Researchers at Unity Health Toronto are calling on governments, healthcare organisations and healthcare leaders in Canada to act on the report’s findings and work to adopt new national standards. Setting up community healthcare centres in the most underserved areas is seen as a key priority.

OurCare is described as the largest pan-Canadian conversation about the future of primary care. Taking place from September 2022 to December 2023, it engaged with Canadians through community roundtables, provincial panels and a national survey about their experiences and ideas on how to solve the crisis. Data from the project showed the number of people across Canada without consistent access to a family doctor or nurse practitioner jumped from 4.5 million in 2019 to more than 6.5 million in 2023.

“I strongly advocate for the swift implementation of recommendations by government and health authorities, starting with the establishment of community healthcare centres in the most underserved areas – specifically, rural and northern communities,” says Elly Grabner, an OurCare panellist from Kamloops, BC.

“These centres would ensure that everyone has access to a doctor when they need it, addressing critical healthcare disparities. Immediate action on these recommendations is vital to improve healthcare access and outcomes for all Canadians.”

Engagement and proposals

The OurCare survey heard from 9279 people in Canada about their access to care, priorities, use of walk-in clinics, virtual care, primary care teams, medical records, and ideas for system redesign. Five provincial priorities panels engaged with 159 randomly selected people across Canada in deep dialogues about primary care in Ontario, British Columbia, Manitoba, Quebec and Nova Scotia. Ten community roundtables also received feedback from 192 participants from underserved communities, including First Nation, Inuit, and Métis people; African, Caribbean and Black communities; immigrants, refugees, migrant workers and other newcomers; LGBTQIA+ migrants; and people with disabilities.

Solutions proposed to address the attachment crisis affecting 22 per cent of Canadian adults without primary care access include:

• scaling up community-governed interprofessional primary care teams;
• growing and diversifying the workforce through more training and accelerated integration of internationally trained primary care professionals;
• enabling patient access to their own health records;
• expanding virtual care integrated with in-person care to improve access, especially in rural and remote communities;
• orienting the system to promote wellness and addressing the social determinants of health;
• ensuring healthcare spaces are safe and accessible for everyone, regardless of identity, ability or language spoken; and
• educating and empowering patients to navigate the system and play a stronger role in their care.

“We heard from almost 10,000 people across Canada who collectively spent about 10,000 hours engaging with us on how to improve the primary care system,” said Dr Tara Kiran, national lead for OurCare and a family doctor and scientist with the MAP Centre for Urban Health Solutions at St Michael’s Hospital. “People shared stories that were both heartwarming and heartbreaking.

“And despite vastly different life experiences and backgrounds, there was so much they agreed on. At its core, they felt strongly that every person deserves access to high-quality primary care and that the system should be accountable to patients and the public.”

National standard

Findings from all three phases of the OurCare initiative also led to the development of the ‘OurCare Standard’ – six statements that summarise what participants felt everyone in Canada should receive:

• everyone has a relationship with a primary care clinician who works with other health professionals in a publicly funded team;
• everyone receives ongoing care from their primary care team and can access them in a timely way;
• everyone’s primary care team is connected to community and social services that together support their physical, mental and social wellbeing;
• everyone can access their health record online and share it with their clinicians;
• everyone receives culturally safe care that meets their needs from clinicians who represent the diversity of the communities they serve; and
• everyone is served by a primary care system that is accountable to the communities it serves.

“The OurCare Standard describes what every person in Canada should expect from the primary care system,” said Kiran, who is also vice-chair of quality and innovation in the Department of Family and Community Medicine at the University of Toronto. “It’s a distillation of all that we heard. Now it’s up to those of us with any power in the system to act on the priorities people in Canada have so clearly articulated.”

An interactive website has also launched, where people in Canada can compare their own care to the OurCare Standard and see how different provinces measure up.