It is welcome news that Conservative Premier Doug Ford has appointed Dr. Jane Philpott, former federal Liberal Health Minister to lead a new primary care action team in Ontario. This cross-partisan effort to solve the primary care crisis in the province is exactly the kind of ‘roll-up-the-sleeves’ approach we all need.
Will it be enough?
Every province and territory in Canada needs a dramatic reformation of the health system to help right our sinking primary healthcare ship. If anyone can fulfil this challenging mandate, Dr Philpott can make it happen. For truly sustainable change, she must prioritize robust health workforce planning.
Primary care refers to routine, regular health care and is the first point of contact an individual has with the health system – usually through a family doctor or nurse practitioner — but better yet, with an integrated healthcare team.
Dr. Philpott’s mandate is to make sure everyone in Ontario is connected to primary care within five years. This is no easy task. A new report released by the Canadian Institute of Health Information (CIHI) details how 12 to 27 per cent of adults across Canada are not attached to a primary care provider.
As more family doctors retire, this situation is likely to get worse.
High rates of burnout, turnover, and retreat from the primary care system in whole or in part have resulted in more limited access, forcing patients to seek care in emergency departments and resulting in longer wait times. Service closures due to lack of staff are becoming commonplace. These issues, which have been longstanding in rural Canada, are starting to impact urban communities.
A variety of solutions to this multilayered crisis have been suggested.
Some advocate recruiting health workers from other countries. But this is ethically questionable, as these countries have urgent sinking ships of their own.
Others suggest the creation of a few private healthcare ‘lifeboats’ for select services – or for those who can pay for those services privately. But this will result in health workers leaving the ‘Titanic’ public healthcare system to take on more water with fewer crew.
These ‘solutions’ ignore how many of the problems we are experiencing are a result of either a complete lack of planning for the health workforce we need to meet patient and population needs or fundamental flaws in the approaches taken thus far, which tend to be isolated attempts focused on single professions and done behind closed doors with limited and inadequate data.
So, what is needed?
First, planning should start with patient and community needs. Once we know what services are needed, now and into the future, we can plan to deploy health workers who can provide those services.
Second, planning should take an interprofessional approach. Because healthcare is delivered in teams, it is necessary to consider all the providers involved in primary care – from family doctors and nurse practitioners to pharmacists, physiotherapists, psychologists and beyond.
Third, planning should be transparent and inclusive. It is stronger when all those involved in training, regulating, employing and supporting health workers bring their knowledge of important factors influencing the capacity of the workforce to planning tables.
Fourth, planning needs to take the whole lives of health workers into consideration; factors such as age and gender matter. Most health workers in Canada are women and as well as caring for folks at work, they also disproportionately provide care at home.
Most importantly, planning should be an ongoing activity, embedded into health system processes and decision-making. Leading practices strongly encourage nurturing a culture of planning which allows for course correcting when needed and improves systems over time.
There are ongoing initiatives that have undertaken just such open, collaborative and interprofessional approaches, bringing needed data to assist those who make day-to-day decisions. Let’s scale these promising practices and bring together collaborative tables with improved data and robust tools for primary care planning.
Canadians deserve to know where we’re headed on this primary care ship and how we’re going to get there.
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About the authors:
Dr. Ivy Bourgeault is a Professor in the School of Sociological and Anthropological Studies at the University of Ottawa and leads the Canadian Health Workforce Network.
Dr. Sarah Simkin is a Family Practice Anesthetist and the health workforce planning co-Lead of the Canadian Health Workforce Network.
