Advice to the National Roundtable on Primary Care

Last fall, Judy Birdsell, ICN’s Board Chair, had the rare opportunity to meet and hear from leaders in Primary Care from other parts of Canada at the invitation of The Honourable Jean-Yves Duclos, Minister of Health. 

“This was an invaluable experience, not only to have ICN’s voice at a national table, but to meet ten other exemplary leaders in Primary Healthcare from across Canada,” says Judy. “This opportunity has enabled connections with several individuals at the roundtable.”

With input from ICN members, we brought the following key messages to the Roundtable:

  • Everyday Canadian citizens need to be embraced as key stakeholders and supported to be effective in that role. It is critical to differentiate the commonly used term of patients from citizens (everyday people with multifaceted lives). Patient connotes dependence rather than partner in care.
  • The community should be the primary level at which we deliver and report health. Community represents a key source of the important physical, social, and spiritual assets that enable health.
  • Our ‘North Star’ for health should be outcomes that matter to all key stakeholders including those important to citizens, not just funders and service providers.
  • Structural change in primary healthcare must be designed from the ground up with full citizen involvement. Citizens are rarely treated as partners in structural and other changes in health care despite being the ultimate intended beneficiaries and funders.
  • Governments and funders must take a longer-term view and not always align with four-year electoral cycles. While focus on the current crisis in primary care is necessary it will not lead to fundamental change and progress unless firmly embedded in longer term strategies with clear goals.
  • Healthcare is only integrated if it is understood, agreed to, and experienced as such by the citizen needing care. Matching community care to needs requires citizen involvement. Community members are best placed to understand their needs.
  • The Medical/Health/Primary Care Home (whatever it is called) should be the anchor for health in most situations and should be the foundation for continuous, compassionate, individualized care when one needs it. One’s complete health record should be anchored to the citizen in their primary health home. Health supports should include consideration of all options available to citizens: online information, publicly funded services privately funded insurance add-ons, social services and so on.

Minister Duclos followed up with us and asked us to provide additional information on the health of communities and how patient perspectives can inform primary care transformation.

We believe that to transform primary care, we need to rethink the relationship between communities and the formal systems (healthcare, social, education…) that are part of them. We also need to recognize that communities are the front line of social determinants of health/illness. This means that we need to focus on community-level health and social outcomes, including physical and mental health, access to primary care teams, and other factors that contribute to healthy, safe, and vibrant communities. Feedback mechanisms like a community dashboard can help guide and inform community efforts.

Citizen perspectives should also be an important part of primary care transformation. Canadians need to be able to define what health and healthcare outcomes are important to them and expect progress toward health equity. We also need to build the capacity of citizens to be effective agents of change. This means empowering Canadians to be knowledgeable contributors to the design and implementation of new ways of delivering care at the community level.

April 2023