Primary Healthcare

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.

  1. Work Down the Backlog 
  • Gain immediate capacity. 
  • Temporarily add appointment slots. 
  1. Reduce demand 
  • Maximize activity at appointments. 
  • Build service agreements between primary and specialty care. 
  • Extend intervals for return appointments.
  • Create alternatives to traditional face-to-face interactions. 
  • Reduce demand for physician visits by optimizing team roles. 
  • Discharge patients to primary care from specialty care. 
  • Optimize patient involvement in care. 
  1. Understand Supply and Demand 
  • Know your demand. 
  • Know your supply. 
  • Consider doing today’s work today. 
  • Make panel size equitable based on clinical FTE. 
  • Establish input equity for specialty clinics. 
  1. Reduce Appointment types 
  • Use only a small number of appointment types. 
  • Standardize appointment lengths. 
  1. Plan for Contingencies 
  • Manage demand variation proactively. 
  • Develop flexible, multiskilled staff. 
  • Anticipate unusual but expected events. 
  1. Manage the Constraint 
  • Identify the constraint. 
  • Drive unnecessary work away from the constraint. 
  1. Optimize the Care Team 
  • Ensure all roles in practice are maximized to meet patient needs. 
  • Use standard protocols to optimize use of other providers. 
  • Separate responsibilities for phone triage, patient flow, and paper flow. 
  1. Synchronize Patient, Provider, and Information 
  • Start the first AM and PM appointment on time. 
  • Do patient registration by phone when confirming the appointment. 
  • Use health prompts to anticipate full potential of today’s need. 
  • Make sure that rooming criteria includes having the patient ready. 
  1. Predict and Anticipate Patient Needs at Time of Appointment 
  • Use regular “huddles” to anticipate and plan for contingencies. 
  • Communicate among care delivery team throughout the day. 
  1. Optimize Rooms and Equipment 
  • Use open rooming to maximize flexibility. 
  • Standardize supplies in exam rooms kept stocked at all times.
Years In Business
0 %
Positive Client Experience
0 +
Projects Completed

Join our list of satisfied clients


Angelo Farneti, DirectorAcklands Grainger
Read More
“While I have rarely been a proponent of consultants, The Poirier Group and their supportive approach have positively changed my view to the immense value that the right consulting organization can bring.”
Joe Rollins, Store OperationsBig Lots
Read More
“Your excellent communication and overall leadership was appreciated. I felt like our two groups were true partners on this project and achieved success together. Thanks again for you and your team.”
Doris Citric, DirectorHolt Renfrew
Read More
“Overall, I would give The Poirier Group an A+ in solution generation, service delivery and providing with a highly talented team to work with. Great work”
Janet Joyce, DirectorColemans
Read More
"Just want to acknowledge the excellent presentation yesterday. It was thorough, comprehensive and well received not only by the Steering Committee but even more importantly by owners. The presentation inspired their confidence in The Poirier Group and in the direction we are moving in this comprehensive process. Great job."
Randy Berry, SVP Operations ExcellenceGovPlanet
Read More
“Looking back on our time with The Poirier Group, we would not have been able to achieve our inventory management and overall business objectives without their services. If you are considering an engagement with The Poirier Group, I highly recommend them.”