Focus on concrete solutions

Michael E. Green

doi:10.46747/cfp.6708563

Dr Ladouceur’s editorial on the important and pressing issues related to the recovery and restoration of primary care services in the third wave of the coronavirus disease 2019 (COVID-19) pandemic missed the mark.¹ While important issues were raised, such as ensuring access to in-person care and appropriate use of virtual care, the commentary and tone were disrespectful and based mainly on anecdote rather than evidence.

As a member of Ontario’s Primary Care Advisory Table on COVID-19 I have been working alongside colleagues from many diverse practice contexts, sharing our insights with each other and the Ministry of Health. These are complex issues related to a range of factors including access to personal protective equipment, Infection Prevention and Control Canada limitations on how practices can operate, local prevalence of COVID-19, etc. Temporary changes to payment structures for physicians have been put in place that may have had unintended consequences. Some of these, like funding models that support virtual care, have the potential for long-term benefit but may need adjusting to ensure they do not disrupt continuity of care or provide patients false reassurance for situations where virtual care is not appropriate.

We also need to look to the future and consider how we can carefully and safely lift some of the burdensome restrictions around active screening, physical distancing, disinfection practices, etc, as COVID-19 infection rates drop and levels of immunization rise. These are the issues that need addressing; we do not need sweeping statements that suggest it is simply the payment models or financial imperatives that are driving the challenges we observe in access to in-person care. In our health care system there is no choice but for most practices to be both businesses and places of care, so these should not be seen as incompatible concepts. A bankrupt practice cannot deliver care to the patients it serves. We should be supporting all of our colleagues with the recovery and restoration of more usual service delivery with concrete advice on how to move forward, rather than pointing fingers.