Longwoods Blog
By: Cynthia Davis, President and CEO, Lakeridge Health
The Systems Approach to Primary Care: Durham Region’s Comprehensive Strategy for Solving the Current Shortage of Family Doctors
We’ve all heard about the shortage of family doctors in Ontario. There’s a steady stream of media reports of communities struggling to recruit new physicians, and emergency rooms filled with patients who have nowhere else to go.
It is estimated that 2.2 million people in Ontario don’t have a family doctor and another 1.7 million have a family doctor over the age of 65.
Fortunately, solutions are emerging.
A comprehensive program of primary care support and expansion is now underway in Durham Region, with promising results.
The program includes cross-sector healthcare partnerships that have already delivered one of Ontario’s most effective regional COVID-19 responses, new and stronger multi-disciplinary supports for primary care providers, and a ground-breaking medical education partnership – the first of its kind in Canada – that will channel new physicians directly into primary care practice.
The long-standing need for a systems approach
The solutions underway in Durham Region are part of an aggressive strategy of health system integration – connecting all services, from primary and community care to hospitals and specialized clinics to long-term care, so they work together as one.
In a fully integrated system, doctors, nurses, and other care providers work in teams. They use a common communication platform and the same standardized care paths and protocols. Patient referrals and transitions between medical specialties happen seamlessly. Resources are shared and used efficiently. The quality and timeliness of care improves, and when it doesn’t, the problems can be more easily identified and solved.
Primary care is evolving toward increasingly integrated models of practice. There is a long history of family physicians operating most commonly as independent businesses. In recent years, many have joined family health teams (FHTs) and organizations to improve interdisciplinary connections. However, these structures vary regionally and provincially, and information systems and cross-sector communications often remain incomplete.
As health care grows increasingly complex, family doctors need to be part of a system. They need support from multiple clinical and non-clinical providers, and reliable connections to an array of medical specialties, diagnostics, and community services.
But no doctor can build this system on their own. They already spend too much time on administration, referrals, and finding patient supports. The job of system-building must be led by larger players in health care, so family physicians and other providers can focus on patient care.
This is what is happening in Durham Region.
A strong foundation for health system integration
Lakeridge Health, Durham Region’s largest healthcare organization, is well-positioned to play a central role in health system integration. It incorporates the Region’s five major hospitals, with a sixth in the proposal stages, a long-term care home, one of the province’s largest mental health providers, and a range of specialized clinics. It has a clinical information system connecting all of its hospitals and six additional hospitals in Ontario’s Central East Region, providing a unified electronic medical record (EMR) for all patients. With a team of roughly 8,000 staff and physicians, it is one of Ontario’s largest healthcare systems, delivering one of the most comprehensive portfolios of healthcare services.
At Lakeridge Health, we’re committed to whole system quality – delivering the best possible care, wherever and whenever it is needed – and we see health system integration as the best and only way to achieve this goal. This is captured in our vision: One System. Best Health.
All of this serves as a strong foundation for health system integration. Only a large, diverse, and well-organized healthcare organization can lead the complex challenge of building the regional networks required to support whole system quality.
The actions underway in Durham Region aren’t about hospitals taking over primary care services. They’re about leveraging Lakeridge Health’s resources to provide critically needed support to family physicians and expand primary care services in areas of greatest need.
The actions are about effective, cross-sector partnerships.
Partnerships that improve and expand primary care
A key part of our integration strategy is close collaboration with the Durham Ontario Health Team (OHT).
OHTs are established regionally by the Ontario Ministry of Health (MOH) to support more coordinated care delivery. The Durham OHT was among the first OHTs established in November 2019. It includes signatory organizations engaged in primary care, acute care, mental health and addiction services, social supports, home and community care, and long-term care. It has broad community support from diverse organizations in public health, social services, education, and the private sector.
The Durham OHT functions as a connector, with a strong focus on primary and community care. It is helping to build partnerships and a community of practice that includes allied services such as pharmacists, as well as family physicians and sub-speciality care.
These partnerships extend beyond creating organizational structures or agreements to developing truly functional working relationships, equipped with essential tools and resources, so that partners can work together efficiently to improve access and deliver coordinated care.
Health system integration in Durham Region is being driven by healthcare leaders and professionals who are building partnerships because they understand the need, and they’ve seen the results.
Partnerships that enable a regional crisis response
Partnerships have been established in the primary care, public health, paramedicine, long-term care, and community care sectors, and with the Durham Region Health Department and Ontario Tech University.
These partnerships have enabled one of the province’s most effective regional responses to COVID-19 and other viral outbreaks, with Lakeridge Health serving as the regional, multi-site centre for advanced clinical care and infection control resources and expertise.
Along with our partners, we’ve developed a COVID-19 Therapeutic Clinic, a Virtual Urgent Care Clinic, rapid vaccine rollout capacity, and a regional network of COVID-19 Assessment Clinics that have been expanded into Cold, Flu and COVID Care Clinics that diagnose and treat multiple respiratory illnesses.
We also work closely with the Durham OHT to provide multi-media communications directing primary and community care providers to available supports, and patients to appropriate care.
This regional response has strengthened relationships between Lakeridge Health and community-based providers and demonstrated how previously disconnected healthcare services can work together. It has also taught important lessons about the infrastructure needed for long-term primary care success.
A network of primary care support and connections
Lakeridge Health is now building the framework required to build a regional network of family healthcare resources that are fully connected to acute and community care services.
This network will be based on expanded partnerships with existing primary care clinics and the establishment of new clinics. Lakeridge Health has already been working with numerous clinics over the last three years to increase community and hospital support.
The plan is to invite all existing primary care providers, including those who practice independently, to join the network to gain full access to multidisciplinary support and resources, without changing their practice. Existing FHTs will be able to enhance services they already provide while helping to strengthen regional connections.
The EMR currently used by hospitals will be offered to all primary care settings to create a fully integrated digital health system, a first for Ontario.
A Department of Family and Community Medicine (DFCM) has been established by Lakeridge Health to coordinate development of the regional primary care network. Plans also include a potential new Lakeridge Health FHT to serve as a regional primary care centre with academic and training capacities.
The network will increase efficiencies and enable patients to access the most appropriate healthcare provider, improving the quality of care and, where possible, expanding primary care capacity.
We know, however, that there will still be a need for more family doctors.
A direct pathway from medical student to practicing family physician
To address this need, we’ve established an innovative regional primary care training and education partnership with Queen’s University School of Medicine.
The Queen’s-Lakeridge Health MD Family Medicine Program offers an alternative to traditional medical education, where students attend medical school and then select a specialty. The program identifies individuals who are interested in family practice at the beginning of their education and provides community-based training from day one. It offers a direct pathway to primary care, including exposure to the full range of clinical and non-clinical professionals in a supportive team-based environment, and development of competencies in areas that are highly relevant to community practice, such as mental health, obstetrics, geriatrics, addictions, and paediatrics.
Students will be fully prepared to begin their practice in Durham Region upon graduation.
The goal of the Queen’s-Lakeridge Health MD Family Medicine Program is to admit, train, and qualify individuals to provide comprehensive community-based care. It addresses the shortage of primary care physicians directly, with future opportunities to add training for allied community care professionals.
It’s a new model with potential to fundamentally change medical education.
Twenty novel medical training positions combining undergraduate (medical school) and postgraduate (family medicine residency) training into a continuous and integrated stream have been made available for the first cohort of students.
The Lakeridge Health Education and Research Network (LHEARN) Centre, an existing education and research facility, will evolve into a satellite campus to support the new program.
A place where healthcare professionals want to work
The Queen’s-Lakeridge Health MD Family Medicine Program is closely linked to all health system integration initiatives underway in Durham Region. Together, they address the critical challenge of primary care recruitment.
Healthcare professionals want to be part of a team. They understand the importance of streamlined connections to specialists and allied services. They want to be able to rely on colleagues for ongoing support and to provide excellent care for their patients when they need a break. They know that team-based models offer a more supportive environment for providers, and more responsive, accessible care for patients.
Healthcare professionals are also choosing where they want to work and live. Recruitment will succeed if we build a system in which people have balance and flexibility, stable incomes, team support, and the ability to focus on patient care. We’re already seeing this in our hospitals, which are attracting professionals who want to work in an integrated acute care environment.
As we extend this foundation into primary care, we know that physicians, including new graduates, will join our growing team.
The time for change is now.
This is an important and exciting time for primary care, and all of health care, in Durham Region. We continue to manage exceptional demands and resource constraints prompted by COVID-19 and other respiratory illnesses, while keeping a strong focus on system integration and whole system quality.
We’re still in the early stages of system-building for primary care, but we have a clear strategic plan and we’re seeing measurable progress.
These mutually supportive measures will, over time, increase our regional primary care capacity, and improve access to all, including currently underserved populations. This will alleviate pressures on emergency departments and acute care.
These measures will improve the efficiency of our valuable healthcare resources through centralized purchasing, data management, and administration. They will streamline interprofessional communications and improve the work lives and well being of our primary care providers.
Most importantly, these measures will improve patient experience, through simplified referrals, seamless care transitions, more accessible, high-quality care, and easier navigation throughout the healthcare journey.
Our primary care challenges are complex, and we believe that solutions must ultimately involve a comprehensive systems approach. We also believe that now is the right time for broad system change. Healthcare professionals have endured the exceptional stresses of recent years and are ready for truly supportive health system integration. In fact, it is long overdue.
1. Primary care attachment data for 2020: INSPIRE PHC Primary Care Data Reports. https://www.ontariohealthprofiles.ca/ontarioHealthTeam.php 2.
2. Premji, Kamila, et. al. Trends in patient attachment to an aging primary care workforce: a population-based serial crosssectional study in Ontario, Canada. medRxiv 2023.01.19.23284729; https://www.medrxiv.org/content/10.1101/2023.01.19.23284729v1
This entry was posted on Monday, April 24th, 2023 at 10:55 am and is filed under Longwoods Online.