1. Comparisons of the restructured primary care in the IMWC countries- Canada Sabrina Wong-University of British Columbia Marie Hélène Chomienne-University of Ottawa Brisbane 2011

2. Primary care in Canada Primary care is the first line of care or “first contact” In Canada family physician gate keeper of the system

3. PC Reform in Canada Canada has gone through a major PC reform in the last decade 90’s, Canadians expressed growing concern about their health care system. Romanow report (2002): gave directions for a renewed PC Community-based Coordinated (IT) Comprehensive Interdisciplinary teams Improved access Canadians receive the most appropriate care, by the most appropriate providers, in the most appropriate settings at the right time.

4. Reform Negotiations with provincial medical associations Since then, every jurisdiction has designed models of care with multidisciplinary teams and innovative approaches.

5. Alberta Primary Care Networks (PCNs). Group of family doctors works with other health care professionals (nurses, dieticians, pharmacists, and mental health workers) A PCN can be comprised of one clinic with many physicians and support staff, or several doctors in several clinics in a geographic area. Each network develops programs that best meet the needs of its population.

6. Alberta PCNs 41 PCNs 2,299 participating physicians 77 % of Alberta’s family physicians (FP) 443 full-time equivalent non-physician health care providers working with family physicians in 29 PCNs FP remuneration mixed payments capitation payment plus additional funding through sources such as grants or other incentive programs. 68% of Albertans were enrolled in PCNs The goal for 2011 is for 80 percent of all Albertans to receive care from PCN teams. The PCI agreement has been an outstanding success

7. Québec GMFs (Groupe de Médecine de Famille) regroup up to 8-to-12 physicians working with clinical nurses Rostered patients are ensured access 24/7 (1000 -2200 patients per FTE physician) Physicians retain same remuneration (FFS) additional payments for non clinical work and on-call GMFs are entitled for financing to rent extra space and hire administrative staff As of May 2011, there were 224 accredited GMFs, representing over 38% of family physicians of Quebec

8. Ontario FHNs, FHGs, FHOs, FHTs FHTs consist of doctors, nurses, nurse practitioners, and other health care professionals FHTs have a mixed billing plan capitation plus fee- for-service (FFS) and bonuses : For each rostered patient (1200 per FP), doctors receive an annual fee, adjusted for age and medical conditions and incentive fees for preventative care 200 FHTs represent 2100 family physicians (less than 18% of all family physicians) and 1400 other health care professionals.

9. Achievements New models of care New funding models Legislation for Nurse practitioners across Canada Definition of scopes of practice Defined collaborative care and CC framework

10. What still needs to be done Evaluation Have we controlled health care costs? Have we achieved equity?