Primary Care Reforms in London, Ontario

This assignment focuses on primary care reforms in London, Ontario. It discusses the different primary care groups operating in the province and their setup and operation. It also explores the ongoing primary care reforms in Ontario, including the CCAC, LHINS, and new Super Agency. Additionally, it includes an interview with someone from a different culture to compare healthcare experiences in Canada and their country of origin.

Work Placement

Contents
Introduction......................................................................................................................................4
Aim of research................................................................................................................................4
Literature Review............................................................................................................................5
Question 1........................................................................................................................................6
Research Primary Care reform in your province.............................................................................6
How many primary care groups are operating?...............................................................................7
Describe how they were set up and how they operate.....................................................................8
Interview the clients/patients who have been selected, asking them to compare their health care
under the current model with their care under the fee-for-service model. What other primary
care reforms are underway in Ontario? (CCAC, LHINS, new Super Agency)...............................9
Question 2......................................................................................................................................10
Select and interview someone from a different culture about his/her experiences with health care
in Canada. Investigate what health care was like in this person’s country of origin by asking
him/her for details as well as by researching health care in this person’s country of origin to
create a more complete picture of the differences and similarities to the heath-care system in
Canada...........................................................................................................................................10
Write a comparison of the health care system in both countries...................................................10
Ask the person to identify problems he/she has encountered and what steps could be taken to
resolve those problems..................................................................................................................11
Make a list of the person’s recommendations for change and state whether you agree with his/her
recommendations and why............................................................................................................11
Question 3......................................................................................................................................12
After visiting several health care office settings, note the layout of the office and reception areas.
.......................................................................................................................................................12
Ask your interviewee if the layout is functional and if there is anything he/she would change
about the setting and why..............................................................................................................13

Taking into consideration safety from injury, fire safety, employees’ comfort, patient flow, and
safety from cumulative stress injuries, design an ideal office including layout and types of
furniture.........................................................................................................................................13
Provide reasons for each of your choices......................................................................................13
Conclusion.....................................................................................................................................15
References....................................................................................................................................16
Appendix.......................................................................................................................................18
Interview Questionnaire..............................................................................................................18
PHIPHA..........................................................................................................................................23
Thank You Letter..........................................................................................................................25

Introduction
Primary care is an important determinant of the welfare of the society. It is the duty of the
government and voluntary groups to make sure that the basic health facilities are provided to
public and there are continuous reforms along with research and development work is being
carried out. In assignment we have tried to understand the primary care reforms in London,
Ontario.
In order to have authenticity in research study, it is important that the interview is conducted so
that the popular opinion is obtained to advance the research study and detect the areas of
loopholes.
The people of London, Ontario are entitled to primary care reforms and it is important that the
research is an all-round one. The aim of research work carried out in the healthcare sector must
be to uplift the health care level and ensure that there is uniformity in giving out healthcare
benefits to the public of all race and cultures.
The national objective that has been set out by the government in the year 200, 2003 and 2004;
the government of Canada has resolved to have new approaches to primary care. There has been
change seen in the territorial and provincial government in bringing a change
Aim of research
Aim of the research is identifying the problem area in primary care and how far the service can
be improved. In order to understand the easy availability of the primary care in London, Ontario

there has been interviews conducted so that the loopholes could be seen well and the reported in
order to take possible action.
In Canada there has been greater emphasis laid on shifting from the solo kind of practice to inter-
professional kind of medical practice. These will help in better and broader kind of healthcare
and preventive activities in the provinces.
It is to be noted that though the government has been taking enough care in improving the
primary care in Canada, the progress is regarded slow, by judging the rate of progress in the last
fifteen years.
The nature of the progress has also been very incremental which has made it difficult for the
statistics to collect reliable data and track down the improvement and progress made. The
reforms also vary in terms of jurisdiction being the product of decentralized form of government
wherein the primary care policy comes within the judgment area of the territorial and provincial
government. Due to this issue there has been a different seen in primary reforms if we are to take
entire Canada into consideration. One can say that the assessing the progress will be quite
difficult and it is important that each of the small unit is taken first and the researchers arrive at a
bigger conclusion that can be collectively applied to whole of Canada.
Literature Review
Ontario has a population that is going up to 13.7 billion which accounts for a total of 40% of the
population of Canada. $6, 109 is the average healthcare expenditure (per person) in Ontario. As
it has been mentioned above that since the year 2002 there has been many choices that have been
made by the government in the healthcare especially primary that has brought changes in many

fields. This includes compensation models, inter-professional team models which were supposed
to change the mode of Fee-for-Service (Ali 2016).
The primary area of change is payment incentives as well as promoting inter-professional team
care. Sadly, there has not been much effort seen in this area and the reason may be lack of
coordination between the government and the accountability structure (Meyer 2015).
Patience Act has help in making the Local Health Integration Network expands its role in the
healthcare sector. Under this program there are two major areas that have been included Family
Health Teams and Nurse Practitioner Led-Clinics. At present these two programs are having
about 3.5 billion patients but there are just 21% of the family physicians who are practicing in
both the programs (Ali 2016).
From here the conclusion can be drawn that there has not been much effects seen in this field and
it is not hard to understand that those who are involved outside the enrolment program are not
able to get the health benefits in the primary care department of Ontario (Ali 2016).
Question 1
Research Primary Care reform in your province
Ontario has seen primary care reforms. Fee-for-service, capitation, and pay-for-performance are
the three major reforms, then and now, that can be included under this heading. With the new
models that have come to play in Ontario there has been an increase in the total earning of
physicians has increased by 32 per cent (2006-2010) and the number of physicians who said that

they are satisfied with the development rose to 84 per cent in the year 2012 which was 76 per
cent in the year 2009 (Meyer 2015).
How many primary care groups are operating?
Understanding the primary care system in Ontario is no easy task and getting to know ways that
can help in easy access to primary care may be a difficult task. There are about 700, 000 people
in Ontario who are not able to access the primary health care.
Here it is also important to understand how primary care is perceived in Ontario. Primary care is
the main point through which an Ontarian can enter into the healthcare system that is being
operated by provincial and territorial government. Here the family doctors play an important
role. Family doctors in Ontario are liable to provide the service of primary care through two
accepted models- solo setting and also group based care.
Solo Setting
The other common name that is used for this service is the fee-for service model and this is the
traditional way that the doctors have been operating. In this method the doctors set up their own
clinic or/and hire some staff for the additional support. The fee is paid to the doctor for acquiring
the service.
The doctors who are operating in solo settings are using the Comprehensive Care Model (CCM).
In this model the patients and doctors get into an agreement. Here the doctor provides after care
hours and booking become easy for three patients who are enrolled (Muratov et al 2018).
Care Group

This was about the solo setting but the main concern here is that of listing out the care groups in
Ontario:
Family Health Groups (FHGs), Family Health Networks (FHNs) and Family Health
Organizations (FHOs) are the three major care groups that are functioning in Ontario. Under this
system the doctor starts to operate. Usually three doctors make up a group. It is seen that one
patient gets enrolled with one of the doctors in the group. After-hour care is being given to the
patients. The models that are mentioned here not to be included in the above mentioned models.
An example is Family Health Teams and Community Health Centres. Here the doctor work in
an inter-disciplinary groups and work with health professionals. The patients are thus provided
comprehensive care in a well-researched way. Care receivers need to enrol in these programs in
order to receive the care and take the services that are provided (Abdool 2016).
Describe how they were set up and how they operate
Here, the patients are being dealt with in this way so that the matters that can be avoided like the
basic injuries. This also helps in keeping the emergency department having less people so that
the most emergency cases can be attended at the earliest. In this regard, there shall also be
lessening in the wait time of the patients. The hospitals will also be more effective in dealing
with the emergency patients as it will reduce the strain on the management and the doctors.

Interview the clients/patients who have been selected, asking them to
compare their health care under the current model with their care
under the fee-for-service model. What other primary care reforms are
underway in Ontario? (CCAC, LHINS, new Super Agency)
When the interviewees were asked to compare the older model with that of the new ones based
on reforms they said that they are happy to it and the level of health care is improving in Canada
which is a sign of a good governance of the sector.
If we consider other primary reforms that are there for the development of Ontario healthcare
standards then LHINS has to be taken into consideration. Local Health Integration Network
makes sure that adequate funding is there for the healthcare sector in Ontario. It does so by
planning, distributing as well as integrating the funding to the provincial authorities of
healthcare. The funds are obtained from Ministry of Health and Long-Term Care (Bobadilla et al
2017).
A total of 14 CCACs are currently functioning in Ontario. Ministry of Health and Long-Term
Care is the funding body here too.

Question 2
Select and interview someone from a different culture about his/her
experiences with health care in Canada. Investigate what health care was
like in this person’s country of origin by asking him/her for details as
well as by researching health care in this person’s country of origin to
create a more complete picture of the differences and similarities to the
heath-care system in Canada.
The person who was selected belonged to India and had come to Canada on a contractual basis
job in a company that has its presence in India too. The patient had developed some
bruises/allergic reaction and had to visit the emergency department. He said that the treatment
was provided quickly and the people at the reception area were moderate in number. In India the
pressure is relatively high and the patient in a public hospital has to wait unless the case is that of
bleeding or breathing.
This could be interpreted as a good sign and can said that the reform is effective and that strain
and time consumption at emergency departments have reduced.
Write a comparison of the health care system in both countries.
The healthcare model that is being applied in Canada (Ontario) can well be applied in India if the
funding is proper. India is a developing nation and has been making considerable progress.
Bringing an improvement keeping in mind the healthcare models that is functioning in Ontario
will bring in greater changes.

If we are to compare the two countries data show that the total spending in the healthcare sector
if India is higher but due to greater number of receiver owing to the large population the quality
of care is compromised whereas in Canada it is sufficient.
Ask the person to identify problems he/she has encountered and what
steps could be taken to resolve those problems.
The problem that was encountered was that of accessing a previous medical records and names
of medicines that he had taken in the past. Those were not here in Ontario and he was sceptic
about taking a new one. But then it all went well in the end. There were not much issue in getting
the health access at short notice.
Make a list of the person’s recommendations for change and state
whether you agree with his/her recommendations and why.
Access is an important area where there could be more empowerments made and the provincial
and territorial government must be making it easier for the patients to get the care rather than
engaging in elaborate procedure. Primary and specialist must have timely access by the people of
Ontario. When this part is being worked up on, there shall be lesser hassle of engaging in
departments
According to the Commonwealth Fund’s International Health Policy Survey’s Alberta is in much
better position in term this if compared to Ontario. In the survey the people of Alberta were
asked how easy it is for them to access the doctors. Out of the total around 45% said that it is
quite easy for them access doctors. In Manitoba it was seen that the people have to go the
emergency department for situations that could have been easily dealt with by a regular doctor.

As far as Ontario is concerned the survey showed that it had a good high percentage of people
who had better access to primary acre services. This is a positive sign to see as the main area of
concern here is primary care.
Data base strengthening and use of apps must be promoted by the healthcare providers in order
to enable the patients have better access to the doctors. Overall there must be rising of more
funding so that research and development in terms of software and IT sector that is functioning
within the healthcare sector London, Ontario.
Another area where there could be more work put in is connectedness.
There is an issue of connectedness that has been seen by the patient and one of the patients
recommends this as an important measure to get rid of the gap that exists between the patients
and getting the care from the healthcare departments.
I personally agree with the suggestions but as far as access part is concerned it is more applicable
to the locals than foreigners.
Question 3
After visiting several health care office settings, note the layout of the
office and reception areas.
After visiting several healthcare offices, it was seen that there is no common layout that observed
and is common in all the structures. When the layout is common it becomes easy for the users
and employees to use it and get familiarized with the setting.

Ask your interviewee if the layout is functional and if there is anything
he/she would change about the setting and why.
The interviewees were asked this question and they did not have much to say about it as they
considered it out of expertise. As users they did not face much issue.
Taking into consideration safety from injury, fire safety, employees’
comfort, patient flow, and safety from cumulative stress injuries, design
an ideal office including layout and types of furniture.
The following is the proposed and suggested design.
Provide reasons for each of your choices.
The reason for choosing this as the layout is that it has proper divisions which will help all the
departments to function individually with adequate space.

Conclusion
Primary care is a significant factor of the well-being of the social order. It is the responsibility of
the administration and charitable groups to make sure that the elementary health amenities are
delivered to community and there are unceasing improvements along with exploration and
development work is being supported out. In project we have tried to recognize the primary care
reforms in London, Ontario.
In order to have genuineness in research study, it is imperative that the interview is led so that
the popular judgment is gained to advance the research study and perceive the areas of
ambiguities.
The people of London, Ontario are authorized to primary care reforms and it is essential that the
enquiries are an all-inclusive one. The aim of research work approved out in the healthcare sector
must be to inspire the health care level and ensure that there is equivalence in giving out
healthcare reimbursements to the public of all race and values.

References
Bobadilla, A., Orchard, T., Magalhaes, L., & Fitzsimmons, D. (2017). Ontario Healthcare
Coverage Eligibility Among New Permanent Residents: A Scoping Review. Journal of
Immigrant & Refugee Studies, 15(4), 384-405.
Muratov, S., Lee, J., Holbrook, A., Costa, A., Paterson, J. M., Guertin, J. R., ... & Tarride, J. E. (2018).
Regional variation in healthcare spending and mortality among senior high-cost healthcare users
in Ontario, Canada: a retrospective matched cohort study. BMC geriatrics, 18(1), 262.
Ali, O., Crvenkovski, P., & Johnson, H. (2016, October). Using a business intelligence data analytics
solution in healthcare. In 2016 IEEE 7th Annual Information Technology, Electronics and
Mobile Communication Conference (IEMCON) (pp. 1-6). IEEE.
Abdool, R., Szego, M., Buchman, D., Justason, L., Bean, S., Heesters, A., ... & Gibson, J. (2016). Difficult
healthcare transitions. Nursing Ethics, 23(7).
Abdool, R., Szego, M., Buchman, D., Justason, L., Bean, S., Heesters, A., ... & Gibson, J. (2016). Difficult
healthcare transitions: Ethical analysis and policy recommendations for unrepresented
patients. Nursing ethics, 23(7), 770-783.
Peter Milczyn, M. P. P. (2017). 2017 Ontario Pre-Budget Submission from the Association of Family
Health Teams of Ontario.
Meyer, M. J. (2015). The impact of resource availability on patterns of discharge to inpatient rehabilitation
after stroke in Ontario, Canada.

Appendix
Interview Questionnaire
Health Care Professional
What do you have to say about the current model of primary care group?
It is pretty good. In the beginning it took time to understand but I believe it is a good step for the
Ontarians.
Do you think it is a good step ahead?
Yes, it is. The doctors under the experimental models are working in a team which makes the
care giving procedure easy to perform and we are able to deal with the patients in a more
effective way than we did under fee-for-service model.
How many patients are you currently enrolled with?
I have around 10 patients enrolled with my team and we are doing a good job in the primary care
sector for now. The future look good for the healthcare department in Ontario and such steps
must always be encouraged.
Have you seen difference in scenario?

Yes. There is a great deal of difference to be seen right now. We often had to deal with two to
three cases at one time and then it would turn out to be ethically questionable if we preferred one
patient over the other based on severity of the case.
Now with the new models in function we see that cases that come to clinic are that of emergency
ones and the patients seem to be relieved by the less time they have to spend on the waiting.
Patient (Native)
Do you think the present model of care is effective?
Yes it is. I can see people talking about it in my vicinity. I think it is a change for good. It has
reduced strain on the hospital and the patients are now in a better and direct contact with the
doctors they have enrolled with.
What more you think can be added to it?
I think there can be more research done, not to change this model but to bring in more models
that would suit the need of the people of Ontario.
Have you ever faced a serious injury or have been a witness of one and noticed lower time
consumption in emergency department in hospital?
No. Nothing of that sort has happened yet.
Patient (Foreign)
Do you think the present model of care is effective?

I do not have much idea about the model and its implementation as I have been here for a short
time. I had developed skin allergy which has often happened to me in India. The primary care
procedure is good. I like the cleanliness. I met an Indian doctor too. He was kind to me and
others as well. I think I will give a good point to the health care department here.
What more you think can be added to it?
I personally do not have much to offer as a consumer of the service. The system here is quite
impressive. I would like to tell my friends in India to take up some of the models from Canada
and try implementing it in India, at least in the major cities to start with.
Minute
Agenda: To research about the primary care need in London, Ontario
The names of the participants: Withheld
Agenda items: Understanding the current primary healthcare in Ontario.
Calendar or due dates: April 2019
Actions or tasks: literature, interview
The main points: There is scope for more improvement in primary healthcare. The current
model is an improvement over the fee for service model.
Decisions made by the participants: Attached in the interview questionnaire.
Most important points: current model is effective
Future decisions: Access is an important area where there could be more empowerments made
and the provincial and territorial government must be making it easier for the patients to get the
care rather than engaging in elaborate procedure. Data base strengthening and use of apps must
be promoted by the healthcare providers in order to enable the patients have better access to the
doctors.

CONFIDENTIALITY AGREEMENT
Purpose: The main purpose that lies behind drafting of this agreement is to protect the identity
of interview. The detail that shall be published of the other party is only age and gender. The rest
shall be withheld with the management. The management hereby takes responsibility of any kind
of information leakage that takes place from the side of management. However the responsibility
shall be acknowledged after presentation of meaningful evidence by the claiming party.
Confidential Information: The information that has been shared to us by the interviewee must not
be shared with any other third party. The management here assures that there shall not be any
kind of sharing of shared files and documents with a third party.
The information that is to be considered confidential according to this agreement has been
underlines below:
 Name, address and phone number of the interviewee.
 Information relating to family of the client (interviewee)
 Information regarding any kind of abuse or trauma or any medical severity suffered by
the client
Terms: By getting into this agreement the client can be assured of highest level of ethical
standards from the side of management. The Confidentiality agreement stands as base to form
trust of the interviewees in the social work that our management has proceeded with in Ontario.
 All kind of communication takes place during the research is confidential except the
answers to the questionnaire.

 The staff involved in the procedure management shall keep all the information withheld
which has been assured by a separate staff agreement, the details of which cannot be
shared with the interviewee
 I as the chief officer, take the responsibility of this confidentially Agreement.
 The sole ethical purpose of this Agreement is to create an atmosphere of trust between
the management and the client.
I_____________ have gone through the above details and agree to go ahead with the process of
research that the management is heading for in Ontario.
Signature of the client________________
Signature of the Chief Managing Officer___________
Date______________
PHIPHA
Personal Health Information Protection Act is popularly known as PHIPHA. Ontario was
introduced to this act in the year 2004. PHIPHA is one of the two components of The Health
Information Protection Act, the other being Quality of Care Information Protection
Act (Schedule B).
Through PHIPHA the information regarding the health of a patient has to be protected. There are
many provisions under it. Here are some of the vital provisions listed below:

Consent is important. For any kind of dissemination of information regarding health, it is
important that that the consent is obtained from the patients. Though in some exception cases,
the procedure may be altered.
It is the duty of the information custodians to keep the health related information under security
and prevent any kind of illegal leaking.
The patients have full right to have an access to their information and they can also demand the
correction of errors.
The patients have the full right to expect all kinds of confidentiality from the custodians.
PHIPHA also laid out the rules that are to be followed if the information is to be used for
research purpose.
Under the act there are also guidelines set for the use of health information for marketing and fun
raising reasons.
When an individual notices an error in their personal health data they can claim the error.
PHIPHA makes a systematic approach to such claims.
If the legislations are breached, PHIPHA lays out the ways of remedies too.
The question rise why is it so important to have confidentiality in medical field and the patients
have the right to demand it:
Patients when they come in contact with the doctors have to share medical information as it is
important for both the parties to exchange this information. There is certain amount of trust that
goes in this and it is through this trust that there is establishing of a trustworthy relation between

the doctor and patient. Without a law that protects this confidentiality, there shall be lowering of
trust in this which is not suited for the ethical and holistic side of the health care sector. Creation
of an environment that has more trust will help in development of the sector.
Thank You Letter
Healthcare and Sanitation, Ontario
Dear participant,
We are glad that you participated in this research program and helped us in gathering important
data which would not have been possible to gather from elsewhere. Primary data are important
for conducting a sound research. We thank you with all our heart.
Your contribution in this program shall always be appreciated and we hope that we are able to
make the best use of the information that you have provided us. Wish us luck for the future
endeavours as we hope to bring changes in the primary care of Ontario, Canada.
The participation is protected with Confidentiality Agreement that has been signed between you
and our management.
Your cooperation is highly appreciated and we hope to work in more projects like this. The sole
aim of the undertaking is to being a change in the society and make Canadian healthcare a better
researched one which has reliable data to formulate policies on.
Thank You!
Regards,
Management

Healthcare and Sanitation Ontario