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Provincial governments are taking steps in the right direction, but they are not coming close to the magnitude of investments needed to fix worsening family doctor shortages, says the lead author of a new Canadian report.

The report titled OurCare was produced based on input from 10,000 Canadians. Its authors call it the largest pan-Canadian conversation about the future of primary care.

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Those conversations and surveys were conducted between September 2022 and December 2023, a period when the shortage of primary care worsened significantly across Canada, said Dr. Tara Kiran, national lead for the project. She is a family doctor and scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto.

“People shared stories that were both heartwarming and heartbreaking. And, despite vastly different life experiences and backgrounds, there was so much they agreed on,” Kiran said.

Members of the public put forward solutions to the lack of access to family physicians, many of which echo recommendations from organizations. Kiran said the paper represented the vision of Canadians for primary health care and that made it stand out.

“What makes this report really unique is that we are hearing from patients and the public. What we are doing is amplifying the voices we heard from people in all walks of life,” she said.

OurCare data suggests 6.5 million Canadians were without regular access to primary care in the form of family doctors or nurse practitioners in 2023. That number was up from about 4.5 million in 2019. In Ontario, 2.3 million people don’t have family doctors, and that number is expected to more than double in the next few years.

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Among solutions put forward by members of the public were increasing the number of community-governed interprofessional primary-care teams, enabling patient access to their own records, orienting the system to promote wellness and expanding virtual care integrated with in-person care to improve access especially in rural and remote parts of the country.

Those who participated also said health spaces should be safe and accessible for everyone and patients should be educated and empowered to play stronger roles in their care.

The OurCare initiative has developed a standard summarizing what participants felt everyone in Canada should receive. Atop that list is that every person should have a “relationship with a primary-care clinician who works with other health professionals in a publicly funded team.” It also stressed that everyone should be able to access that care in a timely way and that everyone should have access to their health records online.

There have been broad calls for more team-based care involving family physicians and other health-care providers such as nurse practitioners and mental-health workers to better provide primary care for patients.

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Ontario is among the provinces expanding their networks of interprofessional teams. It recently announced it was investing $90 million to expand primary-health teams across the province. Health ministry officials said they were overwhelmed with applications.

Kiran said that and similar initiatives by provinces were heading in the right direction, but were not enough to turn around the crisis.

“If we really want everyone to have a doctor or a nurse practitioner, we need to design that system for 100 per cent population coverage. How we design it will be different than making small, incremental improvements,” Kiran said.

She said the amount of money needed to redesign health care to make primary care its foundation was an “order of magnitude more money” than was currently being invested. Not double, not just 10 times as much, but significantly more, she said.

Countries with stronger primary-care systems have healthier populations, better equity of care and lower health costs, Kiran said. “We haven’t had the size of investments in primary care that are needed. If you look at the total health budget spent on primary care, Canada is much lower compared to peer countries.”

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The average of OECD (Organization for Economic Cooperation and Development) countries is 8.1 per cent of global health budgets spent on primary care. In Canada, that number is 5.3 per cent.

“Primary care is the front door that is needed to keep you well,” Kiran said. “Right now more than one in five people don’t have access to that front door and are being left behind.”

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