Using Integrated Care Teams to Improve Access to Primary Care

The City of Toronto is facing unprecedented challenges in meeting the health care needs of its residents due to a significant reduction in the number of family physicians providing comprehensive primary care. Many family doctors are reducing their practices or retiring early due to burn-out with a high administrative workload or because of high overhead in a rapidly growing city. In addition, fewer new graduates are practicing comprehensive family medicine. Over 20% of patients attending our local Emergency Department have no family doctor. The creation of integrated health hubs with improved access to team-based care will be effective in delivering the right care, in the right place. Leveraging data available to the North Toronto Ontario Heath Team (NT OHT), an analysis was completed to define the primary care gap in North Toronto. Using a Population Health Management approach, we learned that the unmet primary care gap in North Toronto will increase by 73% by 2026, due to population growth and fewer family doctors. Over 80% of family doctors do not have access to interprofessional healthcare providers (IHPs), the lowest in Toronto. To ensure access to primary care for all, a strategy was developed with the goal of ensuring every NT OHT resident has access to team-based primary care. This will be achieved by attracting and retaining physicians, by improving access to IHPs locally. The first phase of the strategy is the creation of two Integrated Health Hubs, based on local needs, with input from patient and family group members . These Hubs will recruit primary care providers to support 20,000 unattached patients, along with IHPs that are needed to support this population. In the future, the IHPs at the Health Hubs will be expanded to support and retain local primary care providers and their patients, who do not have access to teams. Furthermore, the IHPs will also provide care to seniors living in seniors buildings in our local community, to support earlier intervention for our senior population with rising care needs. The Integrated Health Hub will be the foundation for this model of care. In addition to team-based supports, other support services on-site will also be explored to improve access (one-stop shop experience for patients), with the potential to reduce the cost of business for primary care providers. The Hubs will also provide back-office supports for primary care as a way of reducing the administrative burden. It is anticipated that these supports will enable larger rosters per doctor, helping to reduce the access issues currently facing our system. A robust plan is in place to shape the development of Integrated Health Hubs, including Vision and Advocacy, Care Model and Operations, Space and Capital, Partnerships and Engagement. The NT OHT is working closely with all stakeholders, including patient and family advisors, primary care, academic leaders, and local community members. Hub development is a key foundation that will enable improvement in access to primary care, making practice easier for our providers, and making life healthier for the residents of the NT OHT.