We organized our recommendations in accordance with the 10 pillars of the patient medical home
1: Administration and Funding
Short-term: Open up Patient Enrollment Models (PEM) and enrollment/registering to all physicians and nurse practitioners through primary care hubs. These hubs would service all patients within a dedicated geography, and would oversee accountability to the PEM contract. The intent of these hubs would be to allow for organizational continuity and coverage and ensure timely access to care.Long-term:New risk adjusted (beyond age and gender) funding formulas would be established to promote population healthcare delivery, and incent care to socially and medically complex patients. Every primary care provider will have access to team-based care aligned with their patients’ needs in the primary care hubs to support holistic care inclusive of social determinants of health for wellness, prevention and management.
2: Appropriate Infrastructure
APPROPRIATE INFRASTRUCTURE
Short-term: Establish networks of primary care providers (family physicians, nurse practitioners and others) in primary care hubs, which will connect into the surrounding health and social ecosystem, inclusive of hospital infrastructure anchors. These networks will together resolve current issues of personal protective equipment procurement and distribution, IPAC implementation and support, virtual care optimization and other necessary steps for the COVID-19 response and recovery.
Long-Term: Networks will evolve into the full Ontario Health Team model, and primary care hubs will make up part of the anchor infrastructure. Primary care leadership in the network will be an equal voice in prioritization, strategic planning andfunding decisions.
3: Connected Care
CONNECTED CARE
Short-term: Build on the movement from sector silos to connected systems, inclusive of public health for data mining, analysis and dashboard creations to support needs-based system planning, delivery and evaluation. Information sharing as a single network for better predictive planning of the health system response to future pandemic surges, and enabling rapid learning analysis of current strategies in the network.Use of digital technologies will allow better care at any location of delivery for of healthcare services, while minimizing the needs for patient transitions between, for example home, emergency, hospital, long-term care, assessment centre.
Long-term: Creation of an integrated digital platform, inclusive of home care, acute care, mental health and community support services to support a single, easy communication system for all primary care providers in the network integrated into primary care EMRs.
4: Accessible Care
ACCESSIBLE CARE
Short-term: Develop or define a primary hub in each geographic area that will be accountable to delivery of care to residents in that area. Redefine “access to care” beyond same day availability to “flexible convenient scheduling that responds to urgency of need and considers patient preferences for modalities and locations of care”.
Long-term: Include access to interprofessional care providers, community agencies and specialists. Creation of a central intake referral process for services outside of primary care hubs. Consolidate into a single system navigation solution for social determinants of health and specialized care services.
5: Community Adaptiveness and Social Accountability
COMMUNITY ADAPTIVENESS AND SOCIAL ACCOUNTABILITY
Short-term: Proactively address the backlog of care and future COVID-19 waves through a standards of care and prioritization guideline using an ethical framework and focusing on safety and population healthcare delivery. This must be inclusive of primary care and other sectors supporting social prescribing and supports for determinants of health.
Long-term: Look beyond the physician to all community programs and assets (provincial, regional and municipal) to enable social prescribing, patient activation and wellness resiliency building.
6: Comprehensive Team-based Care
COMPREHENSIVE TEAM-BASED CARE WITH PRIMARY CARE PHYSICIAN/NURSE PRACTITIONER LEADERSHIP
Short-term: Identify, fund and support primary care leadership development to accelerate primary care hub and network development and to allow every patient who needs it, access to team-based care through their physician’s hub
Long-term: Modify funding structures and resources to allow the delivery of primary care and team-based care for all providers and all patients, ideally in patients’ preferred place of care (home, office, long-term care) and through the means best suited to the needs of the situation (virtual, in-person).
7: Continuity of Care
CONTINUITY OF CARE
Short-term: Declare the value and complexity of generalist medicine. Elevate the role of primary care and ensure remuneration that acknowledges the complexity of primary care services at “top of scope” for complex diagnosis and management. Understand the value-based benefits of continuity of care. De-incentivize/de-prioritize options that place convenience over continuity (virtual walk-in clinics) and care that should be provided by other members of the primary care team.
Long-term: Make generalist medicine a highly desired career choice for medical school graduates. Support areas of expertise within comprehensive primary care, such that they can serve as content experts to each other within networks and be appropriately remunerated. This allows for specialist demand to be reserved for the highly complex and uncommon medical conditions. Ensure a primary care provider human resource management planning process is in place in all OHTs and succession planning addresses the issue of physician retirement/leaves to ensure patients have continuity of primary care.
8: Patient and Family Partnered Care
PATIENT AND FAMILY PARTNERED CARE
Short-term: Include patients and families in evaluation of the current COVID response, and in aspects of forward planning for future pandemic surges. Recognize the value of informal caregivers in home care and long-term care, ensuring forward planning is inclusive of this group.
Long-term: Embed patient and family experience and impact evaluations in the rapid learning system. Develop federal and provincial policies to support wage subsidies for informal caregivers, as done in the UK. Established a shared accountability framework and declaration of responsibility for system planning and resource utilization between the system providers and residents.
9: Quality Improvement and Research
MEASUREMENT, CONTINUOUS QUALITY IMPROVEMENT AND RESEARCH
Short-term: Embed safety in primary care as a key quality metric, and develop training in (for example) IPAC and Quality Improvement (QI) for all primary care providers. Primary care hubs will require support to implement safety procedures, including a model of IPAC and QI.
Long-term: Establish a culture of continuous learning, accountability and quality improvement in primary care, through funding of education and leadership. Support practice change management and implementation through business optimization/practice facilitation teams shared within the network for quality standards.
10: Training and Education
TRAINING, EDUCATION AND CONTINUING PROFESSIONAL DEVELOPMENT
Short-term: Identify primary care leaders in each network and support through skills development, mentoring and remuneration to focus on COVID response and recovery planning and change implementation.
Long-term: Establish primary care leadership recruitment, development, and succession planning in every network, with appropriate infrastructure and funding.