The Ontario family care enrolment example

Hosted by four peak health care, research and consumer organisations and attended by an audience of key stakeholders, the Unlocking the Potential of General Practice Roundtable raised a number of topics which might be considered in a transformation of primary health care delivery through enrolment in family care practices centred on general practice teams.

Professor Walter Rosser from Queens University, Ontario, Canada presented an overview of the changes to general practice and the provision of primary health care services that have occurred over the past 20 years in the province of Ontario. In the early 1990s family practice in Ontario had reached a crisis point with an acute shortage of family practitioners, falling practitioner incomes and over 3 million people without a family doctor.

Advocacy and engagement across all stakeholder groups (general practice, consumers and government) facilitated the building of support for a registration system, with voluntary consumer "rostering" (enrolment) and voluntary participation by family practitioners. The system provides practices with a capitation payment calculated on the demographics of their enrolled patients, and bonus payments for targeted prevention and chronic care. In addition practices are provided with a government grant to accommodate family health teams salaried by the government. These teams, consisting of business managers, practice nurses, nurse practitioners and allied health professionals work alongside the family practitioners to provide a person centred medical home model of coordinated care, which includes access to urgent after hours care every day.

There are no out of pocket expenses for consumers; in fact it is illegal for participating practices to bill a patient in Ontario. Comprehensive electronic patient health records play an important role, with all team members recording in the patient record, and electronic results from all laboratory and other tests, and electronic information from hospitals on any inpatient services all included.

The Ontario experience has:

• made family medicine more attractive with approximately 40% of medical graduates choosing family practice as their first preference, compared with 24% in the 1990s
• improved access for consumers to their doctor of choice
• enhanced team based care
• provided more time for doctors to spend with patients, through the support from family health teams, and by reducing practice management responsibilities and the burden of employment accountabilities
• reduced attendances to emergency departments.

Participants in the Roundtable agreed that there is great opportunity to "unlock the potential of general practice" and build upon existing strengths in the Australian health system to provide integrated and multidisciplinary care. The group agreed that it is critical that we find ways to support and invest in primary health care as part of a better integrated health system in times of austerity and particularly when we have more people living with multiple chronic and long term conditions.

The question is: can we improve upon what we have got or do we need wholesale change to funding models – can we rebalance the system or do we need to "rock the boat"?

Those participating in the Roundtable emphasised:

1. Active engagement among political leaders, GPs, other health professionals and consumers in:
   • preliminary discussions to determine whether we improve upon what we have got or whether we need wholesale change to funding models
   • the overhaul or design of any new funding models to improve care and reduce health care costs
   • applying the learnings from international and national models and identifying the lessons that can be applied in the Australian context
2. Consider the following principles regarding any overhaul of funding in the Australian context:
   • support the delivery of team based person centred care led by general practice, which is coordinated and promotes continuity, and that will meet the growing demand for care, for those with multiple chronic conditions
   • support prevention and population health approaches that deliver improve health outcomes
   • reduce out of pocket expenses for consumers, noting that the costs include health insurance premiums, co-payments, payments for prescriptions, investigations and other treatments, travel costs and loss of income
   • promote innovation of new models of care to deliver local solutions that meet the needs of communities and acknowledge regional differences and circumstances
   • improved integration and connection between public and private providers of health care, and between primary healthcare and hospital services, to make the best use of all available resources
   • support the full integration of electronic health records to improve patient safety and quality of care
3. Utilise innovative pilot projects to explore the implementation of new funding models, with due consideration of the perverse incentives and unintended consequences. Pilot projects based on rostering (enrolment) of patients with chronic disease/s may be a suitable starting point to explore the opportunities and disadvantages of funding model changes.

Spokespeople are available from all host organisations for interviews.

Media contacts

APHCRI – Terry Findlay 0412 949 620

AML Alliance – Karen Warner 0438 179 520

AHHA – Alison Verhoeven 0403 282 501

CHF – Mark Metherell 0429 111 986