We must strengthen the primary care foundation while building an integrated health system – and that requires provinces and territories to finally work together.
Mark Carney’s recent call for Canadian unity in response to external threats resonates beyond trade and tariffs. It applies equally to our healthcare crisis, where 6.5 million Canadians lack access to primary care despite unprecedented federal investments totaling over $200 billion in recent years.

Why does primary care matter?

Here’s the vision: Canadians should move seamlessly through a health system that keeps them healthy, treats them when they’re sick and coordinates all their care. Your family doctor talks to your specialist. Your hospital discharge connects to home care. Your mental health counselor coordinates with your pharmacist. Prevention, treatment and ongoing care work as one integrated system focused on population health and the best outcomes for patients, providers and taxpayers.
But we can’t build this integrated system on a broken foundation. And right now, primary care — your first point of contact with the health system — is that broken foundation.
The numbers tell a sobering story. Since the Romanow Commission in 2002, Ottawa has invested $800 million in the Primary Health Care Transition Fund, $16 billion in the Health Reform Fund, $45.3 million in Team Primary Care training, and most recently, $46.2 billion in new bilateral agreements with provinces and territories.

Yet Canadians still can’t find a family doctor. The problem isn’t money — it’s coordination.

Each jurisdiction has essentially reinvented the wheel using a mix of federal transfer payments and provincial taxpayer dollars: Ontario’s Family Health Teams, Quebec’s Family Medicine Groups, Alberta’s Primary Care Networks and British Columbia’s divisional models all tackle similar challenges in isolation. These are all good initiatives — every province and territory is genuinely trying their best to serve their residents. But they’re working in silos, just like the individual doctors, nurses, pharmacists, dietitians, social workers and others who need to collaborate in team-based primary care but often work in isolation.
This fragmentation means our tax dollars — both federal transfers and provincial contributions –are being duplicated across 13 different jurisdictions, each developing separate solutions to identical problems. It wastes taxpayer money and perpetuates the access crisis that affects millions of families.

We need a ‘Carney-moment’ for healthcare.

Just as Carney argues that economic threats demand a coordinated national response, our healthcare challenges require provinces to work together. The alternative — continued fragmentation — means more emergency room closures, longer wait times and families without care.
There is a federal-provincial-territorial opportunity for healthcare transformation right now. With the federal government preparing its fall 2025 budget, there’s a unique window to rethink healthcare coordination.
We need a different approach: beyond perpetually negotiating separate healthcare deals with each jurisdiction, Ottawa should insist upon pan-Canadian coordination among provinces and territories to actively participate with existing national health organizations, such as the Canadian Institute of Health Research (CIHR), Healthcare Excellence Canada (HEC), Canada Health Infoway (CHI) Health Standards Organization (HSO) and the Canadian Institute for Health Information.
What this means in action:
• Common quality standards that all jurisdictions adopt, so Canadians get consistent, high-quality care whether they live in Vancouver or Halifax.
• Shared measurement systems that track what’s working and enable provinces and territories to learn from each other’s successes
• Coordinated support that helps jurisdictions implement proven solutions rather than reinventing the wheel
• Focused research that builds evidence for what actually improves health outcomes and reduces costs
• A strengthened federal-provincial-territorial primary care table with real authority to coordinate transformation across the country with an eye to ongoing improvement.
The key is using money more wisely by sharing what works and not reinventing the wheel. Federal leadership could facilitate this coordination through existing organizations — focusing on collaboration, ongoing quality improvement and stronger federal, provincial and territorial coordination.
It’s time to make every tax dollar count.
Smart coordination doesn’t mean uniform approaches — jurisdictions can maintain local innovation while agreeing on common standards and shared learning.
The ultimate goal isn’t just better primary care — it’s a health system focused on keeping Canadians healthy and delivering seamless care when they need it.
When primary care works as the foundation of an integrated system, it reduces expensive emergency room visits and hospital admissions while improving health outcomes and patient experience. It means better care for patients, better working conditions for providers, improved population health, lower per capita costs, and greater equity.
The money has been spent. The evidence exists. The expertise is available. What Canada needs is coordinated leadership to fix the primary care foundation while we continue to build and improve the integrated health system that delivers quality care for all Canadians.

Dr. Ivy Oandasan is Professor in the Department of Family and Community Medicine at the University of Toronto and previously, Co-Lead for Team Primary Care.