Every day we hear stories about the primary care crisis in Canada and the urgent need for a solution. Primary care is the first point of contact into the health system for routine healthcare needs. 

More than six million Canadians are not able to access a regular primary care provider. This number continues to balloon. 

Many family physicians are retiring, some reducing clinic hours, and others focusing their practices to address specific conditions. Coupled with a decreased interest in choosing family practice as a specialty, more communities are left vulnerable to the realities of limited access to primary care. 

So, what’s the solution? Governments are celebrating the opening of new medical schools, new nurse practitioner-led clinics and announcing increased scope of practice for pharmacists to manage minor ailments. Unfortunately, these piecemeal initiatives – focused on access alone – will not solve the problems of primary care. 

A patchwork quilt only works when the pieces are put together into a collaborative design. 

We need a primary care system designed to be coordinated, comprehensive and accessible. And we need a primary care health workforce committed to collaboration to make this happen. 

A new way of working is needed.

Every person in Canada should have access to a primary care team, who can manage health issues faced by a patient collaboratively. Whoever is the first point of contact in the health system should ensure that a patient is treated or referred to another team member in a coordinated and seamless manner. 

There is an inherent accountability built in being part of a team, whether co-located or not, to deliver holistic patient care. Without greater access enabled through coordinated team-based care, the health of Canadians will continue to suffer. 

As a family physician and a health workforce researcher, we co-led the Team Primary Care: Training for Transformation initiative in partnership with over 20 primary care practitioner groups and 100 healthcare organizations across Canada to begin to stitch together a quilt of solutions. This taxpayer funded initiative had over 800 participants call on our governments to make sure future investments in primary care include coordinated training to enable Canadians access to a primary care team. 

Another complementary taxpayer funded project, OurCare, collected the perspectives of thousands of people across the country calling for standards to define what every person in Canada should expect from primary care. These include being able to receive culturally safe care, from a primary care clinician, who works with others in a team, providing ongoing care, connected to community and social services, and accountable to the communities served.

Both Team Primary Care and OurCare initiatives launched appeals to the public asking them to urge their governments to support a vision for an integrated primary care system where “access alone” is not enough. We call for a primary care workforce who can provide a full complement of primary care services collaboratively in
supported teams.

No one government, no one healthcare practitioner group, no one group of educators, regulators, accreditors or leaders can solve the primary care crisis alone. We need an all-hands-on-deck approach, and we need it now. 

The recent $25 billion bilateral agreements signed between the federal and provincial/territorial governments as part of “Working together to improve health care for Canadians” is a unique and timely opportunity for this kind of primary care system design. The agreements state that each province and territory must draft action plans to describe how they will use federal funds, identify and measure targets, and report annually on their progress. 

It is critical that our governments build on the insights gleaned and partnerships developed from these two tax-payer funded projects which would enable a good return on investment into primary care redesign – especially given primary/family health care is identified by the federal government as a key area of shared priority. 

We need partners to bring those of us with evidence-informed solutions to fix Canada’s healthcare system together. We’re interested in collectively solving the crisis in primary care with design solutions. Who else will
join us?

By Ivy Oandasan and Ivy Bourgeault
Dr. Ivy Oandasan is a Professor with the Department of Family and Community Medicine at the University of Toronto and is Director of Education at the College of Family Physicians of Canada. 
Dr. Ivy Bourgeault is a Professor in the School of Sociological and Anthropological Studies at the University of Ottawa and leads the Canadian Health Workforce Network.