The Toolkit
Introduction
Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
This toolkit may not be helpful to every practicing family physician. Some practices may not be changing and some physicians may elect to not participate in many of the changes occurring in primary care. However, for those family physicians experiencing and seeking to understand these changes, there is a degree of uncertainty and uneasiness with what may be perceived to be the present and future roles of family physicians in the Canadian healthcare system. These feelings are known to affect both experienced and newer family physicians as well as medical students and residents in their career selections. Although much of the leadership in primary care renewal has come from family physicians themselves, it is well recognized that many of the pressures that continue to force primary care change come from other leaders with diverse agendas in the health system. Much of what is discussed in this toolkit could be useful to those considering the development and implementation of quality improvement initiatives around any of the five themes described.
Nevertheless, it is quite apparent that family physicians entering or contemplating a transition to newer models of primary care practice need more and better information about the challenges associated with the implementation and adaptation of these models. Family physician leaders involved in newer models have repeatedly appealed for supports and tools to facilitate their sharing information and learning from each other about primary care initiatives across Canada. Using peer-presenter and train-the-trainer strategies in different forums with a special focus on those topics related to knowledge transfer in primary care, it is expected that family physicians will find this toolkit to be an asset in change management.
The aim of this toolkit is therefore to facilitate the sharing of perspectives of family physician primary care leaders from all across Canada and to collaboratively develop and disseminate tools that can be used to help family physicians better understand and accept newer models of practice. However, family physicians throughout the country are at differing stages of learning and experience in primary care renewal and will therefore want to pick and choose whatever is helpful in their special situation. And while the CFPC has attempted to be as inclusive as possible, this toolkit is recognized as containing an evolving set of tools, some too advanced and some not advanced enough for different members of the College.
At the outset of this toolkit, it is important to spell out Goals, Principles and Common Elements of relevance to family doctors and that should be applied to many aspects of primary care renewal throughout Canada.
The Goals of primary care renewal should include:
- Preserving the family physician-patient relationship as central
- Improving frontline access to healthcare
- Increasing patient and provider satisfaction with the healthcare system
- Improving the quality of care for patients
- Ensuring the continuity of care for patients
- Increasing the cost-effectiveness of healthcare services
- Improving physician health and wellbeing
Principles that should be applied in the renewal of the primary healthcare system include:
- Community needs assessments
- Voluntary participation of providers and patients
- Collaboration in the implementation of changes
- Developing incentives for patients and providers in supporting change agreed to by those being cared for and those working within the system
- Alignment of primary healthcare with the rest of the health system (vertical as well as horizontal integration)
- The provision of comprehensive care in patient-centred health services
- Ensuring continuity of care
Common Elements being applied to primary care renewal strategies include:
- Patient enrollment (rostering)
- Grouped or networked practices
- Increasing focus on interdisciplinary collaboration in providing care
- Extended access hours
- Enhanced use of information technology
- Expansion of ways to remunerate providers and to fund primary care models
This toolkit and its related aspects have been developed to provide family doctors and other primary care groups in which family doctors practice with a menu of strategies, better practices, key success factors and pitfalls, relevant learnings, and references to additional resources that should be of value to family doctors who are experiencing changes in primary care renewal throughout Canada.
In using this toolkit, family doctors will discover a focus on five key themes. These themes and the materials contributing to each were developed and agreed-upon through the consensus of a number of family doctor leaders in primary care throughout Canada. Support for the development of these themes has come from The College of Family Physicians of Canada (CFPC) and the Government of Canada through Health Canada.
The five themes that form a framework for the development of this toolkit are considered of essential importance to family doctors experiencing change in primary care renewal. These themes form a framework for discussion and while they may not be totally- encompassing, given the experiences of each and every family doctor, they are key to establishing or revising primary care models that recognize the highly valued roles of family doctors in primary care. Each theme has been developed with related resource materials attached for those who wish to use them to address issues that may be beyond the current reaches of this toolkit.
Finally, it goes without saying that just as nothing in healthcare remains static, so the principles, elements and resources of this toolkit will need to be reviewed from time to time to ensure their ongoing relevance to the experiences of family doctors and the continuing evolution of our healthcare system in Canada.
The five themes are: