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Representatives from AFHTO’s Operational Issues Working Group and the AOHC’s CFHT Executive met with the MOHLTC FHT Unit on September 20.The main objectives were to receive updates from the FHT Unit on budgets and other operational matters and to highlight “good news” from FHTs.  The following is a summary of the discussions. a) Recovery of unspent funds

• Recovery of unspent funds currently applies only to vacant position salaries and benefits. The focus is currently on surplus HR funding from the Q1 time period.
• Background: a significant amount of surplus funds are recovered each year from FHTs.  Due to the timing of audited statements, these funds have been recovered in the following fiscal year.  By reconciling on a quarterly basis, it provides more in-year flexibility, either to re-invest funds or to contribute to the government’s deficit reduction commitments.
• Process: based on review of hiring reports and Q1 financials, FHT Unit and FHT will come to agreement on amount to be recovered; following monthly payments will be adjusted accordingly.  Amount recovered is salary + 20% for benefits. This will have no impact on the approved budget for the FHT.
• FHT Unit is open to discussions about re-profiling positions that remain vacant for long periods (as long as the interdisciplinary nature of the team remains intact and the re-profiling is revenue neutral) or addressing in-year pressures. These issues need to be discussed with ministry contact.

b) Plans for funding existing/new Physician Assistants (PAs)

• Existing PAs (funding ends Mar 2013): Health Human Resources Strategy Division manages the PA program, but work is underway on a long-term strategy to support the integration of PAs into targeted areas of Ontario’s health care system.
• Regarding FHTs specifically, although PAs are not currently included in the list of approved interdisciplinary health providers in FHTs, there appears to be a strong case for making this happen. The permanent integration of PAs into FHT’s is one of the areas of focus for the long-term work currently underway.
• The FHT unit is currently working with the Health Human Resources Strategy Division on how this could work. The goal is to communicate this before March 2013.
• It was noted that support from the MOHLTC for a FHT-PA Community of Practice would be appreciated.
• Approvals to hire New PAs: Deadline for hiring is Oct 31. The FHT Unit is in process of finalizing approvals for recruitment.  FHTs should be notified in the next couple of weeks about the status of their application.

ACTION: FHT Unit to send AFHTO & AOHC list of FHTs with existing Physician Assistants. c) Funding for Relief positions

• Lack of relief funding, in particular for reception and RNs, continues to pose significant problems for some FHTs, including patient services, impacting workload and health and safety of providers when an absence creates a scenario where someone is left to work alone.
• Smaller FHTs, rural/remote, and community FHTs may be more greatly impacted by this.
• The FHT Unit will consider a number of options for addressing this issue, including a standard percentage increase for relief funding on a per-request basis, reallocation of unspent salary dollars or 3^rd party revenue to offset cost of relief.  FHTs are encouraged to discuss this problem with their primary consultant.
• Any change in relief funding would not be in effect until 2013/14 fiscal year.
• The question of BSM physician job-sharing was raised. The FHT Unit identifies this as an issue for FHT management to address/implement as appropriate.

d) Association Membership Fees

• The group thanked the FHT Unit for support for association membership fees.
• The FHT Unit confirmed that these funds are specifically earmarked for association fees, and cannot be reallocated if not used for that purpose.
• The expense needs to be reported as a separate line item under general overhead and will be monitored to ensure it is going towards AOHC or AFHTO dues.

e) Preparing for next budget cycle / annual planning

• The earlier start to the budget cycle was noted as a positive change for FHTs.  FHT Unit would like to start 2013/14 budgeting process even earlier.
• FHT Unit analyzed 2012/13 annual plans and will be issuing a provincial snapshot in the next FHT To Print newsletter.  FHT Unit will follow up with each FHT individually about how they compare with other FHTs in their LHINs.
• FHT Unit is reviewing reporting requirements with the eye to streamlining and reducing the burden of reporting.  May include new quality improvement measurements (see (f) Quality  Improvement Planning in FHTs)
• Process: FHT Unit will aim to have a draft revised annual plan template by end of Nov 2012, for input from a small working group of FHTs gathered by AOHC and AFHTO.  The goal is to have the revised plans to FHTs by mid-Dec 2012, with a submission deadline of Feb 28, 2013.
• A request was noted that the measurements related to HealthCare Connect be reviewed with feedback from FHTs, with an eye to improving program processes and related measurements.

ACTION: AFHTO & AOHC to identify working group for Annual Plan review. f) Quality Improvement Planning in FHTs

• Primary care has been identified as the next sector to which the principles of the government’s Excellent Care for All strategy will apply. Family Health Teams will feature strongly in this.
• Although work is underway, this at a minimum will include a requirement for FHTs to undertake quality improvement processes, including the development and implementation of a Quality Improvement Plan.
• The Quality Improvement Plan for primary care is likely to include the following three Quality attributes: Accessible, Integrated and Patient-Centred. The specific quality indicators are currently under development.
• Planning is underway to ensure supports are in place for an enhanced focus on quality improvement, including templates, guidance documents, governance training and other assistance provided by the ministry and Health Quality Ontario.
• The details of the roll-out are still in the planning phase, but more details will be communicated through AFHTO and AOHC shortly.
• Work is underway by the ministry to streamline the reporting burden on FHTs in anticipation of new expectations for quality improvement. The ministry’s intent is to reduce administrative reporting on a quarterly and annual basis so as to free-up capacity to focus on quality improvement planning and implementation.
• The first year of implementation will be a transition year to support FHTs in embedding quality improvement in their on-going activities, with the intent to progressively advance the program in out-years.

ACTIONS

• Kavita Mehta and Ruth Kitson to send FHT Unit sample patient satisfaction surveys.
• AFHTO & AOHC to identify working group for review of draft QI plans.

g) Data Management Support in  FHTs

• The need for data management/analysis support in FHTs was reiterated, especially given the planning for QI.
• FHT Unit is investigating the possibility of implementing a regional data support model. This may be feasible to implement under the umbrella of NPAR (see (k) NPAR: update on evaluation and roll-out plans for more information).

h) Update on plans to integrate primary care with LHINs

• The MOHLTC continues to assess a number of proposals/models that were submitted on restructuring primary care.
• There are legislative barriers that may prevent moving primary care into the LHINs, and other alternative models are being considered that do not require legislative reform.
• In the meantime, FHTs should continue fostering and building local partnerships to enhance service integration and collaboration.

i) Compensation

• The AOHC/AFHTO/NPAO compensation review being developed by the Hay group is scheduled for release at the end of October.
• The FHT Unit regrets that with continued austerity measures in place, there is no news on addressing funding inequities within FHTs and lack of parity across FHTs for similar positions funded through different funding streams.

j) Adding Physicians to Existing FHTs (Patient Enrollment Models)

• There has been managed registration of new physicians in certain patient enrolment models (including those eligible to affiliate with FHTs) to 25/month while a review of the registration process takes place.
• The current interim process is to register 25/month through a needs-based assessment and consultation with LHINs.
• The ministry will consult with relevant stakeholders before finalizing the process.

k) NPAR: update on evaluation and roll-out plans

• The MOHLTC has committed to removing the $1 per service encounter. In order to do this a consent form will be developed to allow interdisciplinary health providers (IHPs) and FHTs to share service-level information with the ministry.
• FHT Unit is looking at options to roll out NPAR to other IHPs.  This will take time, as support for additional NPAR licenses was also identified as a need if it is rolled out to other IHPs.
• Included in this work will be options to re-profile the $1/encounter allocation to support data management and analysis support.
• It was emphasized that different skill sets are required for data entry and data management/analysis.
• FHT Unit will issue a communication to FHTs on the status and evaluation of the program in the next few weeks.

l) Point of Care Testing

• The group shared how point of care testing (eg INR) can be done more cost-efficiently through FHTs than by other providers in the system, such as hospitals or labs, using existing provider resources in the FHT. While the FHT Unit has already approved the one-time equipment costs, there is an ongoing funding need to cover the cost of additional supplies.
• This is an innovative way of reallocating health system funds to enhance services to clients and client experience.
• The FHT Unit affirmed that FHTs can use General Overhead funds to cover the cost of supplies.  Requests for additional funding for supplies will be considered, but individual FHTs need to first demonstrate or estimate the volume of testing being / that will be performed, and the financial need, before additional funding will be approved.
• The FHT Unit will also consider requests to reallocate unspent operating line items (outside of General Overhead) to cover these costs.

m) FHT Good News Stories: areas of priority to showcase

• AFHTO will be issuing awards to 16 FHTs at their upcoming conference, and will share details with the FHT Unit after the event.
• For FHT to Print, the FHT Unit is particularly interested in stories pertaining to quality, access, integration, peer modelling, and the patient experience.

Meeting participants

• MOHLTC: Phil Graham, Acting Manager of the FHT Unit and Richard Yampolsky, Program Manager, FHT Implementation.
• FHT EDs: Randy Belair (Sunset Country FHT in Kenora), Mark Ferrari (Windsor FHT), Ruth Kitson (Community & Primary Health Care FHT, Lanark, Leeds & Grenville) Kavita Mehta (South East Toronto FHT).
• Association staff: Sophie Bart (Association of Ontario Health Centres) and Angie Heydon (Association of Family Health Teams of Ontario).

Do you have input on operational issues for the next quarterly meeting? Please contact:

• For FHT EDs in LHINs 1-4 and 12 (Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant,North Simcoe Muskoka) and all CFHTs across the province:
  • Michelle Karker, ED East Wellington Community FHT
  • E-mail:  michelle.karker@ewfht.ca
• For FHT EDs in LHINs 5-8 (Mississauga Halton, Central West, Toronto Central, Central)
  • Kavita Mehta, ED South East Toronto FHT, Working Group Chair, AFHTO President
  • E-mail:  kavita.mehta@setfht.on.ca
• For FHT EDs in LHINs 9-11 (Central East, South East, Champlain):
  • Joyce Phillips, ED Kingston FHT
  • E-mail:  jphillips@kfhn.net
• For FHT EDs in LHINs 13-14 (North East,North West)
  • Randy Belair, ED Sunset Country FHT,  AFHTO Secretary
  • E-mail:  rbelair@kfht.ca
• For FHT Clinical Leads:
  • John McDonald, Lead Physician PrimaCare Community FHT, AFHTO Past President
  • E-mail:  john.mcd1@sympatico.ca