Canadian Doctors for Medicare Position Statement on Team-Based Primary Care
Prepared by Katie Arnup, Jarol Boan, Rita McCracken, Danyaal Raza, & Kevin Wasko, in consultation with the Primary Care Working Group of Canadian Doctors for Medicare.
To download a PDF copy of this paper, click here.
Canadian Doctors for Medicare believes that everyone in Canada should have access to an interdisciplinary primary care team. Expanding access to this model of care will ensure that patients receive the right care, at the right time, from the right health care professional.
Limited access & shining examples
Primary care is the foundation of high-functioning health systems. Data from around the world show that Team Based Care models have lower overall costs, improve access to most appropriate types of services and reduce inequities in a population’s overall health status, including First Nations and rural populations.
Yet, according to polling data released in September 2022, six million Canadians, or 17% of the population, are without a regular family doctor and are actively seeking one. In provinces like British Columbia and Quebec, that number is more than 1 in 5 people. Within provinces, further disparities in access exist. For example, in Ontario, while approximately 12% of the highest-income residents are without a family doctor, that number jumps to 20% of the lowest-income residents, and there is a similar differential between white and non-white residents.
Health human resource challenges are a key part of the problem. Family doctors have been retiring or burning out at high rates, with many choosing to leave established primary care clinics.
Despite these challenges, Canada has some examples of high-quality comprehensive team-based primary care. For example, Family Health Teams in Ontario provide patients not only with a regular family doctor but also access to other primary care experts like nurses, social workers, pharmacists and/or physiotherapists who work together to improve care outcomes. Unfortunately, only 20% of people in Ontario have access to such care, leading many to turn to emergency rooms or walk-in clinics for care.
Integrated team-based care is the way forward
Canadian Doctors for Medicare supports the expansion of comprehensive team-based primary care. We believe that everyone in Canada should have access to an interdisciplinary team of health professionals who are working to the top of their scope of practice, with team members reflecting the needs of the patient population served. Family doctors in partnership with health care professionals like nurses, nurse practitioners, social workers, pharmacists, dietitians, and physiotherapists all constitute potential members of such a team.
Such a model has been shown to increase the numbers of patients a family doctor or NP can care for, improve patient outcomes, and increase joy at work for providers, while optimizing scarce health human resources. With this model, patients receive the right care, at the right time, from the right health care professionals.
CDM also recognizes the complexity of health needs in the 21st century and that integrated technology is needed to meet those needs. Modern primary care must include virtual care and interoperable electronic health records that are able to communicate with hospitals, specialists, and other community-based health service providers to enhance coordination and a seamless patient’s journey through the health system.
To enhance access, delivery of team-based primary care should be organised geographically, similar to public schools rather than relying on chance or personal connections to find a family doctor. This gives patients the reassurance and convenience of primary care close-to-home, similar to how children attend their neighbourhood public school. Saskatchewan’s Health Networks aim to integrate team-based community and primary health care into such a model. Community Health Centres that dot the country also represent an established, but underfunded model of such a system.
Better primary care is Better Medicare
A universal, accessible, and comprehensive approach is in keeping with the initial vision for Medicare in Canada. As Tommy Douglas envisioned universal health care, its first phase was the removal of financial barriers for those receiving care, a stage that was achieved for physician and hospital services.
However, he saw this first phase of Medicare as a prelude to a more comprehensive second phase, that still remains to be achieved. It encompassed a fundamental restructuring of health care delivery, with a much greater focus on illness prevention, health promotion, and the policies related to addressing the social determinants of health.
Expanding access to comprehensive team-based primary care located in patients’ communities is an important step towards achieving that vision.
Other resources on team-based primary care
