New model medical army

The challenge of keeping both doctors and patients happy in a public system falls to government. Good working hours, pay and support need to be balanced with access, continuity and quality, all within a manageable budget. Many provinces have tried to work these needs into new designs for primary care, with little lasting success. Now Quebec and Ontarioare trying again, with models called Network Clinics and Family Health Teams. As our overview, "A look inside Ontario and Quebec's new deals for clinics," of this issue describes, they've passed some of the important hurdles that have stopped other initiatives in their tracks.

The most important has been getting doctors interested. Both models remove fee caps for doctors, providing a much-needed incentive to see more patients. They also provide an enticing carrot in the form of money for information systems, on-site basic diagnostic facilities and nurses. The drive to bring non-physician health professionals into clinics is not new, but now government understands that it, not the clinic, must pay for them if we are ever to put interdisciplinary care to work.

That's not to say that doctors are perfectly happy with the new deal yet. Quebec's model loses points for refusing to fund information networks for doctors who remain in private practice. And in Ontario, FPs are demanding greater flexibility in the design of teams eligible for support under the program. Essentially, doctors just want some latitude in deciding how they practise, without being left out of the reform loop.

Patients in both provinces are happy at the prospect of having a doctor to call their own. This is a crucial departure from the 'drive thru' solutions to access issues we've seen in the past. Longterm, well-supported relationships are known to improve health outcomes — especially when they are between patient and doctor.

— Susan Usher, Health Policy Editor