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How a primary care 'matchmaking service' kept practices alive in Ontario amid Covid-19

August 27, 2020

    Last year, the Ontario Ministry of Health passed legislation calling on all providers to form integrated health systems—called Ontario Health Teams (OHTs)—to provide defined populations with health and social care under a single funding envelope.

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    This was a significant endeavour: To be successful in any integrated network, it's crucial to involve primary care at the system level—but that's proven to be a persistent challenge in Ontario. For context, primary care in Ontario is quite splintered, with a mixture of capitated, fee-for-service, team-based, and independent practice arrangements.

    So, to gain true representation within the system, primary care organisations in each region must first band together into networks, build trust, and then elect representatives to sit at the OHT governance table on their behalf. This was the big movement in Ontario's primary care space in early 2020.

    Then, the new coronavirus hit. As attention quickly shifted away from OHT development and toward managing the pandemic, primary care organisations in Ontario were left to fend for themselves with limited provincial assistance.

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    Overnight, practice volumes dropped through the floor, and GPs had to either shift immediately to telehealth, find enough personal protective equipment (PPE) to treat patients face-to-face, or shut their doors entirely. Primary care leaders in the North York region of Toronto quickly realised that many GPs across their region (especially those paid for volumes) might have to close their practices if these problems were left unaddressed.

    To address the situation, four GP leaders from the local hospital, a primary care practice, and the North York Toronto Health Partners (NYTHP, the formal name of the local OHT) took it upon themselves to set up a GP matchmaking service to maintain practice viability when Covid-19 first struck. They used a two-step process:

    • First, they created a roster of more than 600 family practice physicians in the area by gathering their names, email addresses, telephone numbers, fax numbers, and postal codes—a tedious but necessary task, as this regional list had never been codified before.

    • Then, they sent out a survey to all the GPs asking about business needs, extra schedule availability, and whether they would keep their practices open to in-person appointments. They then used the survey results to match physician supply, patient volumes, and PPE across the region to keep GP practices open and maintain financial viability.

    The figure below outlines the three ways North York's 'matchmaking' service enabled GPs to continue practicing: 

    This initiative not only allowed GPs to continue operating, but it also laid the groundwork for future GP partnerships in the region. Currently, the GP leaders are working to formalise the network's governance structure.

    While it may seem like a chaotic time to focus on governance and trust-building, the GP leads recognise that they have a small window of opportunity to codify these arrangements before the heightened willingness to partner in new ways goes back to pre-Covid levels.

    As health systems in Ontario recover from Covid-19's initial impact, they'll likely return to OHT development. Going forward, primary care organisations in North York will have a more formalised structure within the OHT and more effective representation.

    As your organisation recovers from Covid-19's initial hit, consider how you can codify arrangements that grew out of natural innovation over the past few months. Many jurisdictions saw advancements in integrated care programmes since tackling Covid-19 effectively required collective efforts from all parts of the health system. Now is the time to formalise these new approaches and partnerships.

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