Alliance for Healthier Communities Submission to the OMA NTF

#Introduction

We would like to thank the OMA’s Negotiation Task Force (NTF) for inviting the Alliance for Healthier Communities (Alliance) to provide feedback to the committee on the upcoming Physician Services Agreement and to participate in your consultations. As you are aware, family physicians working in salaried models of primary care (Community Health Centres, Community Family Health Teams, Indigenous Primary Healthcare Organizations) are essential in ensuring patients receive high quality and timely access to care. More importantly, our members are all collectively committed to health equity and work hard to dismantle barriers, eliminate health inequities, and improve access to health care, especially for those who have historically faced and continue to face discrimination and disadvantage.

We have had the opportunity to survey family physicians in our Centres and their feedback has been incorporated in the co-design of the recommendations and priority areas that will be discussed below. While these recommendations are applicable to physicians affiliated with the salaried models in primary care, many of them could also apply to any physician that work in the various patient enrolment models (PEMs) in Ontario.

#Preamble

As the Ontario Medical Association prepares for the 2024 Physician Services Agreement (PSA) negotiations scheduled to begin in October 2023, the Negotiations Task Force (NTF) is undertaking comprehensive consultations to understand member and group priorities for negotiations, and how best to support doctors in delivering exceptional patient care.

The NTF is seeking stakeholder input, including details regarding why issues are of importance, possible solutions, and examples or personal stories where available to illustrate the challenges.

Stakeholders have been encouraged to consider the following five categories:

1. Compensation (e.g., fee increases, overhead)
2. Fairness (e.g., relativity, gender pay gap)
3. Policy (e.g., virtual care)
4. Accountabilities (i.e., whether physician or Ministry of Health accountability); and
5. Healthcare system improvements (e.g., to improve quality and/or accessibility)

The NTF is looking for submissions that clearly articulate the issue as well as the proposed solution and will ultimately be looking for priorities that are common across groups or the profession.

This submission has been prepared by the Alliance for Healthier Communities (Alliance) to inform your negotiations process. In the preparation of this document, the Alliance consulted with family physicians in the membership through a feedback survey and spoke to important primary care colleagues that also support family physicians. The Alliance looks forward to its ongoing collaboration and relationship with the OMA at ensuring that family physicians who work in salaried models of primary care are well supported in these upcoming negotiations process.

#About the Alliance for Healthier Communities

The Alliance for Healthier Communities (Alliance) represents a vibrant network of 111 community- governed primary health care organizations serving communities across Ontario. Together we have a common vision towards equitable health and wellbeing for everyone living in Ontario, which we strive for by advancing comprehensive primary health care and advocating for changes in Ontario’s health and social systems to address inequities. The Alliance for Healthier Communities stands for healthier people, healthier communities, a more inclusive society, and a more sustainable health care system.

Alliance members include community health centres, nurse practitioner-led clinics, community family health teams and Indigenous primary health care organizations that share a commitment to advancing health equity through the delivery of comprehensive primary health care. These organizations serve populations systemically marginalized and underserved by other parts of the health system; those who face the greatest barriers to health and the poorest health outcomes; including Indigenous peoples, Black populations and other racialized groups, Francophones, people who identify as 2SLGBTQ+, people living in rural, remote, and northern communities, people with disabilities and mental health challenges, as well as recent immigrants and refugees.

Alliance members deliver comprehensive primary health care, embedded in the Model of Health and Wellbeing and Model of Wholistic Health and Wellbeing (for Indigenous-led organizations), and rooted in the belief that health is a state of the best possible physical, mental, social, and spiritual wellbeing.

Alliance members offer primary care services in combination with health promotion and community development activities to address medical and biological issues, and to improve the circumstances in which people live, work, play and age. Comprehensive primary health care not only improves the health of individuals, but it also creates healthier communities – inclusive, connected, and caring places where everyone feels they belong and are empowered to take control of their health and wellbeing.

#Alliance Responses to NTF Survey Questions

#Top 3 Priority Areas

There were several priorities that were identified during our consultations. Fundamentally everyone agrees with one thing – primary care is the foundation of an integrated and high performing health care system, but our foundation is crumbling. Research shows that high-performing healthcare systems are based on a strong foundation of comprehensive primary care. Despite this, millions of Canadians from coast to coast, including the Indigenous peoples and communities of Canada, are currently unable to access the care they deserve. We are hopeful that through the OMA – Ministry PSA negotiations we will see a build back of our health care system that supports the foundation and ensures that family physicians are prioritized in health system transformation.

The Alliance’s top 3 priority areas for consideration by the OMA NTF include:

1. Enable more family physicians to practice in salaried models of primary care (Community Health Centres (CHCs), Community Family Health Teams (cFHTs), Indigenous Primary Health Care Organizations (IPHCOs)) and ensure fairness with equitable physician compensation relative to other Patient Enrolment Models (PEMs).
2. Provide additional administrative support to ensure family doctors have more quality time to spend with patients so that they are spending most of their time caring for their patients and not on administration.
3. Aligning with our colleagues at the Indigenous Primary Health Care Council (IPHCC), we support their priority of improving Indigenous health outcomes with a focus on complexity and chronic diseases, which includes efforts to ensure appropriate access to safe and culturally appropriate care.

#Priority #1: Enable more family physicians to practice in salaried models of primary care (Community Health Centres (CHCs), Community Family Health Teams (cFHTs), Indigenous Primary Health Care Organizations (IPHCOs)) and ensure fairness with equitable physician compensation relative to other Patient Enrolment Models (PEMs).

#Solutions or proposal:

• Increase the remuneration of family physicians working in salaried models, addressing the level of complexity of care that they are providing to their own patients and their communities. This should also include ensuring that all family physicians receive benefits/pension and other salaried employee benefits like parental leave, sick days, vacation days etc.
• Increase the number of FTEs of family physicians working in salaried primary care models and create new or expand existing community governed organizations across the province to address the growing unattached patient population, especially in areas that are racialized and marginalized.
• Co-design the development of a health human resources strategy to address the increasing number of retiring physicians in urban and rural settings to ensure that there is seamless transition of patients to these salaried models of care.
• Apply the Rural Index of Ontario (RIO) to family physicians working in salaried models to remain competitive with PEMs that are in the same geographic region.
• Create a similar program to the RIO that incents family physicians to work in francophone and equity seeking communities, ensuring that there are equitable primary care clinical and social services available.

#Rationale:

We believe that family physicians should have a choice on what model they want to work in and increasingly more and more of them want to focus on work/life balance rather than “hanging their shingles up and setting up their own shop”. In a 2018 study done by Resident Doctors of Canada, the new generation of physicians is less interested in independent practice as they seek better work–life balance and financial security. More than half of resident doctors in Canada would give up some clinical autonomy for a salaried position that included health benefits, pensions and vacation time and a salary model was the most appealing option to 41% of survey participants. Unfortunately, that option is not readily available to many new residents because the growth of salaried positions in primary care has stalled, leading them to open their own autonomous practices (or worse, leaving family medicine altogether) despite being trained in team-based primary care in their residency.

Through all corners of the province, we are seeing an influx of retiring physicians in both rural and urban communities. Many community governed organizations like CHCs, cFHTs and IPHCOs are already supporting these physicians with team-based care and other programs (like mental health and addiction support, frail senior care) but are not able to provide them with the primary care services their patients need. Salaried models are ready to take on the patients of the wave of retiring physicians in the next few years, improving access to comprehensive primary health care, but cannot do so without a mechanism to add additional funded physician FTEs in the communities that need them. There are also many family physicians in other PEMs (FHGs, FHOs and even fee-for-service) who would like to work in a salaried primary care model but the current piecemeal approach of a case-by-case review and approval is cumbersome and quite lengthy. Given many of these patients are dealing with complex health and social needs, we need a strategy now for retiring physicians to ensure patients are not orphaned by transitioning patients to interprofessional teams that include salaried physicians.

For those physicians in salaried models, the level of complexity for health and social care has increased substantially. They feel undervalued by not just the ministry but also OMA as they do not see their needs addressed in the negotiations. The recent salary increases to CHC and BSM physicians, while appreciated, does not address the increased cost of living nor does it appreciate the complex care (and administrative burden) that salaried physicians are expected to manage. Remuneration of physicians who work in this model, especially in rural areas, is often without timely access to specialist support so they are managing extremely complex patients. But their level of pay does not reflect this complexity as their pay is often less than PEMs who have a healthier population.

Incentive programs like applying the RIO to rural communities and adjusting the index to also be inclusive of francophone communities and other equity-seeking communities ensures that there is recognition of the complexity of the care that needs to be addressed. Racialized people, those with lower incomes, and those in poor health were among those least likely to report having a regular primary care provider and those who do work in these communities often feel overburdened by the lack of additional supports (including additional physicians) to help manage the care. This is also coupled with the fact that recruitment is very difficult in these communities and when there is a family physician vacancy, these dollars are sent back to the Ministry to be used in another part of the province. Physician FTE allocation needs to be looked at locally and there needs to dedicated funding protected for those communities, especially during times of difficult recruitment. It is too challenging to ask for funding of new physicians after those funds are returned.

More and more residents are interested in social accountability and providing care in the communities they grew up in or in communities where care is needed the most; however, without a competitive salary and incentives to work in communities where care is more complex, it is very difficult to attract them to work, especially as many must pay down a substantial medical school debt. As complexity in our province continues to grow, we need more physicians working in these types of models to help address the community needs and to provide high-quality care.

#Implications:

Both the OMA and the Ministry needs to ensure that there is improved inclusive communication about the salaried model. Even after years of notifying the government, the salaried and blended salaried models of payment are still not included as a primary care payment model on the Ministry of Health’s website or in its communications - https://www.health.gov.on.ca/en/pro/programs/pcpm/. It is imperative that the OMA and the Ministry explicitly acknowledge salaried models throughout the PSA, in model promotion, and in all other relevant documentation.

The OMA has made it a priority to address the gender gap that exists in medicine, acknowledging that female physicians are more likely to work in lower-paid specialties such as family medicine, pediatrics, psychiatry and obstetrics and gynecology. Aligning with this observation is the fact that there are more female family physicians working in salaried primary care models and as such, are more likely to be less paid than their male physician colleagues in other PEMs. In June 2022 the OMA and the Ministry pledged action on the gender pay gap and one of the first payment models they should be looking at is the community governed primary care salaried models.

#Priority #2: Provide additional administrative support to ensure family doctors have more quality time to spend with patients so that they are spending most of their time caring for their patients and not on administration.

#Solutions or proposal:

• Create a centralized referral system for specialty care (utilizing already existing tools like eReferral) where the desired specialty and distance patient is willing to travel to see a specialist can be specified, so that patients could travel to see a specialist outside of their home area, if it is faster to do so.
• Increase administration funding in primary care, including in salaried models, to allow for hiring of additional administrative staff who can take care of non-medical administration work.
• Simplify, standardize, and integrate simpler, shorter, and more streamlined forms into the EMR (DI and lab requisitions, insurance forms, social programs, benefits etc.)
• Improve outdated digital systems and integrate patient portals – it is essential that the EMR in primary care be the main source of information of a patient’s health and social journey and that all outside records are pushed into the EMR in a timely (and readable) fashion.

#Rationale:

The urgency is very real – the Ontario College of Family Physicians (OCFP) recent survey in May 2023 indicates that 19 hours a week of family physician time is dedicated towards administrative work, representing 40% of their time spent on administration and not direct patient care. And for many, completing this paperwork means extending the workday or working into the weekends, which then negatively affects work-life balance. According to the CMA’s latest National Physician Health Survey, nearly 60% of physicians have said these are issues that directly contribute to worsening mental health.

This administrative burden hampers a family physician’s ability to provide efficient and timely care to their patients, contributing to stress, burnout, and dissatisfaction within the profession. And despite the narrative that exists that this is not an issue with salaried models of primary care given the amount of supports they (are perceived to) have, this very much is a huge issue for salaried physicians. A full-time salaried physician gets paid for a 35 to 40-hour work week – the administration workload is often taken care of after those hours and like all family physicians, this is often unpaid work. Unlike other salaried health care providers in team-based care, some family physicians cannot take lieu time to make up that time (otherwise patients would not receive care) nor are they paid and as such, this is leading to inequity in the way family physicians are being treated.

It is essential we eliminate the administrative burden that is being felt by family physicians so that they can focus on delivering what they were trained to do – provide excellent patient care. Where there is a need to complete administrative tasks then it is important that there is proper support being provided for the paperwork and administrative burden.

In order to free up time to deliver more patient care there needs to be more administrative supports like medical scribes and additional medical receptionists added to the team. Salary primary care organizations also manage and fund the IT infrastructure for the whole team, including family physicians, and have not seen increases in their base budget in over a decade. As the administration burden and complexity in digital tools increases, the organizations are not able to find funding within their existing budgets to support their family physicians and as such, this leads to burnout and dissatisfaction with the system.

We need our family physicians to be present with their patients when they are seeing them for clinical care, not spending their time on a computer charting the visit. The time to incorporate medical scribes in primary care is essential, especially for salaried family physicians who are managing patients with complex needs. Trained to capture and transcribe the relevant information of the patient-physician encounter in real time, scribes help manage on-site physician workflow. And they eliminate the need for family physicians to stay after hours to catch up on paperwork, including charting their patient encounters. It is essential that the OMA NTF help support their family physician colleagues by negotiating for administrative support funding.

#Implications:

Research shows that patients not attached to organized primary care practices in Ontario receive lower quality care, which has widened over time. Every part of the health care system touches primary care, and it is becoming increasingly difficult to free up time to provide direct patient care. Ontario (and Canada) is facing massive shortages of family physicians and if 40% of their time is doing non-clinical work, that means less patients are going to be seen. It also means more physicians will start leaving the profession as they burnout. Family physicians in salaried models are working with patients with complex medical and social needs so their charting is not only more fulsome, but they also need to navigate an increasingly complex health and social system to get their patients access to speciality or other community care. This is an untenable situation.

#Priority #3: Aligning with our colleagues at the Indigenous Primary Health Care Council (IPHCC), we support their priority of improving Indigenous health outcomes with a focus on complexity and chronic diseases, which includes efforts to ensure appropriate access to safe and culturally appropriate care.

#Solutions:

• Ensure accountability to Indigenous cultural safety training and inclusion of traditional practices. The Alliance supports the recommendation by the IPHCC that the Ministry and the OMA fund mandatory Indigenous Cultural Safety (ICS) training for physicians practising in all models, with a specific focus on introducing accountabilities into Family Medicine Patient Enrolled Models’ contracts, regardless of practice location.
• In addition, the Alliance supports IPHCC’s request for OMA to improve awareness among its membership of Traditional Healing practices which should include ongoing education sessions co-led by the IPHCC and funded as CME to be taken annually.
• Address Indigenous health complexity and chronic diseases by implementing an Indigenous complexity code for all primary care, regardless of practice model, for outcomes achieved based on eligible services delivered to Indigenous patients. Further details on this recommendation can be found in the IPHCC submission to the OMA’s NTF.

#Rationale:

• The recommendation pertaining to ICS training will ensure that patients who may be seeking Traditional medicines along with western medicines are not prevented or deterred from doing so. Indigenous Cultural Safety training will also support physicians in understanding the importance of Indigenous cultural and Traditional health and wellness practices. By educating all practitioners, including physicians, it will help reduce the racism and discrimination often felt by Indigenous individuals seeking care and will ensure that care is provided through a patient-centred lens, respecting choice and tradition.

#Implications:

• Most Alliance member organizations already implement ongoing ICS training for all health care and administrative support members on the team, including family physicians. With Ontario having the largest Indigenous population in Canada at close to 375K, only 23% live on reserves which means the majority are living and seeking care from other ‘mainstream’ parts of the health care system across the province. Mandatory ICS training ensures that the OMA is supporting the Truth and Reconciliation Commission of Canada: Calls to Action Health Action #23: provide cultural competency training for all healthcare professional which will ensure that the Ministry is held accountable in meeting in its own priorities pertaining to Truth and Reconciliation with the Indigenous community.

#Virtual Care

In December 2022, a new virtual care framework came into effect in Ontario.

1. How has the virtual care framework impacted your group/organization and patient care?

At the beginning of the COVID-19 pandemic we saw family physicians and primary care teams pivot quickly to provide care for their patients by moving to virtual care to ensure seamless and continued care, while also protecting the acute care system should there have been an influx of people diagnosed with COVID-19. Within 48 hours, the primary care sector went virtual despite no additional funding or change management support. And while many primary care practices stayed virtual for a long period of time, CHCs, cFHTs and IPHCOs ensured that their doors were open to in-person care as they knew not everyone could or should be served through digital means.

New technologies and innovations can improve the productivity of our health care system yet at the same time technologies can exacerbate disparities between patient groups^vii - without the digital tools necessary (both hardware and infrastructure), patients living in racialized or marginalized communities or those who are underhoused may not have the tools or resources needed to access the care they need. This is especially true in many clinical practices where there is now a virtual triage first (online, by phone) before being able to access care; thus, this drives people to hospital emergency rooms if they do not have the tools they need.

Telephone usage was the highest virtual care tool used, often in rural and northern communities where there are still considerable challenges with access to reliable internet and broadband connections.

However, data plans are increasingly expensive and without subsidies or access to cheaper plans there will continue to be a wider gap with access to care.

There is a primary care attachment crisis in the province and for those patients that are unattached, they come to the door of our members centres seeking care and support. As we hopefully move into access to team-based care for all, our current capacity does not allow us to care for more patients but our family physicians and nurse practitioners in salaried based models are active in supporting care for the unattached as a short-term measure until they are successful in finding a new provider. Unfortunately, we have now moved towards virtual primary care for unattached patients who are using a "pay for use" model that are run by big corporations like Maple and Tia Health and who do not work at attaching these patients to health care providers to ensure continuity and comprehensive care. Innovative models of collaboration, such as the Renfrew County Virtual Triage & Assessment Centre, could help preserve and expand care for unattached patients. And will ensure that patients are not paying out of pocket for care.

2. Are there any changes to the virtual care framework that your group/organization would like to see addressed in this round of negotiations? Please provide your rationale for these changes and be as specific as possible.

There are many physicians who have long-lasting relationships with their patients that span many years and as such, use secure messaging as a way to provide simple guidance or advice – this approach to virtual care is not included in the framework and should be captured in future iterations.

With every new change to the digital health and virtual care strategy there is also a learning curve and a cost. To quote one of our family physician members: “too frequent eChanges causing too much required eLearning causing too much eOverload + eBurnout + eDelays”. We need to keep that in mind if there are further changes to digital or virtual care. Every time there is a new digital tool introduced there is also a cost – as mentioned above, our member centres have not seen increases to their base budgets in years and funding all these new tools is cost prohibitive. If we want to make sure we are supporting our family physicians, we also need to make sure that the organizations that salaried physicians work in are also supported and funded so that they can provide the tools that are needed.

#Primary Care and/or Specialty Care

Are there any priorities related to primary care and/or specialty care that your group/organization would like to see addressed in this round of negotiations?

1. Priorities related to primary care

Primary care is in the midst of a capacity crisis – results from the seminal OurCare national survey estimates that one in five Canadians, or 6.5 million people, do not have a family physician or nurse practitioner. Of that, fewer adults who were racialized, lower income and in poorer health reported having a family doctor or nurse practitioner. The Canadian Resident Matching Service (CaRMS) show 100 positions in family medicine went unfilled in 2023, a pattern that has been seen over the last few years.

Ultimately this shows that medical students are not choosing family medicine residency as their first choice. While these positions could be filled by international medical graduates (IMG), we also know many of the new graduates are not interested in practicing comprehensive primary care and move onto other positions that give them work/life balance like hospitalist work, speciality work and/or locum positions. It is imperative that we all work collectively at ensuing that we can recruit more medical residents to work in comprehensive primary care by providing them with value for their work, choice in the model they want to work in and surrounded by a team to collaborate with.

Other priorities that are related to primary care that we would like to also suggest:

• Enrolment of patients to nurse practitioners – we understand the OMA is working alongside with the Ministry to look at how to enrol patients to nurse practitioners in the province and we appreciate your ongoing support in this area. Nurse practitioners in CHCs and IPHCOs are the MRP with substantive case loads. As we see capacity challenges in the sector continue, enrolment of patients to MRPs like nurse practitioners will provide the province with a range of health care providers that can work to their full scope of practice and fill in a much-needed gap in access to care.
• Patients with complexity often have multiple chronic conditions, which require ongoing management by a family physician and, often, a range of other healthcare providers. A move towards recognizing complexity is welcome and will be a great planning tool to identify what additional supports are needed in a patient population. We understand the OMA has been working on complexity modifiers as you look at physician remuneration – our members see social and health complexity every day and the move towards recognizing complexity is welcome and supported. The Alliance has a lot of data and lessons learned on managing complexity and would welcome the opportunity to work in partnership with the OMA on this.
• We need to improve our IT systems so they are fully integrated medical records that are interoperable, searchable and provides the wholistic picture of a patient’s health and social care - the current system that is broken up into multiple vaguely named systems that do a portion of one job but not the other is becoming extremely frustrating and leading to missed diagnoses, missed investigations, missed follow ups, etc. The current system leads to significant periods of work time spent fighting to accomplish a given task rather than providing patient care.

2. Priorities related to specialty care

The relationship between primary care and specialty care is extremely critical and important to ensure seamless patient care. However, our members are seeing increasing fragmentation between primary and speciality care and this is leading to increased administrative burden and frustration:

• As noted above with reducing the administrative burden in primary care, there is an immediate need for a centralized referral system for the different specialists on a regional basis that also notes wait times. This will avoid having to send multiple referrals in the hope of finding a specialist physician that accepts and will reduce the need to send in multiple referral consults (which also increases administrative burden).

• Better understanding of scopes and responsibilities of work – family physicians need specialists to work with them in patient care (and vice versa) and should not depend on the family physicians having to do extra work to provide patient care (e.g., re-referrals at short intervals, separate forms or portals for referrals, follow up on referrals still being faxed on wait times, not sending consult notes in a timely manner). We are also increasingly seeing patients being discharged from specialists to family physicians post-discharge to manage post-surgical care like suture/staple removal or other workups without easy access to guidance on next steps.
• There needs to be accountability for specialists doing their own administrative work and following the new guidelines for responding to referrals as noted by the CPSO – they also should be making every effort to get to know the patient that has been referred to them and doing their own physical exams, especially since a referral to a specialist can be one of the scariest moments in a patient’s life.
• There is often a challenge referring patients with complexities to specialists – when the patient is deemed too complex the specialist refuses to accept the referral. In some parts of the province this can prove a challenge as there are limited options for patients. This results in patients travelling great distances to get access to care or not receiving the specialist care they require.

#Recruitment/Retention Challenges

Is your group/organization experiencing recruitment/retention challenges? If so, please describe. 

Like every part of the health care system, primary care is facing intense recruitment and retention challenges. Salaries in primary care have never kept up with cost of living and vacancies in our centres have never been higher, especially as we continually lose highly skilled professionals to the acute sector. The recent approval of Bill 60, Your Health Act, 2023 presents a challenge as we anticipate seeing health care providers, including family physicians, moving to these private surgical and diagnostic facilities. It is essential that we do not erode the already fragile primary care health human resources by losing providers to this alternate approach to care.

Canada is a diverse country and we will be welcoming many more immigrants in this country over the next decade. We already have a health care workforce that is not always reflective of the population, so it is essential in the recruitment of new family physicians in the future we are actively recruiting in communities of highest needs (especially Indigenous & Black communities). Incenting family physicians to practice in the communities that they grew up in could be done through further medical school subsides and providing them with a salaried position in a primary care organization. This will ensure they would not have to worry about overhead and are immediately surrounded by a team of health care providers who work collaboratively to provide care for the most marginalized. Many CHCs, cFHTs and IPHCOs are in communities where social and health care needs are greater and there should be a more concerted effort to increase the number of family physicians working there. This also includes francophone physicians – we are a bilingual country and finding francophone physicians to work in French-speaking communities is becoming increasingly difficult. There needs to also be a concerted effort in ensuring that medical schools are accepting bilingual candidates so that they can practice not only in francophone communities but also anywhere there are French-speaking Ontarians.

We have also seen that healthcare providers are feeling helpless with the lack of supports for their patients and for themselves. We need a plan today on how to manage this massive wave of MHA, not just in patients but also with our family physicians and all health care providers.

#Modernizing Home and Community Care

Comprehensive care coordination is a key dimension of quality, patient-centred primary care, and it is essential to ensure seamless transitions between settings and among providers. Effective care coordination reduces duplication, facilitates better access, contributes to better value by reducing costs and, above all, results in a better experience for patients. It ensures continuity of care regardless of setting, including home and community, hospital, long-term care, and team-based primary care.

Embedding home and community care coordinators in our member centres has shown improvements and the Alliance welcomes the opportunity to work with the Ministry to spread this approach across the province.

#Social Prescribing

As complexity increases, so does the need for things like social connectedness. Social isolation was highlighted during this pandemic as a factor that increased feelings of loneliness, anxiety, and depression. We know that 80-90% of our wellbeing is determined by factors outside the mainstream health care system and one way to address these factors is through social prescribing.

Social prescribing is an integrated and streamlined way to support patients’ health and wellbeing by addressing the social determinants of health, particularly the need for social connectedness. It is a structured pathway for referring people to a range of non-clinical services, and it seeks to address people’s needs in a holistic way. The pathway involves a social prescription from a primary care provider, like a family physician, who refers patients to a navigator that connects them to a suite of social and community supports drawn from the assets of the community.

The Alliance has been a leader in social prescribing in the country and recently was awarded a substantial funding grant by the Public Health Agency of Canada to spread the work, especially for those who face disproportionate challenges because of discrimination, socio-economic status or social exclusion. It is time to leverage our learnings and rollout a provincial-wide social prescribing program that recognizes the need to support every Ontarian in their health and social journey. We would welcome the opportunity to work with both the OMA and the Ministry to co-design an approach so spread social prescribing that would help support all physicians in the province.

#Other Comments

Do you have any other comments you would like to share with the Negotiations Task Force?

In the submission provided by the IPHCC, they respectfully ask that members of the OMA Negotiations Task Force apply a health equity and anti-racism lens as they undertake these consultations and future negotiations. This is consistent with the OMAs Prescription for Ontario: Doctors’ 5-Point Plan for Better Health care which calls for the following, “Health-care planning should always be done through an equity lens, and in a culturally sensitive way that breaks down barriers for marginalized people, particularly racialized, Indigenous and LGBTQIA2S+ communities, and those whose first language is not English”. The Alliance supports this comment and would encourage the NTF to ensure there is a health equity lens taken during the upcoming negotiations as well.