Strengthening Primary Care in the South West LHIN

With the goal of improving access, accountability and performance, the South West LHIN will work with the Ministry of Health and Long-Term Care to implement a multi-year collaborative reform strategy.  The core of this work will be connecting and integrating Primary Care Providers with other care providers. There is also a need for dedicated work to respond to the needs of currently under serviced Indigenous communities.

Provincial reports such as Bringing Care Home, Health Quality Ontario’s Advancing Integrated Care, Patients First: Action Plan for Health Care, the Price Baker report and key reports from organizations such as the Ontario College of Family Physicians and the Ontario Medical Association, all emphasize the foundational role primary health care plays in coordinating care for people accessing the health system. This aligns with the LHIN’s Blueprint-Vision 2022 document, which calls for local care coordination, inter-professional support and an integrated system of care that includes primary care as part of the team. Improving access to primary care is also a focus of the South West LHIN’s 2016-19 Integrated Health Service Plan (IHSP).

Together with the LHIN, system partners will:

  • Work with the Ministry to implement a multi-year collaborative reform strategy with primary care providers.
  • Work towards same/next day access to primary health care.
  • Build capacity for primary health care to meet the needs of all populations within the LHIN.
  • Build capacity to identify and support people with chronic conditions in primary care.
  • Provide Primary Care Physicians and their patients with more timely access to specialist care.
  • Advance the South West LHIN Primary Care Network structure.

Addressing Communities with High Physician Needs

When a doctor moves, or retires, an entire community’s health care can be affected. For these communities, it is more difficult for residents to access a family physician. To help determine those areas of high primary care need in our geography, the LHIN developed a defined, transparent, predictable approach including consistent criteria to support decision making.

The South West LHIN has developed the following list of criteria to further understand and identify areas of high primary care physician need:           

  • Information provided by the Primary Care Branch of the Ministry of Health and Long-Term Care including:
    • Census Sub-Division (CSD) with a low ratio of Family Medicine doctors to population
    • Rurality Index for Ontario (RIO) score at CSD level
  • Local data and knowledge:
    • Doctor to population ratio based on family physicians with a comprehensive care practice
    • Number of family physicians that are anticipated to retire this year, or within the next few years
    • Impact of potential retirements on local populations
    • Ability of the current complement of family physicians to meet the needs of the community by assessing patient attachment rates, family physicians engaged in specialty practices and other roles in communities
    • Primary Care Physician Billing Model by CSD

The following general principles will be considered in identifying high need communities:

  • High need is proposed to be where a patient has to travel beyond commutable range and in communities with a population of 30,000 or less.
  • Patient demographics – high number of patients not attached to a family physician in community, high number of medically complex, senior and/or vulnerable people.
  • On the ground information from the Health Force Ontario Regional Advisor identifying high need areas.
  • An area not determined to be high need based on the criteria mentioned may be considered to be high need in order to serve surrounding high needs communities, provided it is within a 30 minute travel time.
  • An area with no physicians may be added to the high needs list if the area is a catchment for an identified high needs area.

Through this analysis, the South West LHIN will be able to identify and prioritize a number of areas of high primary care physician need. Communities that scored as highest need and/or highest risk in a number of areas will be identified on our list of Communities of High Primary Care Physician Need. Communities targeted for improvements through the Ministry’s Areas of High Physician Need list will be those with an existing Family Health Network or Family Health Organization model. More information on areas of high physician need can be found on the Ministry of Health and Long-Term Care website. A separate LHIN-wide strategy will be developed to address high physician needs in communities not identified on this list. 

The LHIN will strive to maintain awareness of potential high needs communities about whether or not there is active recruitment happening. In communities without active recruitment, we will work with Health Force Ontario to determine how best to support community efforts.

For more information on the South West LHIN’s Communities of High Primary Care Physician Need list, please contact Kristy McQueen, System Design and Integration Lead at kristy.mcqueen@lhins.on.ca or call 519-640-2583.

To discuss your community needs, please contact Jane Tillmann, Health Force Ontario Regional Advisor at j.tillmann@healthforceontario.ca or call 519-200-4896.

Understanding Health Inequities and Access in Primary Care

A person’s income, education, ethnicity, geography, ability and gender can determine their vulnerability to illnesses, the severity and consequences of ill health, and their ability to access health care. In 2016, the South West LHIN in partnership with the West Elgin Community Health Centre jointly sponsored a study called Understanding Health Inequities and Access to Primary care in the South West LHIN to gain a better understanding of the needs of those facing multiple barriers to accessing health care. The study also works to understand the changing demographics of both the general population and Primary Care Providers.

Based on the findings of the study a report was generated with recommendations to support equitable access to primary care. The research focused on five vulnerable groups:

  • Indigenous people;
  • ethno-cultural groups and recent immigrants;
  • rural residents;
  • people with low socioeconomic status; and
  • seniors.

The report identified five key barriers for these groups including poor timeliness of care, geographical, financial, health literacy, and poor relationships with health care providers.

It also outlines five overarching recommendations that support equitable access to primary care including: 

  • Every person in the South West LHIN will have access to culturally safe primary care, regardless of their culture, economic status or where they live, that is provided by primary care providers who have the necessary knowledge and skills to communicate with patients such that the patients feel respected and receive information that they can understand and act on to improve their health.
  • Every person in the South West LHIN will have timely access to primary care, including same day, next day, planned visits and after hours care.
  • To support the provision of optimal (quality) primary care, all primary care providers must have access timely, consistent, effective wrap-around services in office (or virtual) for patients aligned with need.
  • Timely, quality primary care will be available to people in the South West LHIN by ensuring the right mix and distribution of primary health care providers throughout the region.
  • Primary care providers will have access to shared information on patients including real time data and resources available to enable them manage the health of the population and work collaboratively with other health care providers in the provision of seamless care and services for their patients.

These recommendations will now inform the development of a comprehensive, integrated and coordinated primary health care system in the South West LHIN.

Fall 2016 Primary Care Provider Forums

On December 7, 2016, Ontario passed the Patients First Act that will help patients and their families obtain better access to a more local and integrated health care system, while improving the patient experience, and delivering higher-quality care. The Act includes transformational and structural change to the health care system, closer alignment of primary care and public health to other health service providers, sub-region geographies for health planning, the transfer of CCAC service responsibilities to the LHINs, and inclusion of Indigenous voices in health care planning.

During October and November 2016, the South West LHIN invited family physicians and nurse practitioners to attend primary care provider forums to give feedback to the LHIN about the changes in the Patients First Act, as well as how to be successful in implementing changes. The LHIN will be using the advice and recommendations from the forums to help develop strong clinical leadership both at the LHIN and sub-region levels.

Resources