Some patients get special care in Ontario. Twenty percent of patients have priority access to extra, insured services with very short wait times. Government apparently spends 60% more for the privileged care. If you roster with a Family Health Team, you could get some too.
In Family Health Teams, social workers handle mental health concerns. Pharmacists review complex medication lists and track INRs if required. Dieticians help with diabetes, high cholesterol or obesity. Nurses offer smoking cessation programs where they counsel, support and follow patients trying to quit. And much more.
Family Health Teams (FHTs) include family doctors, nurse practitioners, nurses, social workers, dieticians, pharmacists, support staff, administrators, other professionals and sometimes part-time medical consultants.
The Ministry of Health website says:
Family Health Teams were created to expand access to comprehensive family health care services across Ontario. Since 2005, 184 Family Health Teams have been operationalized through five waves of implementation, with the last 50 implemented in 2011/12. There are currently over 3 million Ontarians enrolled in Family Health Teams in over 200 communities across Ontario.
Getting a spot in a FHT feels like flying first class: privilege, access and priority.
Family Health Teams have complex needs. A few of the issues include:
- An additional layer of bureaucracy
- Staff reporting changes (to admin vs. MD)
- Sharing resources can cause strain – especially if FHT has multiple sites
- MD leadership is largely unpaid
- Multiple meetings
- Complex governance: especially if aligned with hospitals, LHINs and teaching programs
- Complex legal issues and contracts
- IT infrastructure and maintenance
- Attempts to contract MDs to another bureaucracy
- On-call requirements
- Continual checking and oversight of scheduling and care
- Monitoring of staff activities
- Patient complaint processes
- Quality committees
- Forms committees
Bureaucratic Method
Like many issues in health, everyone agrees on the general outcome. We all want high quality care designed around patients’ needs. But we disagree on how to get it done.
Politicians believe in bureaucracy. They place their faith in central control. They can take credit for projects that they control from the top. Politicians need special projects like FHTs to demonstrate how they’ve added value to healthcare.
Bureaucrats believe physicians are mostly incompetent at managing primary care. They interpret doctors’ pleas for necessary services as greedy requests for more income. Bureaucrats think they can arrange better healthcare than doctors, if they manage and control it themselves.
We already have government owned, staffed and managed practices in Ontario. There’re called Community Health Centers. They work very well in specific communities but seem too expensive to offer everywhere.
FHTs provide an attractive way to offer care. No one debates that. If we spend 60% more for any service, we expect some improvement. We need to ask whether we could get the same or better outcomes for the same investment.
A Better Way
Nothing beats the efficiency and personalized patient attention offered in a small clinic. Even large clinics function best when broken into teams or pods so staff can develop relationships with patients and with each other. Primary care is a service, not a product. Great service is personalized, local, prompt and meets individual needs.
Instead of building bureaucratic monoliths, governments should consider giving extra funding to family doctors. Let small teams of physicians show how funding changes outcomes from a baseline. Let them hire and build allied teams. Government could reward high performers with even more funding for new, creative solutions.
Politicians give family doctors low fees and then complain about less than ideal care. Those of us working in FHTs love them but know they’re probably too expensive to offer everywhere. Instead of trying to reinvent primary care, politicians might consider letting front line professionals prove how well they can provide care free from bureaucratic baggage. I suspect it would improve patient care for much less cost.
photo credit: haltonhillsfht.com