Did you know, only 88% of Canadians have a primary care provider versus 95% in our comparative countries? Evidence shows that timely access to primary care resources, reduces illness and even death. When patients are able to see their primary care Doctor and get the attention they need at the right time, the increasing downstream burden on acute care, homecare, and long-term care is reduced.
Primary care is typically a one-on-one model, vital for providing first-contact, accessible, continuous, comprehensive, and coordinated care for patients. Despite the intent, over six million Canadians lack a primary care provider even though physicians in Canada have increased. Almost half of the doctors are general practitioners.
There are several issues creating this patient-provider gap including: doctors’ workload; administrative duties; funding models; uneven geographical distribution; and early departures from their practice due to burnout and financial strain.
The issue of no national standardized physician fee schedule, with historical differences compared to their counterparts in many other countries, leads to disparity in fee schedules and differentiated per capita spending. This disparity has burdened Canadian physicians, who often run independent practices, as they struggle to remain financially viable amidst rising costs and increased patient complexity.
Concerns regarding healthcare accessibility and quality in Canada are mounting, as a significant portion of Canadians lack an assigned primary care physician. A recent Angus Reid Foundation survey found that about 40% of adults encountered difficulties accessing key health services such as emergency and non-emergency care, surgeries, tests, and specialist appointments over the past six months.
The implication of difficulties in accessing primary care leads to delayed diagnoses and treatment, increased reliance on emergency services, and reduced health outcomes for patients who could have benefited from earlier treatment.
Canada’s GP structure is typically one issue per visit which creates a gap in care as many patients with a chronic disease need a more holistic approach. A congruent fee structure would properly compensate the care provider to allow a comprehensive visit focusing on improving their patient’s overall health. This solution would free up the burden on downstream health system resources and reduce physician backlogs.
This key measure is currently elusive at best. There is no standard patient workload or requirement for Doctors to publish how many patients they have on their panel, or roster. Panel size presents a challenge as it does not account for the differing needs of individual patients.
For instance, while both a healthy 30-year-old and an 80-year-old COPD patient are counted as “one,” their care resource requirements significantly vary. Creating a standardized patient health scale, like the Candian Triage and Acuity Scale, would allow us to truly understand the daily workload that physicians feel in Primary Care.
The connection between primary care and specialty care is sometimes slowed due to referral bias. One physician may prefer the services and techniques of a specific specialist and only refers their patients to that provider. The best experience for the patient is to use pooled referrals, which puts the patient in line based on need and time entering the referral cycle. This method reduces overall wait time, improves health outcomes and reduces future burden on the down stream services.
1. Increase Virtual Care Where Appropriate
The healthcare landscape underwent significant transformation during the pandemic, notably with a marked increase in virtual care utilization among providers and patients. Following the stabilization period post-pandemic, some provinces have revised the billable rates for in-person and virtual consultations, creating a significant incentive and bias for in-person patient visits. This emphasizes the significance of the in-person patient-doctor relationship.
However, as demand continues to increase across the country, there is opportunity to alleviate a GP’s workload by streamlining virtual consultations for simple visits such as prescription refills and minor ailments. We do believe proper funding for virtual appointments should be reinstated where it has been withdrawn. Until that happens, we can help with the Advanced Clinical Access model to strategically schedule in-person appointments, reduce visit times and add virtual appointments where appropriate, add or increase the use of automated dictation, and increase patient and Doctor interactions. These methods would help physicians and clinics manage patient load more efficiently, reduce the staff workload and where desired, expand the patient panel size.
2. Advanced Clinical Access
Advanced Clinical Access, which Dr. Mark Murry created, seeks to predict the daily patient demand for care and respond to it rather than attempt to control it. The model is based on the principle that when supply and demand are equal, there is no need for waiting in the system. While traditional systems divide demand into urgent and routine seemingly to control demand, it creates two separate queues for different types of patients. Removing the queues removes the delay. An Advanced Access system is designed to eliminate waiting times. To do this, each clinic must manage its total resources to provide care. When the resources are managed well, capacity is created. In an optimal system of “advanced access,” an organization provides enough capacity in the clinic for health services to meet the demand of its patient population at the time the demand occurs.
Traditionally, healthcare organizations have viewed the demand for healthcare as insatiable. Therefore, the typical approach to access was built on the need for barriers in order to not to be overwhelmed by patient demand. Improving access therefore involved complex scheduling systems, a wide variety of appointment types and lengths, long waits to see providers, the transfer of demand to other areas of the health care system such as urgent care or the emergency department, and elaborate triage systems that attempted to distinguish patients who could wait for care from those who could not.
The following strategy will build a sustainable system for Advanced Access.
