Patients propose real world solutions to Quebec's primary care crisis

A new report shares patient-led solutions to help address the worsening primary care crisis in Quebec, where more than two million Quebecers have no assigned family doctor or nurse practitioner, among the worst rates in the country.

Canada itself is among the worst performing among developed countries, with more than six million Canadians lacking access to a family physician. Residents of rural and smalltown communities face even more profound challenges to access, highlighting the need for more to be done in Quebec to find real world solutions to these ongoing problems.

As part of the national OurCare initiative, 31 members of the community, representing regions across Quebec, spent more than 30 hours listening to experts and deliberating, before producing a report outlining 31 recommendations that focus on: recognizing systemic issues affecting health, attracting and retaining primary care professionals, flexibility and innovation, team-base care, decentralized governance, and protecting and promoting the public system.

Included among the recommendations are:

• Reduce time spent by clinicians on low-value administrative tasks to free up time for
  clinical tasks, continuing education and quality improvement.
• Offer greater autonomy to health care professionals other than physicians in order to facilitate access to care and services.
• Promote and encourage better interdisciplinary collaboration between health care providers and community services.
• Ensure that primary care providers foster an institutional culture that takes account of the social determinants of health and ensure good continuity of care.
• Prioritize and respect the right to independence of people, particularly those with visible and invisible disabilities, by providing them with assistance, such as better home care.
• Develop public education and communication tools including information on how the system works, services offered, and the rights of users.
• Create a people's committee with a mandate to monitor and make recommendations on legislative and government activities relating to health care and the production of information on the health of the population.
• Define a better legal framework for overseeing private for-profit practice, so as not to undermine access to health care services covered by the public system.

The Quebec members of the panel of citizens showed great sensibility to cultural safety and empowerment of patients, but also the importance of good working conditions and the well-being of health care workers.

"The OurCare initiative showed that members of the public want to be heard when there is a discussion about improving health care and they want to be part of the decision-making process," says Dr. Nebojsa Kovacina, Quality Improvement program director in the Department of Family Medicine at McGill University and co-lead of the Quebec component of OurCare. "It struck me how well the members of the public understand the present issues and challenges of the system."

Improving accessibility has been a theme found throughout the country. "Equity and accessibility were core values put forward by members of the public," notes Dr. Tara Kiran, the national lead for OurCare and a family doctor at St. Michael's Hospital, a site of Unity Health Toronto. "They strongly believe that everyone has a right to high-quality primary care, regardless of their background or circumstances."

According to Mylaine Breton, Ph.D., Full Professor in the Department of Community Health Sciences at the Université de Sherbrooke and co-leader of the Quebec component of the OurCare project, many of the recommendations on improving accessibility and equity focus on optimizing interprofessional collaboration and empowering patients through active participation tools.

"The thing that struck me the most about the panel was how enthusiastic everyone was," adds Tara Slade-Hall, one of the community panelists. "It became very clear to me that not only are Canadians and Quebecers proud of our Medicare system, but we're willing to do what it takes to promote access for all. I would like to highlight the fact that, as a group, we shared the common belief that everyone should have equal access to the same quality and speed of care, regardless of who or where they are in Canada."