Canada is in the midst of a primary care crisis. Primary care is the first point of contact Canadians have with the healthcare system outside of hospitals – often via a family physician or nurse practitioner. Unfortunately, an estimated 6.5 million Canadians do not have a family physician or a nurse practitioner.
Provincial government plans to address the crisis have largely focused on increasing the number of health workers. But increasing numbers alone, by making more spots available in medical and nursing schools, and recruiting health workers from out of country, will not be enough to solve the crisis.
We need to reorganize the work of healthcare workers to better use their expertise, reduce duplication and enhance the coordination of care experienced outside of hospitals to improve healthcare access.
No one practitioner can do it all because this no longer fits the reality of the kind of health issues people face today. Patients — especially those with chronic or complex health needs — are better served by a team of healthcare workers whose skills complement each other.
A team-based approach can better balance the workload among team members and enable each member to better use their skills and training. Not only can this help to reduce burnout, it can also improve job satisfaction.
Some provincial governments have been creating more practice opportunities for primary care teams working collaboratively. Many provinces are implementing new practice approaches like the Patient’s Medical Home with family physicians working in teams with other healthcare professionals providing accessible, high-quality care for their patients.
But effective teamwork doesn’t just happen magically without dedicated training and support.
Training healthcare workers to practice in primary care teams is a necessary part of any strategy to address the crisis. Teamwork among healthcare workers must be fostered through knowledge about what each other can do and opportunities to practice working together.
It may come as a surprise to many Canadians that few healthcare workers learn explicitly about the roles each plays, or could play, in the care of patients. For example, various health professionals, including physicians, may not be aware that registered nurses can conduct annual wellness exams, including pap smears; that midwives have the authority to prescribe drugs; of the role that occupational therapists have in providing mental health services; that audiologists can help older adults with hearing problems develop new listening and communication skills; and that pharmacists have prescribing authority to collaboratively manage chronic diseases and minor ailments.
Team based care operates on the premise that enabling these primary care providers to complement rather than substitute each other in coordinated ways offers better access to care.
Without this critical knowledge, health workers don’t know how to work together most effectively. Lack of knowledge can lead to a lack of trust and duplications of services without coordination that can be costly and time consuming to patients and the health system.
Like any team, successful primary care teams require training and practice together to learn how to leverage their strengths.
This idea is not new. Over 20 years ago the Commission on the Future of Health Care in Canada argued that: “If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”
A unique federally funded pilot project called Team Primary Care: Training for Transformation is working to address this foundational and outstanding gap. It brings together over 20 practitioner groups representing all aspects of primary care to create training content, tools and approaches that enable each team member to learn about, from and with each other, and enhance their ability to work better together delivering more and better primary care.
The project focuses on enhancing the training of specific primary care practitioner groups as well as practice-based training of existing primary care teams, bringing on new providers to accomplish transformational change at many levels. Spreading and scaling the tools and approaches of this project is paramount and will begin with the support of over 100 health professional and educational organizational partners across the country.
It’s time healthcare workers learned how to work in teams.
Now, all governments need to work with health provider educators to support necessary education reform as part of the transformation to primary care teams. Patients, health providers and the health system alike will benefit.
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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, leads the Canadian Health Workforce Network, and co-leads of Team Primary Care.
Dr. Ivy Oandasan is a Professor at the Department of Family and Community Medicine at the University of Toronto, is Director of Education at the College of Family Physicians of Canada, and co-leads of Team Primary Care.
