Question Period Note: Family Health Teams

Far too many Canadians are still struggling to secure timely access to family health service, whether from a doctor, nurse, or team of providers. This issue disproportionality impacts those living in rural communities.
Recently, media reports and experts have been framing the lack of timely access to family health services as a crisis, with repercussions for the broader health care system.

• The Government of Canada recognizes that far too many Canadians lack timely access to a regular family health services provider.
• Budget 2023’s historic announcement includes close to $200 billion over 10 years for health care, including $25 billion over ten years to support provinces and territories through bilateral agreements.
• Improving access to family health services is at the core of these bilateral agreements.
• Transforming the delivery of those services, including through team-based care, will help Canadians get care when and where they need it, from a team, doctor or nurse practitioner.
IF PRESSED ON HOW FEDERAL INVESTMENTS ARE ENHANCING ACCESS TO FAMILY HEALTH SERVICES…

· Transforming how family health services are delivered will improve access to care, better support our health workers and better support the health system as it adapts to the changing needs of Canadians.
· Team-based care can play a key role in expanding access to family health services in that it is centered on the patient, who can get the services they need from a range of health providers, when and where they need them.
· The historic investments announced in Budget 2023 support the provinces and territories in their efforts to transform family health services.
IF PRESSED ON THE NUMBER OF CANADIANS WITHOUT A FAMILY HEALTH SERVICES PROVIDER…

· Our government recognizes that Canadians continue to face challenges in accessing a regular health care provider, be that a doctor, nurse practitioner, or team of health care professionals.
· According to Statistics Canada, in 2022, approximately 14% of Canadians did not have access to a regular health care provider.
• As part of the Working Together plan, there is a federal, provincial and territorial commitment to collect, use and share health information and to inform Canadians of progress with key common indicators.
• The Canadian Institute for Health Information (CIHI) is leading a process to review and refine eight initial common indicators, including one related to measuring access to family health services.
• CIHI released an initial snapshot of indicators for the four shared health priorities in August 2023 drawing from available data. CIHI relied on the 2021 Statistics Canada data for the family health services indicator, but due to differences in calculations, the CIHI report indicates that approximately 12% of Canadians do not have a regular health care provider.
• CIHI and Statistics Canada are currently working together to refine these indicators.
IF PRESSED ON INVESTMENTS IN FAMILY HEALTH SERVICES WITHIN PROVINCIAL AND TERRITORIAL ACTION PLANS…

· The government of Canada has now signed bilateral agreements with all provinces and territories under the Working Together plan, and we are encouraged by the strong collaboration that is driving progress in access to care.
· These agreements are flexible, and provinces and territories have tailored them to address the unique needs of their populations and geography.
· Through these agreements federal funds are being used to strengthen family health services, for example:
o Alberta is expanding team-based care and enhancing virtual care to increase access to family health services.
IF PRESSED ON HEALTH HUMAN RESOURCE CHALLENGES, INCLUDING SHORTAGES BEING FELT ACROSS THE COUNTRY

· Our government recognizes that health human resource shortages are creating challenges for all Canadians to get timely access to family health services.
· Budget 2024 proposes to provide $77.1 million over four years, starting in 2025-26, to address critical health human resource supply challenges.
· This funding will support the integration of IEHPs into Canada’s health workforce by reducing barriers and addressing critical gaps in training opportunities.
· Funding will create 120 medical residency training positions, increase capacity to support accelerated licensure processes and get IEHPs working more quickly and provide support to help IEHPs navigate credential recognition systems.
IF PRESSED ON VIRTUAL CARE

· In response to the pandemic, the Government worked with provinces and territories to accelerate uptake and use of virtual care, supported by $200M in funding in 2020.
· Since then, virtual care has become an important way for Canadians, including those in rural and remote communities, to get the care they need, when they need it.
· The historic investments announced in Budget 2023 will enable provinces and territories to transform the way family health services are delivered, including through virtual care, in ways that make sense in their respective contexts.

Family Health Services
Family health services are the backbone of high-performing health care systems. They serve a dual function in the health care system as the direct provision of first-contact services and a coordination function to ensure continuity across health care settings. However, Canadians continue to struggle to access family health services. In 2022, 14% of Canadians 12 years and over lacked a regular health care provider, with gaps felt particularly acutely by Indigenous populations. In 2021, 17.8% of Canadians lived in rural communities, but they were served (in 2022) by 12.8% of family medicine physicians practicing in Canada. In 2017-2020, 20.3% of First Nations people living off-reserve, 17.9% of Métis, and 56.5% of Inuit across Canada reported being without a regular health care provider. Recently, media reports and experts have been framing the lack of timely access to family health services as a crisis, with repercussions for the broader health care system.

It is well recognized that multidisciplinary team-based care is critical to increasing timely access to care for patients. Team-based approaches, with optimized scope of practice, create efficiencies that can allow primary care providers to add new patients to their panel thereby increasing provider-patient attachment, and improving timely access to care. Team-based models of care can improve quality of life, well-being and satisfaction for providers resulting in improvements to retention and recruitment. Team-based models also offer the potential to enhance access to services that have traditionally not been well integrated with primary care, such as mental health and substance use and addiction services, as well as with the broader social services sector.

Virtual Care
Virtual care is increasingly recognized as an important component of high-quality care and can help support access to family health services, particularly in northern, rural and remote communities. The adoption of virtual care accelerated as a health system response to the COVID-19 pandemic. In 2020, in response to the pandemic, the Government collaborated with provinces and territories to accelerate uptake and use of virtual care, supported by $200M in funding in 2020. $150M of this funding was provided to provinces and territories through bilateral agreements to enhance virtual services and $50 million went to Canada Health Infoway to support provinces and territories to implement virtual care.

Federal Investments
Budget 2023 outlines the federal government’s plan to provide close to $200 billion over ten years in health transfers to provinces and territories, including $46.2 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, funding for personal support workers, and an increase to the Territorial Health Investment Fund. In addition, Budget 2023 announced $2 billion over 10 years to address Indigenous health priorities and $505 million over five years, starting in 2023-24, to the Canadian Institute for Health Information (CIHI), Canada Health Infoway, and other federal data partners.

Canada Health Transfer Five Percent Guarantee: The federal government will provide top-up payments to achieve Canada Health Transfer increases of at least five percent per year for the next five years. The last top-up payment will be rolled into the Canada Health Transfer base at the end of the five-year period, resulting in a permanent funding increase. This represents an estimated $17.1 billion over ten years in additional funding through the Canada Health Transfer.

Tailored Bilateral Agreements: The federal government will provide $25 billion over ten years through a new set of bilateral agreements to address individual provincial and territorial health system needs, such as expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems through standardized health data and digital tools.

Bilateral agreements are intended to be flexible and provinces and territories have options to tailor their respective Action Plans in response to the unique needs of their populations and geography. The Government has now signed bilateral agreements with all provinces and territories. Agreements and action plans are available online from the Government of Canada and provinces and territories will provide annual progress updates to their residents.
HHR and FPT Collaboration
Budget 2024 proposes to provide $77.1 million over four years, starting in 2025-26, to address critical health human resource supply challenges. This funding will support the integration of IEHPs into Canada’s health workforce by reducing barriers and addressing critical gaps in training opportunities. Funding will create 120 medical residency training positions, increase capacity to support accelerated licensure processes and get IEHPs working more quickly and provide support to help IEHPs navigate credential recognition systems.

On October 12, 2023, FPT Ministers of Health issued a public statement reaffirming their commitment to supporting Canada’s health workforce so our health workers are able to provide high-quality, accessible, and effective health services for people living in Canada. In particular, FPT governments committed to concrete actions focusing on:
• Retention, reducing rates of stress and burnout and improving workplace culture, flexibility, and wellness so health workers can stay in their jobs;
• Domestic education supply and demand, enhancing Canada’s capacity to produce a domestic supply of key health professionals, including more training opportunities for Indigenous Peoples that meets national demand for care and keeps pace with a growing and aging population;
• Foreign credential recognition and ethical recruitment, making Canada a country of choice for health care providers by reducing the time it takes for internationally educated health professionals (IEHPs) to join our workforce;
• Labour mobility, supporting an agile and flexible workforce to support access to care; and
• Health workforce data and planning, improving the availability, sharing and standardization of health workforce data to support health workforce planning.

On November 1, 2022, the Government of Canada established a Coalition for Action for Health Workers. The Coalition’s efforts are focused on identifying approaches to drive pan-Canadian action and progress on policy implementation, informed by real world perspectives. The Coalition is comprised of representatives from key groups, including nurses, doctors, personal support workers, colleges and universities, patients, and equity-seeking communities, and reports to the Deputy Minister of Health.

Digital Health and Health Data
Digital health tools and health data play an important role in facilitating integrated care, enabling team-based care, and providing patient access to personal health information. Yet, digital systems across the country are highly fragmented leading to a poor ability to collect, share, and use health data. The implications for primary care are significant, given its central role in enabling the coordination and integration of care across the entire health care continuum.

For example, according to CIHI’s snapshot report published in August 2023, in 2021, less than 2 out of 5 (37%) Canadian doctors (not including Quebec) reported sending patient information electronically to other doctors involved in their patients’ care. Recent Canadian research shows that Canadians want digital access to their entire health record and want their primary care provider to have this complete access as well.

Through the federal Government’s Working Together plan, provinces and territories will be able to invest in and build a world-class health data system, which will help:
• Canadians access their own electronic health information and make sure it can be shared between health professionals and across health settings, allowing patients and health care providers to work together more effectively;
• Clinicians have the information they need to make the right decisions with their patients; and,
• Governments make informed decisions for the overall improvement of Canada’s health care system and better prepare and manage for public health events, ultimately benefitting all Canadians.

In 2022, 14% of Canadians 12 years and over lacked a regular health care provider.
In 2021, 17.8% of Canadians lived in rural communities, but they were served (in 2022) by 12.8% of family medicine physicians practicing in Canada.
In 2017-2020, 20.3% of First Nations people living off reserve, 17.9% of Métis, and 56.5% of Inuit across Canada reported being without a regular health care provider.
Access to family health services is a shared health priority identified in the Government’s plan for Working Together to Improve Health Care for Canadians.