Primary Care Reform: Considerations to Get it Right

One year ago, Canada was in the midst of wave 3. The pandemic had already devastated many parts of our health system. Individuals, health leaders and front line workers wrote of the tremendous pressures on care providers and the awful effects of burnout. We anticipated there would be additional strains as other services and transformational initiatives were halted to address the public health crisis.

These predictions are proving true. Today, to varying degrees across the country, our surgical waitlists are longer and lack transparency. Diagnostic labs are overwhelmed and backlogged. The demand for mental health support far exceeds supply.  Many Canadians lack consistent access to primary care in their communities.

“The pandemic exposed weaknesses, vulnerabilities and inequities in our health system” is a common - and accurate - statement.  Canadian and global leaders have brought forward recommended solutions, many of which were tabled pre-pandemic.  Primary Care reform is no exception; it is essential to unlock capacity and efficiency in other parts of the sector.  

Ten months ago I relocated with my family to another province. Making a change involves gaining as well as giving up. In my case, leaving Toronto for Vancouver included giving up a coveted spot as a rostered patient in a primary care practice.

Many things are working well. We have easy access to walk-in clinics where the clinical care and patient experience has been excellent. Technology has made it simple to book appointments, receive reminders and set up virtual follow up appointments.  And I know we will have access to urgent care if we need it.  However, with almost 1M people in BC without a family doctor, I have no illusions that I will be rostered in a primary care practice anytime soon. There is simply no available space.

The Canada Health Act defines the principles that govern our public health insurance system; public administration, comprehensiveness, universality, portability and accessibility. While clear and reasonable, no one believes the application of these principles is simple.

For a population to be “well,” a sustainable, accessible system that facilitates longitudinal care is key. We have great examples of effective, patient focused primary care groups across Canada. Still, there are some ongoing challenges with staffing, compensation and scale.  The model does not need to reflect the traditional 1:1 doctor to patient relationships of generations past.

Here are some considerations to get it right, based on Canadian and global learnings, notably from the National Health Service in England:

✓ Establish core principles of provision of care from the most clinically/socially appropriate providers
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✓ Strategic alignment of financial and clinical drivers, including shared risk and rewards
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✓ Centrally facilitated partnerships with specialist networks, acute care, community care - and other aspects of health and social services (i.e., housing, volunteers, etc.)  
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✓ Digital solutions must be leveraged to improve experience, drive operational efficiencies, facilitate access to providers and increase engagement of family members
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✓ Integrated health information systems to ensure that clinical and non clinical decisions are data driven and that information can be shared with patients, families and across the care continuum

As human beings we are at our most vulnerable when it comes to our health. Our privilege and experience (or lack thereof) with the health system can have a profound impact on our overall wellness. Effective and accessible primary care is essential. To ensure the health of all Canadians, we must move forward with a clear and comprehensive primary care strategy that is based on experience, evidence, and an optimistic vision for the future.