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Letter to the Editor:

Christie Blatchford raises a number of important issues in her column about Family Health Teams, the most fundamental one being whether such models improve primary health care for individuals, families and communities.  Certainly such models have worked well in other jurisdictions, and the concept of interdisciplinary care in health and medical services has, without question, proven its benefits. Indeed, Christie Blatchford herself indicated that ‘for the most part, the early evidence is that FHTs do result in better outcomes for patients, particularly those with complex medical problems such as diabetes.’  Moreover, as she points out, ‘The move to FHTs also has seen more than 2.1 million Ontarians who didn’t have a family doctor get one.’

This of course doesn’t mean that the process should be accepted without acknowledgements of its flaws and challenges. Indeed, since FHT’s were first introduced in 2006, five separate ‘re-iterations’ have been introduced, producing slightly differing requirements in their development, resulting in some misunderstandings.  However the overall model has been improving itself, and it seems likely that some further adjustments will continue to serve Ontarians well into the future.

Christie seemed to be surprised that family doctors providing care in such models are reimbursed better than their counterparts in the fee for service model. It is no accident that the Ministry has been moving towards improved recognition of family doctors who are prepared to provide comprehensive family medicine with 24/7 coverage and long term commitment to complex care patients and their families. Until recently, medical students were not choosing career paths in family medicine because the work had been generally under-valued and poorly resourced.  The increasing choice of speciality fields by students, and the rapid growth of the walk-in clinics based on fee-for service care, were the increasing evidence of that reality.  The new models have gone a long way to encouraging students back into family medicine as a career path by providing the additional supports and recognition that were lacking in the past. Surely Christie is not suggesting we abandon the advances that we have made to improving the interest of students to enter broadly based family medicine.

I must express my disappointment that, as Chair of the Humber River FHT Board, I was not at least offered an opportunity to present a perspective on her references to our FHT. Instead,  information was provided from an unidentified source; I would have hoped for a bit more balance.  To be fair, I would not suggest that we are without challenges, being less than a year old year and coming together from a variety of community based practices and perspectives. Yes,  there is much to do, and indeed, helpful working relationships have been welcomed as we find the best avenues to do so.

To note one such misstatement, the building pictured in the commentary is not ours; we simply rent  some space on the 2nd floor. Personnel issues were also referenced in the article, citing anonymous sources. All new organizations suffer through growing pains, but I would dispute the interpretation offered in the article.  The full information will be presented in an appropriate setting, and we look forward to having an open discussion. In the interim, this is an inappropriate forum in which to respond.

Humber River Family Health Team is barely a year old and the health professional staff have been working less than six months.  We are working hard, developing programs and sites to provide innovative, team-based care to the over 50,000 patients of this FHT. We have begun to develop other sites where groups of physicians and other team members will work together in the same space, as required by the Ministry. We are working with architects on plans for sharing of space on the same terms. The Board has not yet finalized these plans nor has it made any proposal for new space to the Ministry.   Physicians who are part of the team are also located in other sites, and the non-physician health professionals rotate through three different sites to see patients as close to their homes as possible.  They also do home visits when requested by the physicians. As part of a governance review, we have been engaged with a consultant since early this year, and we are now in process of making the recommended changes to improve our operations.

As physicians we became  involved in the Humber River Family Health Team because we believe in providing the best care for our patients. There is no financial incentive as we are reimbursed  for our medical services independently outside the FHT model. Christie Blatchford was correct to say that, within our catchment communities, we have some of the greatest health disparities with some the lowest health resources in the GTA.  Through the Family Health Team, we are connecting them with other health professionals, such as nurse practitioners, nurses, chiropodists, and social workers.  Our Family Health Team is working together to manage chronic diseases such as diabetes, mental health and addictions, cancer, and palliative care. In future, we plan to enhance the range of our services with occupational therapists, pharmacists, consulting specialists, to add programs dealing with COPD and asthma, and to support health and prevent illness through well women and children programs, smoking cessation, and other educational programs, and research projects specific to our population.  We have been actively reaching out to work with the community in innovative methods that will lead to collaborative care across a variety of health services within our catchment communities.

We welcome helpful criticism to improve the care we provide and to enhance the services that are needed.  In undertaking such a review, though, it would be helpful to have a balanced and non-biased approach with the objective of finding solutions, not simply laying blame.

Sincerely

Ralph Masi,  MD, CCFP
Board Chair
Humber River Family Health Team

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The primary criticisms within the article are misuse of unspent salary dollars and the physician governance model as a conflict of interest. This is based on allegations involving 2 of 200 Family Health Teams (FHTs). At the Prince Edward Family Health Team (PEFHT), 100% of staffing dollars have been entirely dedicated to adding new personnel for the care of our community. These dedicated employees are beginning their 4th year with salaries frozen. In my experience, the physician governance model promotes more effective services because our organization is ultimately responsible to the physicians whose patients are served by these programs. Our governance is keenly aware of how our services are being delivered to our patients; if even a single member physician/NP is dissatisfied with a service to their patients it is reviewed immediately and results are reported back to the board.

After many years in public service I can say with confidence that there has yet to be invented the funding model that cannot be taken advantage of by unscrupulous individuals. This is true in every sector of society – public and private. Ontario’s Family Health Team model of service is one with which I am proud to be associated.
Duff Sprague
Executive Director
Prince Edward Family Health Team
Please visit us at www.pefht.ca
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Family Health Teams are all about improving care for patients.  Christie Blatchford said it herself — “Early evidence is that FHTs do result in better outcomes for patients, particularly those with complex medical problems such as diabetes.” Teams also work with specialists, hospitals and community agencies to make more efficient use of Ontario’s health resources.

It is sad to see this progress overshadowed by the isolated allegations in Christie’s story. Improvement is based on evidence.   Family Health Teams continue to combine evidence, innovation, collaboration and learning to improve access to care, help patients achieve better health, and use the precious resources of our health system wisely.

As the evidence of their value expands, let us hope these Teams can also expand so that all Ontarians can access high quality interdisciplinary primary health care.

Angie Heydon
Executive Director
Association of Family Health Teams of Ontario (AFHTO)
203 College Street, Suite 402
Toronto, ON M5T 1P9
E-mail:   Angie.Heydon@afhto.ca
Direct phone #: 647-234-8503
AFHTO phone #:  647-AFHTO-05 (647-234-8605)
Web:      www.afhto.ca

This entry was posted on Tuesday, June 12th, 2012 at 12:46 pm and is filed under Longwoods Online.