Province must take on strong stewardship role guiding LHINs on primary healthcare plans

AOHC has issued an urgent call to the provincial government to take on a strong stewardship role guiding Local Health Integration Networks (LHINS) in primary health care planning.

The call forms the major argument in a new AOHC discussion paper called An Emerging Primary Health Care Strategy for Ontario. The paper offers AOHC’s initial recommendations on next steps to transform primary health care, the part of the health system repeatedly flagged as needing the most improvements in order to make progress towards better care and better value for health care dollars.

The paper stresses Minister Matthews must move quickly to articulate a clear, cohesive long-term vision and guiding principles for primary healthcare transformation. The need for the province to swiftly clarify its vision and guiding principles is urgent because of its recent action plan’s commitment to transfer jurisdiction of primary health care to the LHINs, several of which are already considering significant proposals for change.

While AOHC welcomes increased accountability for primary health care under the LHINs, its new discussion paper stresses the role of the Ministry of Health and Long-Term Care (MOHLTC), stating: “Without a clear vision and supporting strategy, there is no roadmap for change and more importantly – the LHINs will not have a common understanding on how to fulfill their new role to plan primary health care in their region. As stewards of the health care system, MOHTLC must lead the development of this vision and strategy in partnership with the LHINs and with the leadership of primary health care.”

The discussion paper urges the MOHLTC and the LHINs to adopt 10 key elements of a vision and strategy to guide planning and development of primary health care throughout the province. These include:

1. A population-needs based and health equity planning approach
2. A commitment to interprofessional team primary healthcare organizations as the model of the future for all Ontarians, (i.e. Aboriginal Health Access Centres, Community Health Centres, Family Health Teams and Nurse Practitioner-Led Clinics)
3. A direction to LHINs to develop a network of primary healthcare organizations (PHCOs) and ensure everyone has access to the appropriate mix of models, depending on the needs of the community
4. A strong and accountable primary care governance model under the authority of the LHINs to oversee planning, development and delivery of services
5. A commitment to community governed primary healthcare models
6. A mandate that all PHCO’s be required to provide system navigation and care coordination for those they serve – including as they transition in and out of other parts of the health, community and social service systems
7. A requirement that all members of interprofessional teams work to full scope of practice
8. A requirement that PHCOs provide extended hours, implement advanced access and provide 24/7 coverage wherever possible
9. Immediately legislate PHCOs under the Excellent Care for All Act
10. 0.   Mandate PHCOs to sign accountability agreements with the LHINs

The discussion paper also outlines the catalytic role AOHC members can play positively transforming primary health care. These member centres include 73 Community Health Centres, 10 Aboriginal Health Access Centres, and 15 Community Family Health Teams, as well as 4 community-governed Nurse Practitioner-led clinics. During the next three years, these centres will:

1. Expand the number of people they serve who face the greatest barriers accessing health services
2. Commit to serve the “1%” of the population a number of reports have identified as being the most heavy users of the acute care system
3. Continue to work with partners in community support and mental health and addiction organizations to review and coordinate services, reducing duplication
4. Ensure all members of interprofessional teams are working to full scope of practice
5. Ensure all those served receive system navigation and care coordination across the health and social services systems
6. Implement advanced access and extended hours

AOHC welcomes feedback on its discussion paper and the commitments its member centres have made. Please send input to Jacquie Maund at Jacquie@aohc.org.

This discussion paper is a first in a series of initiatives AOHC is launching to encourage a transition to a people and community-centred primary healthcare system that supports the best possible health and well-being for everyone living in Ontario.