Summary of the Discussion at the Strategic Planning Retreat of the OCFP Executive Committee held on February 20, 2010

Transcription

1 Summary of the Discussion at the Strategic Planning Retreat of the OCFP Executive Committee held on February 20, 2010 Contact: M. Janet Kasperski, RN, MHSc, CHE Chief Executive Officer THE ONTARIO COLLEGE OF FAMILY PHYSICIANS 340 Richmond Street West Toronto, Ontario M5V 1X2 Phone: ϖ Fax: ϖ Website:

2 Summary of the Strategic Planning Session 1 THE SIGNIFICANCE OF THE INUIT INUKSHUK THE INUIT INUKSHUK HAS EVOLVED INTO MORE THAN JUST A STONE MARKER. IT HAS BECOME A SYMBOL OF LEADERSHIP, COOPERATION AND THE HUMAN SPIRIT. EACH STONE IN AN INUKSHUK IS A SEPARATE ENTITY; HOWEVER, EACH ONE IS CHOSEN BECAUSE OF ITS ABILITY TO FIT EFFECTIVELY WITH EACH OF THE OTHER STONES. THE STONES ARE SECURED SIMPLY BY THE BALANCE THAT THEY ACHIEVE TOGETHER. EACH STONE SUPPORTS THE ONE ABOVE IT AND, IN TURN, IS SUPPORTED BY THE ONE BELOW IT. TOGETHER, THE STONES ACHIEVE STRENGTH THROUGH UNITY. THIS IMPORTANT MESSAGE CAN BE TRANSLATED INTO A PHILSOPHICAL APPROACH TO THE PRACTICE OF FAMILY MEDICINE AND THE HEALTHCARE SYSTEM IN GENERAL. THE MESSAGE FROM THE BUILDING OF AN INUKSHUK REFLECTS THE FACT THAT A GROUP OF FAMILY PHYSICIANS AND OTHER HEALTHCARE PRACTITIONERS CAN ACHIEVE GREATER SUCCESS THROUGH CO-OPERATION AND TEAM EFFORT THAN CAN BE ACHIEVED BY INDIVIDUALS WHO WORK INDEPENDENTLY. THE INUKSHUK STANDS FOR THE IMPORTANCE OF FRIENDSHIP AND REMINDS US OF OUR INTERDEPENDENCY ON ONE ANOTHER.

3 Summary of the Strategic Planning Session 2 INDEX 1.0 Overview of the Strategic Planning Day Introductory Remarks: Dr. Robert Algie (President )...4 CELEBRATING OUR PAST SUCCESSES 2.0 Our Past Successes Family Medicine in the 21 st Century: Are We on the Right Track? Evaluating Our Success in Implementing Our Initiatives Successfully Completed Initiatives Initiatives Requiring Further Development Activities Identified from Lessons Learned in THE NEAR FUTURE 3.0 Trends, Issues and Responses Required in the Near Future Trends Currently Impacting on Practices in Ontario Issues Requiring Actions in the Near Future Proposed Responses for the Near Future...9 FAMILY HEALTH TEAMS 4.0 Family Health Teams and Alternative Payment Plans What Has Worked Well That We Need to Preserve What Is Not Working That We Need to Change Strategies to Enhance the FHT Model Strategies to Enhance the Quality in FHTs and All Family Practices...13 THE NEXT DECADE 5.0 Trends, Issues and Response Required for the Next Decade Trends for the Next Decade Issues Requiring Actions in the Next Decade Responses for the Next Decade...16

4 Summary of the Strategic Planning Session 3 MOHLTC s TRENDS 6.0 MOHLTC Identified Trends Trends The Impact of the Trends on Family Physicians and the OCFP s Responses...18 PRIORITY INITIATIVES FOR Priority Initiatives Closing Remarks...19 Appendix A: Establishing Family Medicine as the Cornerstone of the Transformational Agenda: A Ten Year Retrospective Appendix B: Budget 2010: The Fork in the Road Appendix C: Patient-Centered Medical Homes in Ontario Appendix D: The Report of the External Expert Panel on Trends Appendix E: Family Physicians Proactively Addressing Patient Care Issues Arising from Societal and Healthcare Trends

5 Summary of the Strategic Planning Session Overview of the Strategic Planning Day Prior to the retreat of the Executive Committee, a survey was undertaken amongst our Board members and the key family physician leaders. The results of the survey were used to direct the dialogue amongst the Executive Committee members. The survey addressed trends that will impact on the OCFP and its members in the short-term given fiscal realities, as well as those trends that will have long-term impacts throughout the next decade. The survey also asked for comments on the Family Health Team model. Mr. Saint-Onge led the Executive Committee members in a discussion that reviewed our past successes in implementing the 1999 Vision of Family Medicine in the 21 st Century, our success in implementing our key initiatives in 2009 and a planning exercise touching on the near future and a long range plan. Mr. Saint--Onge wove in the results of the survey to help the Executive to focus on the trends and issues that the OCFP needs to respond to in the near future ( ) and in the long term during the upcoming decade The dialogue was free-wheeling and the comfortable surroundings made the day feel more like a discussion around a kitchen-table; however, the day was productive and the dialogue was meaningful. The following captures the issues and planning activities that occurred during our strategic planning day. 1.1 Introductory Remarks: Dr. Robert Algie Dr. Robert Algie, President of the Ontario College of Family Physicians launched the Executive Committee s Strategic Planning Day by welcoming the Committee members (Drs. Anne DuVall, Stephen Wetmore, David Tannenbaum, Allyn Walsh, Frank Martino, Renee Arnold and Ms. Jan Kasperski) and Mr. Hubert Saint-Onge to Northwest Ontario. Dr. Algie provided an overview of the purpose and format for the day by noting that the Executive would spend the day discussing the results of the survey on trends completed by the Board and other family physician leaders. Dr. Algie explained that the examination of the trends would assist us to develop strategies that will be needed as we face the near future. Fiscal restraints, the reduction in hospital services especially in smaller communities and human resource shortages were identified as key issues that need to be addressed in the near future. Following an in depth planning session on the near future, the Executive would then need to concentrate on identifying the vision for the future and the strategies to make that vision a reality in preparation for the discussions at the Board Retreat. Following the review of the purpose of the day, Dr. Algie introduced our facilitator, Mr. Hubert Saint- Onge.

6 Summary of the Strategic Planning Session 5 Celebrating Our Past Successes 2.0 Our Past Successes 2.1 Family Medicine in the 21 st Century: Are We on the Right Track? Family Health Teams resemble the model of care described in the OCFP s discussion document Family Medicine in the 21 st Century: A Prescription for Excellent Health Care. The Executive Committee agreed that the MOHLTC is on the right track in developing Family Health Teams. They are very close to incorporating all aspects of our vision for family medicine described in our discussion document; however, more work is needed on the ground in communities throughout the province to ensure that they reach their full potential. With several members within the MOHLTC s bureaucracy questioning the cost-effectiveness of the model, the OCFP needs to provide the Minister with reassurance that FHTs are providing enhanced care now and that the members of each FHT are working hard to become as efficient as possible. It was noted that the work of demonstrating effectiveness and efficiencies needs to be community-based in order to avoid a top-down approach. The OCFP has a great opportunity to provide easy access to the Quality in Family Practices tool and to work with partners such as AFHTO and QIIP to ensure that FHTs continue in their pursuit of excellent healthcare. It was noted that they need time to focus on quality first and foremost and, over time, will be able to accommodate more patients. The Executive also noted that proper measurement systems that take into account the realities of family practices and their complicated patients populations need to be in place to evaluate outcomes and celebrate success. (See Appendix A: Establishing Family Medicine as the Cornerstone of the Transformational Agenda: A Ten Year Retrospective) 2.2 Evaluating Our Success in Implementing Our Strategic Initiatives Successfully Completed Initiatives Our Think Tanks on Rural/ED Issues, Palliative Care and Pandemic Planning were well-received and made important contributions to planning in the province. Our relationship with OMA has improved. It remains positive at the Executive level and the Section is offering us more respect and wanting to work with us. The Family Medicine Interest Groups are thriving and the interest in family medicine amongst medical students and residents has increased tremendously in the last five years. We are enjoying increased success in working with the LHINs and we are seen as a strategic partner by most of the LHINs In spite of e-health scandal, the roll-out of the EMRs/EHRs is back on track with the transfer of funds to OntarioMD. Progress is being made in regards to Aboriginal Health.

7 Summary of the Strategic Planning Session 6 Our ASA and CME-on-the-Road programs are thriving. We continue to be successful in submitting proposals that receive project funding to develop relevant CME/CPD for our members and to conduct health service research. These activities tend to most visible to our Members. The Primary Health Care Research Network has received funding to support researchers in Departments of Family Medicine, NOSM and the OCFP to form a hub for research in primary healthcare/family medicine in the province. The work with CPSO on narcotics abuse and diversion and the MMAP program plus the increased number of policies that CPSO requested the OCFP to review speaks to a positive relationship with CPSO Initiatives Requiring Further Development The Leadership Development Program s proposal did not receive funding. The OCFP should use its own funds to launch the program since it is now vitally needed by leaders in FHTs and especially by family physicians throughout the province. The roll-out of H1N1 vaccine was well-handled in some Public Health Units and not in others. The relationship between family practices and PHUs seem to be an important variable in the success of the program in the various regions. The OCFP should forge an enhanced relationship with the Medical Officers of Health to increase the likelihood of that PHUs will work on relationship building with family practices at the local level. The Health Protection and Promotion Task Force/Committee should help to address this issue. The OCFP should disseminate information across the province on lessons learned from the work done in setting up FHTs. The OCFP should work closely with the e-health Agency and OntarioMD to ensure that the allocation of supports for IT is not stalled. We need to identify/develop appropriate tools to be used to monitor quality outcomes. The current method of judging quality in family practices based on guidelines developed for individual diseases does not work in family practices where judgment is needed, given multiple disorders and complex drug regimens amongst the patient populations. The federal and provincial perspectives need to be taken into perspective. CPSO has agreed that participation in the Quality in Family Practice program would be used as an alternative to a peer assessment. We need to work with CPSO to ensure that the program encompasses all aspects of the peer assessment program. Work is also needed to address the work of Accreditation Canada vs. the Quality Program so that practices that choose the Accreditation Canada route are judged using similar criteria and outcome measures Activities Identified from Lesson Learned in Evaluating how well we have done in implementing our Strategic Initiatives is a positive experience that sets the stage for the upcoming year. We should ensure that Executive Retreat is used for careful evaluation of the progress.

8 Summary of the Strategic Planning Session 7 An Executive Champion should be appointed for each of our priority strategic initiatives. The OCFP is able to excel when we work in partnership with other organizations. A survey/key informant interviews should be carried out to find out how we are viewed as an organization by our partners in the system including the MOHLTC. The survey should be constructed to also provide information on how our initiatives fit with those of our partners. We need to understand how our members see us and how we can best serve their needs. The ARMs/Inside Outs should be used to gather this information. We need to start planning for the next decade, not just the next three years. This year should be spent developing a compass to point us in the right direction. This will set the agenda for the next ten years and will respect the work undertaken in 1999 that set the stage for the work that was completed during the past 10 years. The Board s Retreat will be used to envision where family medicine will be in 2020 (Vision 2020) and a Summit should be held in September will bring together the major stakeholders to confirm the Vision and identify the actions needed to make the Vision a reality. THE NEAR FUTURE 3.0 Trends, Issues and Responses Required in the Near Future The Executive Committee reviewed the results of the Board survey and provided additional comments on the trends, identified the key issues and responses that are required in the near future. 3.1 Trends Currently Impacting on Practices in Ontario The Growing Importance of LHIN s Although it is difficult to determine what will be the eventual role played by LHIN s, greater emphasis is being placed on planning and resource allocation at the regional level with the LHIN s. Not all LHINs look at family physicians as being front and centre in the provision of primary care and some consider them replaceable to some extent. Closing of Emergency Rooms in Small Communities and Rural Settings The current trend to close the emergency rooms of smaller hospitals remains of concern due to the unknown impact on the quality of care in the systems, cost and the impact on the recruitment and retention of physicians, nurses and other health care professional. The projected results also include a weakened level of support for the education of future family physicians in rural settings. Increasing Patient Load The patient load is increasing rapidly in most practices. Caring for an aging population living with chronic diseases is the most significant issue for family physicians. Family physicians will be assisting patients to access the healthcare

9 Summary of the Strategic Planning Session 8 system that will become increasingly burdened by our aging population. The OCFP needs to advocate for more capacity in the system. At the same time as we are experiencing increased morbidity, the economic downturn and budget deficits will result in reduced hospital capacity. Consequently, physicians will experience a significant downloading of responsibilities without the tools to manage the increase patient workload. The Increasing Importance of Electronic Communication With the downloading of responsibilities for patient taking place as a result of the streamlining of hospital care, the management of information technology and the shift to electronic communications in health care will take on greater importance. Uncertainty in Regards to the Retirement of Family Physicians There will be considerable uncertainty created by state of the pensions for the average physician and the impending retirement of large numbers of family physicians. The Changes Surrounding the Employment Status of Family Physicians With the emergence of collaborative models and the gradual reduction of independent practitioners, questions surrounding the employment status of family physicians are likely to emerge. 3.2 Issues Requiring Actions in the Near Future The Committee identified the following issues to be addressed in the next 2 to 3 years: Uneven Relationship of LHIN s with Family Physicians Family physicians have uneven relationships with the LIHN s. Many of the LIHN s have had problems engaging family physicians. Not all LHINs look at family physicians as being front and centre in primary care and consider them replaceable to some extent. Physician substitution sometimes appears to be an underlying motivation. Loss of the Identity of the Family Physician With family physicians constantly being referred to as primary care providers, there is a tendency for the role of the family physician to be lost in the mix. As a result, family physicians are increasingly feeling a loss of identity as it pertains to their role. Difficulty in Accessing Care Family physicians are experiencing increasing challenges in ensuring that their patients can get access to the care they need. Insufficient Flow of Information The current flow of medical information across the system is not sufficient to manage the downloading of patients resulting from the streamlining of hospital care.

10 Summary of the Strategic Planning Session 9 Left out (Orphan) Physicians There is a widening gap between "have docs" in better funding and service arrangements and those who are left out (and want to get in). It is very concerning to hear that our new doctors are searching and cannot find the kind of interprofessional practices that they have trained in and see as ideal ways to practice. Concern was expressed regarding the impact that this will have on our ability to continue to interest medical students and family medicine residents in the practice of comprehensive family medicine. Access to Consultants Family physicians are experiencing increasing frustrations providing their patients with timely access to consultants. In many cases, consultants appear to be carrying out an inappropriate triage of patients. The resulting lack of responsiveness leaves family physicians and their patients with significantly reduced access to effective care. Managing in a Context of Intense Change Family physicians find it increasingly difficult to maintain control over their practice environment in a changing world. 3.3 Proposed Responses for the Near Future The Executive identified the following potential responses to the trends and issues: Reinforce Positive Relationships with LHIN s Local family physicians need to be supported to find better ways to build relationships with LHIN s. The OCFP should continue to play a key role in ensuring that family physicians become more actively engaged with their local LHIN s: Family physicians, collectively, need to learn how to work better with LHIN s. The OCFP needs to continue to offer assistance to the LHIN s to help them to engage local physicians. The OCFP needs to have a presence in all LHINs and should identify the Board and other OCFP members who are already active at the LHIN level and support them so that their OCFP involvement is acknowledged in the LHINs. The OCFP should encourage the LHIN s to provide direction to the delivery of primary care at the community level; however, they need to be clear about the reasons why it is essential to maintain a distinctive role for the family physician in providing the continuity of care. The OCFP should ask MOHLTC to request that the family physicians be linked in to LHIN-driven initiatives such as the Diabetes program currently being implemented. Champion Strategic Investments To avoid the downloading of responsibilities from hospitals to family physicians and other primary care providers, we need to champion well-targeted, strategic investments in the community. In addition to strategic investments in family practices and the primary care sector, Ontario will need to develop an appropriate

11 Summary of the Strategic Planning Session 10 infrastructure (i.e. a strong and stable cadre of homecare providers and other community-based service organizations) to ensure that the health needs of the members of the aging population can be met in the most efficient way possible. (See Appendix B - Budget 2010: The Fork in the Road) Vigorously Pursue the Distributed Education Approach We need to pursue with energy and resolve the distributed education approach we have championed. Involving small hospitals and FHT s to support the recruitment, retention and training of our new family physicians in rural settings. Targeted Education Programs The OCFP should provide education for our members on the exercise of leadership, planning and the development of effective governance practices. Educational initiatives should be married with incentives related to quality care. Our educational platform should facilitate the implementation of the quality care agenda. Advocate for the Faster Deployment of Information Technology It will be important to ensure that the pace of deployment of information technology is kept up, indeed accelerated, in order to help family physicians with the downloading of responsibilities for patient care. Identify the Implications of Potentially Slower Retirements of Physicians The OCFP needs to develop a better understanding of the retirement plans of family physicians and the implications this will have for the provision of primary care at the community level. Coordinate Educational Resources The OCFP should continue to work with the Academic Departments of Family Medicine and NOSM to help coordinate and plan with MOHLTC educational resources for future family physicians in the province. This would include the roles of community hospitals, geographic boundaries of the academic health science centres and medical placement programs like ROMP. Investigate the Employment Status Question The OCFP should investigate the questions surrounding the employment status of family physicians as they become more embedded in a capitation mode of payment as part of FHT s and other forms of group partnerships. Determine the Patient-care Quality Impact of Rostering Research is needed to determine if care qualitatively improves with a system of care where the patients are rostered. For instance, we need to find out whether there is a greater risk of CPSO infractions in connected versus unconnected practices. Foster Greater Levels of Inter-dependence Between Family Physicians Whether family physicians join a connected practice or stay independent has to remain a choice; however, the OCFP should continue to encourage family physicians to become more connected with one another by linking in real or virtual group practices and networks.

12 Summary of the Strategic Planning Session 11 The OCFP should work with the Ministry to find appropriate ways to connect family physicians that are not taking part in a collaborative, team-based arrangement. In some cases, this might best be achieved by building stronger links between family physicians and their local hospital, other organizations such as CCACs or by building upon the Family Health Team s administrative structures to support more family physicians and their patients. Advocate for Better Access to Care for Patients The OCFP needs to be advocating for timely access for patients to appropriate consultants. This might be best achieved by linking consultants more closely to family physicians through our Mentoring programs. The OCFP also needs to work with OMA to develop effective solutions to this issue. The OCFP should help to formulate care plans with a clear delineation of the responsibility of family physicians for patients not able to access care. The OCFP should advocate for enhanced strategies to manage chronic illness. Clarify the Role of Family Physicians in the Context of Inter-professional Work The OCFP should continue to exercise leadership in embracing inter-professional work. At the same time, we need to define what it is that we as family physician's offer to the team and what it is that makes us different from the rest. The identity of the family physician playing a central role in the healthcare system needs to be reaffirmed. This can be achieved while appropriately defining the complexity of care provided by family physicians and the many responsibilities that they assume in their day-to-day work. The evidence points to the fact that health systems make the best use of resources when they support family physicians to meet the comprehensive health needs of their patients. The OCFP needs to emphasize that a key aspect of the role of a family physician in the context of inter-professional work is the accountability for the continuity of care for patients. The OCFP needs to address the recently coined convention of genericising family as a primary care providers along with a whole host of other healthcare professionals. This convention has had a negative effect and has undermined the key role of the family physician in relating to patients with the accountability for ensuring the continuity of care. The development of teams requires role definition with ongoing work to help to determine best person for which role within primary care with an emphasis on enhanced quality, rather than quantity. We need to continue to deliver the message that family doctors remain the best providers of care while taking care to make family practice attractive to new family physicians who, rightly, do no want to spend 14 to 16 hour days seven days a week in their practices. Enhance the Dissemination of Information to Family Physicians Systems to increase communications between community physicians are required. The OCFP needs to get involved in the virtual dissemination of information and knowledge for our members.

13 Summary of the Strategic Planning Session 12 We need to provide educational tools/programs that will help family physicians to exercise leadership at the community level with more confidence. Provide Family Physicians With a Map of Their Options for Structuring Their Practices In the current context of intensive change, a number of family physicians feel that they are not in control of the work environment. It is important that family physicians do not feel that they are the victim of change but are in fact being given more options from which to choose how they want to practice and serve their patients. Provide educational programs for family physicians that will help them better understand the options the have and how they can pursue the option that will best suit their practice and their patients. Focus on solo/small group physicians and provide education on service trends, and the need to participate in initiatives. FAMILY HEALTH TEAMS 4.0 Family Health Teams and Alternative Payment Plans The Committee recognized that FHO and FHN funding models, in conjunction with FHTs, have changed the landscape of care in the province. The success of FHTs is tied to the new funding models. As well, some of the challenges that they face are the result of the funding models. The Executive identified the following in regards to FHTs: 4.1 What Has Worked Well That We Need To Preserve? Encouraged recruitment because it is seen as attractive. Provided a supportive environment where better care can be provided. Increased the level of job satisfaction of family physicians by easing some of the financial pressures. Provided access to greater services for patients, including to mental health support. Created a good environment for family physicians to work together in teams with greater cohesiveness. Inter-professional teams rather than as independent practitioners have allowed for better access to care with greater quality. Made it mandatory to have IT support. 4.2 What Is Not Working That We Need To Change? In some practices, access to care has been reduced. Bureaucracy can become burdensome. The importance of the patient-family physician relationship can be overlooked in the drive towards team-based care. Regardless of how effective the team functions, family physicians are still providing the continuity of accountability for their patients.

14 Summary of the Strategic Planning Session 13 Some negative behaviours have emerged (e.g. rostering of such a large number of patients that access to care for them is compromised). While the MOHLTC has encouraged such behaviours in its quest to address the orphan patient population there is a growing push by the MOHLTC to make FHT providers accountable to quality outcomes. As high quality becomes a targeted outcome, these negative behaviors will be addressed. The funding models and the allocation of interprofessional team members need to be better aligned with the realities of rural settings (e.g. rural communities may have a small patient population to roster, yet need 24/7/365 cover for their emergency department, inpatient and long term care facilities. Capitation funding does not accommodate the needs; moreover, each community is allocated a certain amount for the number and mix of professionals that may not relate to the actual needs. The blended payment models do not provide the proper incentives for complex care or recognize the special requirements in rural communities and need to be tweaked. 4.3 Strategies to Enhance the FHT Model Advocate for an acceleration of the implementation of the program in order to provide patients with equal access to care. Work with the OMA/MOHLTC to ensure that incentives are in place to provide quality care in FHTs and traditional practices and advocate for the use of the reopener to tweak the blended funding models. Work with AFHTO to ensure that FHT s bring increased efficiencies over time. The OCFP should focus on quality agenda. The McMaster/OCFP Quality in Family Practice should be seen as the quality umbrella. The OCFP should champion it and actively launch the OCFP web-based Quality training program to new and existing practices. Advocate tighter governance structures and processes for FHO s and FHT s and ensure self-policing on quality of care. Provide leadership training to family physicians to help them be more effective in team context. Continually assess what is or is not working and refine. Focus on research into the interventions and programs developed and utilized in FHTs to determine their impacts on patient? Are FHTs actually making a difference and at what cost; how do we measure those differences and then tell the FHT story? 4.4 Strategies to Enhance Quality in FHTs and All Family Practices The practice tool kits developed by the OCFP and McMaster for the Quality in Family Practice program should be distributed to support quality outcomes for new and existing teams. The OCFP should exercise leadership resulting in a partnership between our Quality in Family Practice Program, AFHTO and QIIP to help FHTs enhance outcomes. It will be important to understand the roles that each organization brings to the table and the resources that they have. Through this process, we

15 Summary of the Strategic Planning Session 14 would then map out what each organization can do separately and as a coalition to support FHTs. A Summit should be planned to bring the organizations together to define the partnerships and to plan for the work to be undertaken jointly over the next three year. While the work of establishing the FHTs have been in the foreground until recently, FHTs are now at the stage of need to focus on effective governance structures and supporting processes as key to effectiveness. Several excellent programs are offered throughout the province to provide the needed training. The OCFP should identify educational opportunities and distribute the information to FHTs. The OCFP should play a major role in finding adequate supports for non-fhts and determining the best way that FHTs could contribute to enhanced quality outcomes in traditional practices. As an example, FHTs could be expanded to include more physicians and other healthcare professionals rather than creating more FHTs. This model would use the current governance/managerial structures to reduce costs while providing more patients with enhanced care through interprofessional teams. (See Appendix C: Patient-centered Medical Homes in Ontario Journal Article in the New England Journal of Medicine) THE NEXT DECADE 5.0 Trends, Issues and Responses Required for the Next Decade 5.1 Trends for the Next Decade The Board survey results with comments from the Executive were used to identify the trends that we face in the upcoming decade: Aging Population Dealing with multiple co-morbidities and polypharma; Increasing workload/needs per patient while patient roster sizes are expected to increase by MOHLTC; While more patients will require more care, the volume of work per physician of the new generation of doctors and senior physicians not yet ready to retire may decrease. Increased Morbidity Climate change with result in: new patterns of infectious diseases; Increase in stress related illness; Increase in respiratory related illness. Retirement Wave of Family Physicians at a Time of Increased Demand for Care

16 Summary of the Strategic Planning Session 15 The wave of retirements may come at the exact time that the demand for care will be at its highest. The wave of expected retirements expected imminently may be delayed if the market does not rebound quickly and may make it difficult for new family physicians to find practices in the community of their choice. Senior physicians are being replaced by new doctors who wish to work fewer hours. Accommodations are needed for female physicians who need to work parttime during their child-bearing years. It is difficult to replace rural doctors, the demands on time and the lack of supports. Limits to the Growth of Health Budgets The healthcare system is facing another period of financial uncertainty due to the increasing government debt in an era of an aging population; Ever rising health care needs and costs means that comprehensive health care at government s expense only, may not be sustainable and co-existing private options will likely emerge and increase to keep the public system viable. More Pervasive Application of Information Technology Readily available information technologies will reshape the traditional silos (hospital FP CCAC, in particular) and will shift of the populations (both patient and provider) to the community/home care and family practices rather than the hospital-specialist/long term care sectors. Advances in technology will allow for better synthesis and analysis of data, providing the possibilities of better long term planning. These tools will be available in the average doctor's office to assist with individual patient care planning and support practices to actively address the health needs of the practice population, as well as immediate quality feedback. More active leadership role and affirmation of identity Family physicians will be increasingly involved in more connected, team-based collaborative settings. They will be called upon to increasingly play a leadership role, not only in their own internal practices but also in their communities. Family physicians will be pressed to clearly distinguish themselves in the eyes of the new breed of patients who receive their health care from other professionals - nurse practitioners, social worker, midwives, etc. 5.2 Issues Requiring Actions in the Next Decade Financial Issues/ Economic Restraints The need to avoid the possible re-occurrence of the stop-and-go funding patterns of the 1990 s. Erosion of Family Physician Role Family physicians are frequently being identified as just one of many primary care providers. The message that family physicians should only be involved in activities that are not within the scope of practice of other practitioners will narrow the role that family doctors play in their practices and will weaken their relationship with patients.

17 Summary of the Strategic Planning Session 16 With more specialist becoming overwhelmed and other healthcare professionals taking on tasks usually performed by family physicians, the role of family physicians may become more like that of an internist-consultant. Given that there are many health providers ready and willing to step up and take over many of the tasks that family physicians should be doing, the OCFP should: continue to support our Members to maintain high standards and quality care; ensure that family physicians are positioned to effectively address health care needs in an efficient manner; put in place the means for self-monitoring to stop negative behaviours that are not aligned with the four principles of family medicine; address the dilution of primary care provision to many other healthcare professionals since it is leading potentially to conflicts, division of care funding and added bureaucratic burden. Uncertainty Regarding the Availability of Family Physicians The inability to forecast the timing of retirements for family physicians makes it difficult to define an HR strategy based on the requirements for new graduates. New family physicians are preparing for a different life style and approach to practice. The replacement of retirees with these new physicians with different priorities makes it essential to innovate in order to accommodate their needs. 5.3 Responses for the Next Decade Advocacy of Healthy Life Style Tackle issues on preventative health where we can make a difference. Childhood obesity would be such an issue that our Childhood Obesity workshop is attempting to address. Ensure that family physicians (especially the FHN, FHO/FHT leaders) function as employer role models (i.e. five star employers ) in terms of providing our own employees with a healthy work place. Build Sustainable Models of Collaborative Care Ensure that FHT s and other models of interprofessional collaboration have the knowledge and skills to meet the needs of aging population and increasing complexity; Find ways optimize roster sizes based on workload analysis; Continue to look at appropriate supports for family physicians to continue offering the most comprehensive care (e.g. the promising palliative care mentorship program). Advocate for Better Coordination of Primary Care Now that new models of family practice have a stronger presence in the province, enhanced coordination of primary care services and the introduction of innovation should be the next wave of the OCFP endeavors. For instance, investments in family practices and urgent care centres may better serve the needs of the community by providing more comprehensive services than walk-in clinics and would alleviate problems at the remaining well-staffed and well-organized ERs.

18 Summary of the Strategic Planning Session 17 Ensure that all elements of the system play the right role in providing the most efficient primary care for our patients, including after hour clinics. Advocate for regional structures to better link family practices and provide the infrastructure for quality activities in the practices. Planning to Address Lack of Access to Care Develop a plan to help family physicians look after their responsibility for patients not able to access care. Professional Identity Make it a top strategic priority to strengthen the professional identity of family physicians. Information Management Help physicians find ways to make appropriate and timely use of technology in daily practice. Provide ongoing assistance with management of an efficient communication network for issues of critical illness, pandemic, etc. Ensure that an information management platform is established and able to more forward. The platform should not be restricted to IT, but include other information initiatives as well. Facilitate the centralization of information that supports workflow needs (i.e. be the place to go to for information, education, teaching needs etc). Capability Building for Added Skills in Family Practices Develop additional workshops aimed at providing family physicians with the additional skills needed (e.g. colonoscopy, colposcopy, etc.), building on the strength of our current programs and perhaps modeling on the strength of such programs in the USA. Lead Innovation Initiatives Launch a Health campaign focusing on evidence-based practices. (provide an update to the Board on the OCFP s participation in the SPARK campaign). Leverage IT in creative ways to increase connectivity among family physicians. Put in place initiatives to lead inter-professional integration at the community level. MOHLTC s TRENDS 6.0 MOHLTC Identified Trends 6.1 Trends The MOHLTC s report by the External Expert Panel on Trends was reviewed. The identified trends are as follows: Person-centred Care

19 Summary of the Strategic Planning Session 18 Sustainability, Productivity and Innovation in the Healthcare System Chronic Disease Prevention and Management Health Human Resource Management Mental Health and Addictions E-Health Public and Population Health Disparities in Health Consumerism in Health Care Health Care Facility Infrastructure (See Appendix D: The Report of the External Expert Panel on Trends) 6.2 The Impact of Trends on Family Physicians and the OCFP s Responses The Executive reviewed the MOHLTC Trends and identified a number of issues that arise as a result of the trends. The following represents some of the issues and the OCFP initiatives to address them: Person-centred Care Patient/physician relationship my doctor Respect for family medicine by public Patient self management google Sustainability, Productivity and Innovation in the Healthcare System Work with OMA re evidenced-based appropriateness of various procedures Emphasize primary care/family medicine as cost-effective investment IT/team based Chronic Disease Prevention and Management Aging population / home care Palliative care Diabetes Health Human Resource Management How many placements (Belleville example) Mental Health and Addictions MMAP CMHCN Opioids Aboriginal Health E-Health Essential tools for safety Public and Population Health Health prevention H1N1 18 months

20 Summary of the Strategic Planning Session 19 Disparities in Health Advocate for healthy communities urban health Consumerism in Health Care Deal with doctor-in-a-box set ups (e.g. WalMart) Health Care Facility Infrastructure Advocate the development of facility infrastructure is conducive to interprofessional collaboration. (See Appendix D: Family Physicians Proactively Addressing Patient Carew Issues Arising from Social and Healthcare Trends) PRIORITY INITIATIVES FOR Priority Initiatives The Executive Committee members identified the priority initiatives that they recommend to the Board that should be implemented in in addition, each Executive member agreed to champion one or more of these initiatives if they are approved by the Board. The priority initiatives are as follows: Leadership development for group practice leaders...anne/allyn Accelerate the Quality program... Anne/Frank Summit on family medicine in the next decade (with exercise to align stakeholders)...bob/steve Defining the identity of family practitioners...anne/allyn Based on public perceptions of why they go to a family physician and the adoption of new language to avoid being generalized as primary care providers (i.e. family physicians and other primary care professionals). 8.0 Closing Remarks Dr. Algie provided closing remarks and adjourned the Strategic Planning Day by thanking Mr. Saint-Onge and the Executive Committee members for their hard work and thoughtful contributions to the process.

21 Summary of the Strategic Planning Session 20 APPENDIX A Establishing Family Medicine as the Cornerstone of the Transformational Agenda: A Ten Year Retrospective

22 Summary of the Strategic Planning Session 21 APPENDIX B Budget 2010: The Fork in the Road

23 Summary of the Strategic Planning Session 22 APPENDIX C Patient-Centered Medical Homes in Ontario

24 Summary of the Strategic Planning Session 23 APPENDIX D The Report of the External Expert Panel on Trends

25 Summary of the Strategic Planning Session 24 APPENDIX E Family Physicians Proactively Addressing Patient Care Issues Arising from Societal and Healthcare Trends