of health professionals, not just individual family doctors, which evidence suggests improves patient outcomes.

Its 10-point to-do list includes specific actions to make primary care more efficient and effective.

These include: cutting the administrative workload of clinicians to free up more time for patient care; creating national licensing for health professionals; developing performance indicators for team-based care to ensure the model is improving health outcomes; and having patients in a team-based environment be partnered with a “lead practitioner” so that a non-physician can co-ordinate their care.

The report also stresses that primary care initiatives must be equitable, increasing access for everyone but especially those who are traditionally underserved, such as Indigenous communities, Black Canadians, newcomers to Canada, children and youth, seniors and members of the LGBTQ community.

Martin hopes the report will show Canadians the measures needed to increase their access to primary care and spur them to demand action from governments.

“One of the most important ways that democracy functions is by arming people with the information that they need to be able to put the pressure on decision makers,” she said.

The Public Policy Forum report is the second in a yearlong project by the Ottawa-based independent think tank called Taking Back Health Care.

The first report, released in January, called for rapid and bold reform, and included a proposal to shift to a geographic model of primary care that ensures all Canadians have access to a family doctor or nurse practitioner within a 30-minute drive of where they live or work.

Martin said a forthcoming report will focus on digital health information, data governance and the future of virtual care.

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie or reach her via email: mogilvie@thestar.ca