Improving access to primary care through team-based care

Primary care in Ontario is in crisis, and team-based care is a key solution to helping the 2.3 million people in the province without a family doctor. In this second episode of a three-part series, physicians explain the benefits of team-based care for themselves, the patients they serve and the system as a whole, based on the Ontario Medical Association's Prescription for Ontario: Doctors’ Solutions for Immediate Action advocacy document. Listen in as we hear from Dr. Sundeep Banwatt, a family physician in Mississauga and the clinical director of the integrated primary care centre CarePoint Health, and Dr. Riva Levitan, a family doctor in Ottawa who works in a family health organization.

Transcript

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Georgia Balogiannis: In this podcast, the Ontario Medical Association looks at current issues of interest in healthcare. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

Primary Care in Ontario is in crisis and team-based care is a key solution to helping 2.3 million people get access to a family doctor. This second of a three-part series looks at the OMA’s recent advocacy document for change, titled Prescription for Ontario: Doctors’ Solutions for Immediate Action. Physicians explain the benefits of team-based care for patients, doctors, and the system as a whole. 

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Georgia Balogiannis: Dr. Sundeep Banwatt is a family physician in Mississauga and the clinical director of the integrated primary care centre CarePoint Health.

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Dr. Sundeep Banwatt: I connect with team-based care in two fashions — one as a clinical director for CarePoint Health, which is a interprofessional integrated primary care centre, and we extend team-based care services to those physicians who affiliate with us directly. And in the other capacity I'm also an affiliated physician who gets the benefits of these team-based care services as an individual private-practising family physician. Accessing or being able to access team-based care is just allowing the ability for more wholesome and holistic approach to patient care. 

As a family physician, we deal with a host of different health issues, but there are other allied health professionals who can help really add to a patient's healthcare journey. So in family medicine, there are a lot of single and solo providers who don't have access to team-based care. As clinical director at CarePoint, our goal and our mission has been to connect team-based care services to any physician payment patient enrollment model, regardless if they're fee for service, solo practise, group practise, family health organisations. 

Now, it's been a challenge trying to get individual, autonomous practises to connect and affiliate with a new organisation was always a challenge, but part of what we did to break down those barriers is I go into practises on a regular basis to talk to physicians where they work to discuss the challenges they have, and we meet with our physicians on an ongoing, regular basis, both virtually in emails and in person. And that's the big commitment that we've made to help facilitate practises. 

By doing that, we offer our practise facilitators to help with change management, to offset any of the onboarding, to not make and add burden to their practises, thereby allowing kind of a seamless transition towards team-based care services. The funding came through business case application through the interprofessional care team business case, and using that type of funding allows us to then create these affiliations with doctors and family doctors in our region. And that then allows us to take over the team-based care approach and help physicians transfer their kind of practise towards a team-based approach.

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Dr. Sundeep Banwatt: So how do we extend these team-based care services to a group in a community, especially in an urban centre? How do we achieve that? They're all on different EMRs and they're all on different platforms, and we use different technology tools to create that connection and use technology to connect back with them as well. Team-based care is an important part of a patient's need for their healthcare, but it's also integral in terms of the work I do as a family physician, as it allows me to affect other parts of health that are not just thought of as the medical part of health. 

The social determinants of health are a huge component of a patient's journey through their health. Team-based care is a challenge when I can't access it efficiently and effectively. How do we make that connection efficient? How do we make it easy? How do we not add work to our plate that's already so heavy to begin with? 

And how do we ease that burden on family physicians and team-based care services allow that allied health commission to be a part of the team and to contribute greatly to a patient's care. This is a community initiative that starts with a smaller group of family physicians, but we're also looking at the community at large and hope to be able to expand team-based care to our whole region when family physicians and patients who need it.

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Georgia Balogiannis: Dr. Riva Levitan is a family doctor in Ottawa who works within a family health organisation.

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Dr. Riva Levitan: The government or the Ministry of Health is going to have to decide either they want to get family medicine working again and allow us to work at top of scope and open up the pocketbooks providing funding for team-based care. I think they need to figure out a way to get team services and money to support them out to the community. It can't come out of our income. When I pay my nurse, when I pay my MOA, that is all coming out of my gross, but I cannot be paying for a nurse practitioner, a dietitian, a social worker to do my case management. 

Instead I do that all myself and that's become very, very difficult as patients have gotten more and more complex. I would love to see mobile teams for team-based care that go around and support community offices. And one thing that is dire for us and takes tons of time is our work on case management. Super complex patient with psychosocial problems. You need to call around, accessing care. A lot of paperwork goes into that. A lot of time goes into that. That is not the role of a family physician. That is the role of a case manager in a family practise team. If they could just get us case management urgently now, that would decrease my burden personally, for sure.

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Dr. Levitan: If we don't figure out a way to support these community physicians, you're just throwing the baby out with the bathwater. They will just become more and more stressed. Strained practises will become obsolete and unmaintainable. And physicians retire, period. People don't go into practises without adequate supports. I would like the Ministry of Health to put their money into some infrastructure for community practises. 

If I was able to develop the suite down the hall from my practise, which is large enough for six physicians — there are four of us in our building who would like to move into that suite and we would then be able to recruit two others. And this would be a practise that could have some longevity. However, two small family practise offices with two physicians each — new grads are not looking for those situations.

Georgia Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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