Tackling complexity through integration

Canada’s family medicine crisis is complex. The health care system faces an aging population, increasing rates of chronic conditions, high rates of migration and ethnocultural diversity, and growing fiscal constraints. Health systems are also facing the challenges of the 4 Cs: COVID-19, cost of living, conflict, and climate change.¹ All are intertwined and are creating complexity never before experienced and far too complex for a single provider to manage alone. The future of family practice lies in integration.

The College of Family Physicians of Canada (CFPC) outlines a community-oriented system of integrated primary care in its Patient’s Medical Home vision.² This vision is based on models of primary care organized in teams of health care providers. These Patient’s Medical Homes are embedded within linked community and social services and secondary and tertiary care facilities, forming Patient’s Medical Neighbourhoods.³ The vision is that patients move seamlessly through these neighbourhoods, receiving the right care by the right provider at the right time in the right place. Services are driven by the needs of the community and resourced accordingly. Patient’s Medical Homes and Neighbourhoods are digitally enabled and connected with interoperable electronic medical records and virtual platforms that support team communication and collaboration. Continuity of care is shifted from the patient–family doctor dyad to the patient-team relationship.

To achieve and sustain this vision of integration, health professional education must be transformed in parallel. Family physicians must be resourced to gain the knowledge and skills needed to collaboratively address complexity and lead high-functioning primary care teams. The aim of the CFPC’s Outcomes of Training Project⁴ and Team Primary Care: Training for Transformation⁵ is to transform family medicine education to better support family doctors to work and lead within the rapidly evolving system. The Outcomes of Training Project will resource additional training experiences in key areas of societal need and medical and technological advancement, while Team Primary Care will provide enhanced training opportunities for practitioners. Both projects aim to better address the challenges faced by communities and the health care system.

However, to manage the 4 Cs effectively, integration needs to extend beyond the practice and training environments: it must also occur across sectors and systems. In Canada, we have relatively robust primary care and public health systems, but they arguably do not work closely together, and the pandemic highlighted challenges created by this lack of integration. An international survey, FM Vax, on the integration of public health and primary care in COVID-19 vaccination campaigns, demonstrated the efficiencies gained when these systems are integrated: the greater the integration, the greater the system efficiencies.⁶

In May, I was fortunate to attend Thriving People and Flourishing Planet: Leadership in Action, a working summit where a group of leaders from various sectors came together to address the challenges we are facing in terms of planetary health, social inequities, and worsening health outcomes. The strategies collected were inspiring, despite the dire context emphasized by the organizers. Participants developed hundreds of practical, pragmatic actions over a few hours, confirming the power of integration across sectors.⁷

The future of health care in Canada lies in micro-, meso-, and macro-level integration, across professions, systems, and sectors. Let’s not waste this crisis. Let’s continue to work collaboratively to build a better system—one that values and supports family physicians and ensures accessible, efficient health care for everyone in Canada.

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