In the lobby of a grocery store in the Leaside neighbourhood of Toronto, a small group of perky women and one man are trying to thrust flyers into the hands of customers. Many shoppers, pushing carts and laden with bags, rush past them, assuming they’re soliciting donations or selling something.
But others stop short and react with incredulous delight when they hear what Vyshnave Jeyabalan is offering. “Excuse me,” Ms. Jeyabalan asks shopper after shopper, “do you have a family doctor?”
Ms. Jeyabalan is a project manager with the North Toronto Ontario Health Team, an initiative of the provincial government based out of Sunnybrook Health Sciences Centre. On this autumn weekday morning, she and her colleagues are spreading the word that some nearby primary-care clinics are accepting new patients. Shoppers in need can fill out an electronic intake form on the spot, and the North Toronto group will later match them with a doctor or nurse practitioner in their area.
“They’re surprised we’re out here,” said Kitty Liu, then-director of the North Toronto OHT, one of 58 teams across the province that co-ordinate health services at the local level. “It’s not very often that people would be in the community asking, ‘Do you want to be our patient?’ Because it’s typically the other way around.”
“Typically the other way around” is an understatement in a province where photos of hundreds of people in line for a doctor in the town of Walkerton flew around social media last January faster than the winter storm that struck as they waited. At the time, the best available data suggested that as many as 2.5 million Ontarians had no primary-care physician or nurse practitioner, up from 1.8 million in 2020.
To address the crisis, Premier Doug Ford scored a coup. He convinced Jane Philpott, a widely respected former federal health minister, to leave a plum job as dean of the school of medicine at Queen’s University to become the province’s primary-care czar. She started her work as head of Ontario’s Primary Care Action Team, or PCAT, on Dec. 1, 2024.
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Ontario sought out Jane Philpott, a former federal health minister, to overhaul primary care in the province.Adrian Wyld/The Canadian Press
In the year since, the government of Canada’s most populous province has approached primary-care providers with more carrots than sticks, unlike its counterpart in Quebec, which threatened to fine doctors if they failed to meet certain performance targets. The Coalition Avenir Québec backed down last week after physicians vowed to flee the province in droves.
The North Toronto OHT recruiting patients at a grocery store is one example of how Ontario’s primary-care plan is playing out on the ground, spurring excitement among health care workers and experts who say primary care in Ontario had been underfunded and ignored for too long.
“I just about fell off my chair when I heard this was happening,” Rick Glazier, a Toronto family doctor and veteran health policy researcher, said of Ontario’s new emphasis on primary care. Not only did the government hire Dr. Philpott, it also “put a stake in the ground,” he said, by promising that every Ontarian would have a family doctor or nurse practitioner by 2029.
“And then, that same chair, I almost fell off again when I saw there was a lot of money attached,” Dr. Glazier added. The Ford government has committed $2.1-billion over four years to revitalizing primary care.
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Health Minister Sylvia Jones speaks at the legislature on Oct. 21, 2024, the day she and Premier Doug Ford announced Dr. Philpott’s appointment.Chris Young/The Canadian Press
Despite optimism in the field, the Ontario government has been reluctant to say much publicly about how close PCAT is to achieving its goals, other than trumpeting the partial clearing of Health Care Connect, the central wait-list lambasted in a recent Auditor-General’s report for leaving patients in the queue too long.
The office of Health Minister Sylvia Jones declined to make Dr. Philpott available to The Globe and Mail for an interview, despite requests dating back to October.
The government has also declined to make public its rich internal data on attachment rates. Health-policy wonks describe “attached” patients as those who have an ongoing relationship with a family doctor or NP who provides comprehensive primary care.
People familiar with PCAT’s work say that Ontario Health, the agency that oversees day-to-day operations of the medical system, has an excellent dashboard with attachment data down to the first three characters of a postal code, which OHTs are using to target their resources to the places where need is greatest.
Rather than making the dashboard public, the website of INSPIRE-PHC, the provincially funded primary-care research network that Dr. Glazier co-leads, and which released the 2023 estimate of 2.5 million Ontarians without a family doctor, features a note instructing OHTs to e-mail Ontario Health to access their internal reports.
“It makes it seem as though there’s something to hide, but I’m not sure there is,” said Noah Ivers, a family physician at Women’s College Hospital in Toronto and the leader of a research project evaluating the work of PCAT. “I think there’s mostly good news, like stories of people really trying hard to serve their communities.”
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Just more than two million Ontarians don’t have a family doctor or nurse practitioner, Dr. Philpott said in a speech in October.Eduardo Lima/The Globe and Mail
Dr. Glazier said he also wants to see the attachment data made public.
A spokeswoman for Ms. Jones declined to say when or if the government plans to release detailed attachment data. The Health Minister’s office responded to 13 written questions from The Globe with a five-paragraph statement.
“Our government is proud to be the first Canadian jurisdiction to pass legislation that establishes a framework for its publicly funded primary care system,” Ema Popovic wrote, “as well as leading the country with 90 per cent of people connected to a regular primary-care provider, and through our $2.1 billion Primary Care Action Plan, we are connecting everyone in the province to a provider by 2029.”
Dr. Philpott, who is known as a stickler for reliable statistics, receives a detailed report every Monday about PCAT’s drive to attach.
In a speech to a primary-care research conference in October, she shared that the number of unattached Ontarians is lower than the old estimate of 2.5 million, mostly because the government and the INSPIRE-PHC researchers have agreed to refine and align their counting methods.
PCAT still has a long way to go. As of March 31, Dr. Philpott told the conference, the number of Ontarians without a family doctor or NP was 2,015,464.
Dr. Philpott’s work as primary-care czar began, unofficially, when she met Premier Ford in the third week of October of last year. As she told the primary-care conference, “His team said, ‘It’s very important that the two of you sit down together over a cup of coffee, look each other in the eye, and agree upon what you’re committing to one another.’”
Mr. Ford gave Dr. Philpott 100 days to draw up a plan. She and her small staff, working out of an office in the Whitney Block near Queen’s Park, were counting down the days on a whiteboard when members of the Premier’s staff started popping in to ask if they could work faster. The government was eyeing a snap election.
“In the end, we had 55 days to develop a plan,” she said in her October speech.
The broad strokes, unveiled on the eve of a campaign the PCs would go on to win, were this: Ontario would spend about $2-billion over four years to create and expand hundreds of additional primary-care teams. Their goal would be attach about two million more people to family doctors or nurse practitioners working alongside allied health professionals.
In June, the government announced the first round of funding under the auspices of Dr. Philpott’s PCAT. Just over $235-million would go to more than 130 new and expanded teams, with an eye to attaching 300,000 new patients to primary care.
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Dr. Wideman, left, works with one of the teams set up with PCAT funding in the first round.Jennifer Roberts/The Globe and Mail
Two of those teams were in North Toronto, where officials say the internal data show about 30,000 people, or about 16.5 per cent of the catchment of 180,000, don’t have a doctor or NP. One team was anchored at the Sunnybrook Academic Family Health Team, the other at Vibrant Community Health.
Together, they received $4.25-million to add about 9,500 new patients to their rosters by next summer. But they won’t be doing it alone. As Anne Wideman, a family doctor with the Sunnybrook team and co-leader of the North Toronto primary-care network, explained, each anchor organization expanded its reach by approaching smaller doctors’ offices nearby and asking what it would take for them to enroll more patients.
“People submitted, literally, ‘I think I could do 100 more patients if I had an AI scribe that was paid for, and a half-time nurse,’” Dr. Wideman said.
By tailoring their funding proposals to those types of requests, the two North Toronto groups brought four other doctors’ offices into their fold.
Ontario Health, meanwhile, made clear to them and other successful bidders that a specific number of patients were expected to be attached for every PCAT-funded health professional. The two North Toronto teams have enrolled 4,342 new patients since their funding came through in the summer.
“The accountability feels different,” said Lori Brady, the vice-president of community integration, partnerships and outpatient care at Sunnybrook Health Sciences Centre. “We’re being asked to meet monthly. That’s never been the case. We’re being asked to share data around how we’re doing and how we’re progressing.”
About 40 kilometres west of Sunnybrook, WellFort Community Health Services cares for a patient population that looks very different from that of mostly upscale North Toronto.
WellFort is a community health centre, a long-standing model of interdisciplinary practice in which doctors are paid a salary to care for marginalized populations. The WellFort CHC has two locations in the immigrant-rich communities of Brampton and Malton, a neighbourhood in Mississauga. Like the North Toronto groups, WellFort, which also received PCAT money to attach more patients, has been busy spreading the word that the doctors and NPs in their expanded network have room for new patients.
WellFort convinced other traditional doctors’ offices to join their efforts by offering them resources they didn’t have before, explained Kimberley Floyd, chief executive officer at WellFort, which is located in the Central-West OHT.
For example, a local branch of the Canadian Mental Health Association that is part of the WellFort-anchored team is using the new primary-care funding to put mental-health workers inside some doctors’ practices on a regular basis. Those doctors, knowing they can count on expert support under the same roof, agreed to take on more patients with complex mental illnesses.
“That’s the difference with these primary-care investments,” Ms. Floyd said. “It’s not a referral. It’s, ‘I know that a mental-health worker is in my practice on a regular basis and is now part of my team.’”
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Kimberley Floyd, at left with nurse practioner Alla Yurova, is CEO of WellFort Community Health Services.Eduardo Lima/The Globe and Mail
Still, there are doctors who dislike this government-dictated model, where PCAT investments must flow through one of two pre-existing types of primary-care practice, a community health centre (like WellFort or Vibrant) or a family health team (like the one at Sunnybrook.)
Most of Ontario’s family doctors work in other types of practices, and many wish they could receive PCAT money and employ PCAT-funded staff themselves, said Zainab Abdurrahman, president of the Ontario Medical Association.
“We’re concerned that the call for proposals will not increase attachment as effectively as it really could,” she said, “because we’re not looking at it for all family doctors.”
WellFort, a CHC, received a total of $8.5-million in funding in two tranches, the first of which came before Dr. Philpott was appointed. The health centre and its affiliated doctors’ offices have managed to attach about 16,000 new patients since last year, well on their way to hitting their target of 20,000 before next summer.
But Ms. Floyd and her colleagues also know that target falls short of the need.
When they begin crafting their first primary-care funding proposal in 2023, the best estimate was that 80,000 people in the Central-West OHT’s catchment area were unattached. Now they know the true figure is closer to 120,000, partly because they have better data, but mostly because Brampton’s population has grown at the speed of a runaway train that even a souped-up primary-care system can’t seem to catch.
As Christmas nears, parts of the Four Corners physiotherapy room are draped in tinsel. By next summer, WellFort aims to have 20,000 new patients at its health centre and affiliated doctors’ offices.
Eduardo Lima/The Globe and Mail
When it comes to judging the performance of Dr. Philpott’s Primary Care Action Team, Dr. Ivers and his research colleagues will eventually have answers. They plan to compare primary-care teams that received dedicated PCAT funding with those that didn’t, and to traditional doctors’ offices, to see which type signs up the most patients.
That research will take time. Meanwhile, Dr. Ivers, who is also the scientific lead of the Office of Health System Partnerships at the University of Toronto, and his team have already evaluated whether the province sent its first batch of funding to places legitimately in need of more primary care.
“It’s a pretty good-news story,” Dr. Ivers said. “The money, more or less, went to places where I think the average taxpayer would be like, that’s good.”
The other basis on which to judge PCAT so far is Health Care Connect, a service run by the provincial government that was designed to pair patients with family doctors and nurse practitioners. It usually makes headlines as a bad-news story.
A provincial Auditor-General’s report released earlier this month did not help its reputation. Besides noting the service’s historical sluggishness, the report said that, in December of 2024, a dozen OHTs told the Ministry of Health it shouldn’t bother updating Health Care Connect’s legacy software because the tool was “no longer fit for purpose.”
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Auditor-General Shelley Spence pressed Ontario on its Health Care Connect wait-list in her most recent report.Sammy Kogan/The Canadian Press
Regardless, the Ontario government and Dr. Philpott had already decided to make clearing the Health Care Connect list an early test of the PCAT. They promised to clear the 235,000 people whose names were in the system on Jan. 1, 2025, by the spring of 2026.
The office of Ms. Jones, the Health Minister, says 70 per cent of that list has been cleared. In North Toronto, for example, there were 208 people left on the list as of Dec. 11, down from 2,206 on Jan. 1.
Dr. Philpott told the primary-care conference in October that although some registrants were removed because they had moved away or died, about 85 per cent were newly attached to a primary-care team.
Recently, Dr. Philpott received word in her Monday reports that some OHTs doubt they can attach the remaining Health Care Connect patients by spring. When she hears that, she threatens to solve the problem herself.
Dr. Philpott tells them, “I’m getting in my car, I’m going on Google, I’m going to find the names of every family doctor, and I’m going to show up with doughnuts and coffee, and I’m going to say, ‘What can I do to help you so that you could take care of more people?’” she said in her speech. “Because it is not an option to not clear this list.”
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