What is the role of Primary Care in our Evolving Health System?
As part of our ongoing series in advocating “A New Vision for Aging”, the Ajax-Pickering Advocacy members hosted a roundtable evening with Dr. Robert Drury to better understand the evolving role of primary care in a changing health system and provide feedback from a consumer point of view. The evening started with a brief overview from Dr. Drury on the role of physicians “then” and “now” to set the table for feedback and to help understand the evolving roles. Key messages included:
- Practices are moving from solo practitioners, where one doctor had control of a patient with a single disease or problem, to interrelated and collaborative teams with specialists and technology support. These teams are made up of doctors, nurse practitioners, physical therapists, pharmacists, occupational therapists, social workers and case managers, supported by technology like MRI and cat-scans. The teams now deal with multiple chronic diseases, including mental health issues.
- Groups of doctors are forming “Family Health Teams” with multiple doctors available through a single practice and they are beginning to use electronic records. Go to http://www.health.gov.on.ca/en/pro/programs/fht/ for more information.
- There is a shift in terminology from primary care ‘doctor’ to primary care ‘provider’ and can include all the functions mentioned above and is focused on the continuum of care across all sectors. This will become more important as the provincial strategy moves toward “patient-centered” health care, financing shifts from the acute sector to home and community care and the initiation of “Health Links” in the community for more comprehensive care for patients and caregivers. Go to http://www.centraleastlhin.on.ca/report_display.aspx?id=28386 for more information on health Links in Durham and Peterborough as examples.
- There is an evolving and important role for electronic health records that are being used to create the “cumulative patient summary sheets.” These have been, typically, in the manila folders in the doctors’ office and hand written but are being transformed to electronic records. There was much discussion on the “hit and miss” implementation by doctors and comments about Ontario being behind other provinces in this transition. These sheets are generated by Primary care, CCAC and Acute care on discharge and now the patient can request a copy of this electronic summary sheet. (some doctors will have a service charge).
- Of the approximately 1,100 doctors in our CE LHIN, most of the 110 Peterborough doctors work within Family Health teams or Health Links. Durham’s 400 doctors are beginning to form these health teams but most of the 500 Scarborough doctors remain solo practitioners.
- The language of primary care is moving from “you will….” to “we recommend….” As these collaborative practices form, on implementation doctors are moving from a “fee for service” model of compensation to a “capitation” model of compensation (OMA preferred) where doctors are paid for the caring of a patient for the year versus fee for service at each visit.
The feedback from our CARP members was very positive and thankful for such a frank discussion and lead to a couple of questions at the end:
- How receptive are the doctors in our community to these changes and what can be done to further educate and link them to this dialogue?
- What role must the patient and caregiver take on and how do we begin to educate the community on all of these changes in a way in which they understand the relationships?
- What role can CARP play, not only in advocating the health changes required (CARP’s One Patient Brief) but, equally important, how do we educate our members and the community at large on our responsibilities as patients and caregivers versus sitting back and waiting for change to occur?
For more information on the Provincial Health Strategy, the ‘Excellent Care for All,’ go to http://www.health.gov.on.ca/en/public/programs/ecfa/.
Dr. Robert Drury – Primary Care Lead for the Durham and North East (Northumberland County, Peterborough City and County, City of Kawartha Lakes, Haliburton County) Clusters Dr. Drury, a Lindsay-based family physician with over 35 years of experience practising across Canada including Northern Ontario, British Columbia and Prince Edward Island is the former Chief of Staff at Ross Memorial Hospital in Lindsay and was a member of the executive committee that oversaw the development of the Central East LHIN’s Clinical Services Plan. He has also served as the hospital’s Vice President and President of Medical Staff, Chief of Obstetrics, Chief of Pediatrics and Utilization Physician. As a surveyor for Accreditation Canada, he has surveyed small community hospitals and larger tertiary centres from Vancouver to St. John’s Newfoundland. Recently Dr. Drury travelled to Ghana in West Africa as part of a medical team to provide care in isolated communities. If you would like to provide additional feedback regarding this roundtable, please email us at [email protected]