Supporting primary care: Tool kit for the future

Tom Bailey

Less than a decade ago, family doctors across Canada began to hear whispers about “primary care reform” (PCR). The meaning wasn’t initially evident, and perhaps it still remains obscure.

The term “primary care” is not well understood by the public, or perhaps even by the professionals actually working in the domain. While primary care defines first-contact services, family doctors provide services to their patients at primary, secondary, and even tertiary care levels. Family medicine is much more than primary care.

As professionals working to keep up with increasing demands, family doctors might wonder why primary care is in need of reform.

First, good evidence suggests that primary care matters to the health outcomes of populations. The work of Dr Barbara Starfield in particular has highlighted the benefits of a strong primary care system that includes family doctors. Countries with strong primary care systems have better health outcomes.

Second, there is evidence of substantial variation in outcomes within the primary care system. As the standards of care for different populations vary widely, it is evident that the system could do better.

Third, evidence suggests the health needs of populations are changing and will continue to change in the future. The aging baby boomer cohort is but one example of changing system demographics to which primary care must adapt.

So in a very real sense, PCR is “evidence-based.” For all of the above reasons, primary care needs both renewal and reform. And since most patients do not require health care services beyond primary care, it should not be surprising that so much of health policy focuses on this part of the system.

A lot has happened since the advent of PCR. Most family physicians in the country have been affected in some way, and many claim the reform has not gone far enough.

In response, the College of Family Physicians of Canada (CFPC) began an intensive examination of the future of family medicine in 2000. An important outcome of this was a position paper entitled Family Medicine in Canada—Vision for the Future, released in November 2004. This paper calls for the need to value, support, and strengthen the family doctor’s role in primary care as well as other parts of the health care system.

With the support of Health Canada, the CFPC has also led 4 projects to strengthen this role:

Family Medicine Interest Groups;
Increasing the Role of Family Medicine in the Undergraduate Curriculum;
Family Physicians and Other Specialists—Working and Learning Together; and
Increasing Support for Family Physicians in Primary Care.

While each of these projects has made valuable contributions to family medicine in Canada, Increasing Support for Family Physicians in Primary Care tackles an overarching issue—the very nature of the practice of family medicine in the future. Without adequate support for family practice—despite all the evidence for its pivotal role in health care delivery—we stand at the brink of a crisis. There is no need to interest medical students in family medicine or become more recognized in the medical school curriculum if we cannot sustain the core practice of family medicine.

This project has brought together family physician leaders from across the country to assist family doctors as they become more involved in PCR activities. The project resulted in creation of a primary care tool kit built around a framework of 5 key themes: remuneration, governance, interdisciplinary collaboration, continuity and comprehensiveness of care, and information technology.

Other projects in the last few years have focused on some or all of these activities, but few have come close to mastering them. The tool kit provides an overview of each of the themes and describes the key success factors and pitfalls related to each. In addition, the tool kit provides resource documents.

The tool kit is available from the CFPC website (http://toolkit.cfpc.ca). Resources will be added as they become available. Users will also be able to print or e-mail documents from the tool kit.

The tool kit is intended to be dynamic and interactive. This website will help guide family doctors as they continue to tackle the many challenges of system change and development. Much work remains in PCR. We hope this primary care tool kit will help many family doctors to better understand both the complexity of change and some of the approaches available for dealing with it successfully.