Overview

Governance

For most family physicians, the development of new and changing primary care models has led to higher levels of sophistication in the way care is organized and managed. New or changing models of primary care mean new or different relations and agreements with others within the health system - patients, providers, managers and health authorities. This has led to the need for family physicians to be more knowledgeable about the governance agreements they make with health authorities and between themselves, whether assumed or contractual. Nevertheless, it is well recognized that some governance agreements have led to considerable controversy amongst family physicians and between family physicians and health authorities because of their length, amount of detail and use of language that could be misinterpreted or that requires legal counsel to translate. While appropriate remuneration is the key enabler for family physician commitment to new primary care models, reaching an acceptable governance agreement is almost equally as important.

Most family physician leaders have embraced more structured and organized primary care developments. However, the reality is that all family physicians need to become more knowledgeable about the implications of governance agreements signed between family practice groups and provincial / territorial health authorities or governments – that is, the effects of governance on the system's expectations of themselves, their patients, other managers and funders of healthcare systems. Family physicians have a role in primary care governance agreements and all family physicians must have access to decision-making authority where their voices will be heard.

Even so, some family physicians will still view governance agreements with disinterest because such material will be viewed as lacking the clinical stimulation of patient care and decision-making. For these physicians, it may be important for their family physician associates and leaders to guide them and to point out the effects of governance on themselves and the more formal and structured primary care models in which they work. It should also be understood that this primary care toolkit resource on governance is intended to be a fundamental help to family physicians in developing primary care models – but will not provide all of the details associated with the wide variety of governance agreements being used and considered all across Canada. For the astute family physician interested in detailed governance agreements, there will always be the need for more information.

Governance implies accountability. Accountability is bi-directional. While governments and health authorities are required to meet the expectations of family physicians within new or changing primary care models as defined by their governance agreements, family physicians, in turn, are also accountable to meet their patients' and communities' expectations for the delivery of health services. For while most Canadian family physicians are familiar with the limitations often imposed by their accountability for clinical care within a publicly funded system, governance within the development of new primary care models implies accountability in a different ways - to new structures and new relations with unfamiliar organizations. Whether ultimately dealing with regional health authorities or family health teams, it is incumbent on family physicians in each local jurisdiction or region to understand and appreciate the kinds of obligations and responsibilities they may assume within new governance and contractual agreements either with health authorities or between one another and other providers. And it is recommended that these be understood long before family physicians are asked to sign on the dotted line of a new agreement.