Thank you very much, Mr. Lobb. Good morning, members of the Standing Committee on Health.
I am a family physician. I practised in Corner Brook, Newfoundland, for almost a quarter of a century and worked for the College of Family Physicians for the last 10 years before becoming executive director and CEO at the beginning of last year.
I am privileged to be with you today, and I want to thank you for the invitation. My remarks will provide an overview of current best practices and the potential for federal government contributions related to scopes of practice of family doctors in Canada.
The College of Family Physicians of Canada, CFPC, is the voice of family medicine in Canada. We represent over 30,000 family doctors. We advocate on behalf of our members to ensure the delivery of high-quality health care. Our mandate in the area of education is to establish standards for the training, certification, and maintenance of certification of family physicians and to accredit the postgraduate family medicine training programs in Canada's 17 medical schools.
The mix and complexity of services provided to patients within the scope of family medicine is crucial to Canada's health care system. We are the point of first contact or the backbone of providing primary care and sometimes secondary care to Canadians. Everyone in Canada should have a family doctor to provide continuous, lifelong care in family practices, emergency departments, hospital wards, and patient's homes in every community in Canada.
The federal government has a role in supporting innovative primary care models. It must work with provincial and territorial governments to improve team-based care. Interprofessional teams and the services they deliver must be defined by the needs of the population we serve. To do this, governments can foster collaborative team care through funding structures that support the full scope of practice of all service providers, reward team effectiveness and efficiency, and reinforce organizational accountability in relation to appropriate access and the delivery of population needs-based services.
I would caution us against parcelling out the role of providers. In order to feel cared for—and by that I mean you can think of two experiences: one experience in health care where at the end of the day you really feel that the people who were there really looked after you, and another experience in which probably the right decisions may have been made but in the end you may not necessarily have felt cared for. I want to talk about the first model.
In order to do this the role of all providers must be accepted globally. The federal government must work to ensure health care access for those who live in more remote parts of our country and to aboriginal communities. We have developed a new competency-based education model called the Triple C curriculum in which we ensure that family medicine residents get appropriate experiences to provide comprehensive care, continuity of care, and educational experiences that are centred in family medicine. We prepare our future family doctors to be socially accountable to all populations, including vulnerable populations, and rural and remote populations.
We hope that the federal government can support the CFPC patient medical home vision that by 2022 every person in Canada will not only have their own family doctor but also have a personal family physician whose practice serves as the patient's medical home. This model is a model of team-based, patient-centred model of care where health care providers work to their scope to ensure excellent care and strive for the patient's best outcome.
To me, changing population needs and scopes of practice evolve within different medical specialties and health professions. The implementation of team-based care allows health professionals such as nurse practitioners and physician assistants to work with family doctors and provide a good scope of services. Overlapping scopes of practice provide opportunities for patients to benefit from the distinct strengths of individual health professionals who are part of a team. A clear understanding of scopes of practice among team members can help guide which providers will deliver services to best meet patient needs by providing timely quality care.
We support models of practice that include enhanced roles for other professionals besides physicians to improve access to care for patients. We must ensure, however, that the expansion of scopes of practice does not compromise patient safety and quality of care.
For example, prescribing rights must go hand in hand with the ability to make a diagnosis and take into account a differential diagnosis, the results of investigations, and above all, the patient's perspective regarding management. In most cases, professionals granted the right to prescribe medication should do so only in settings where they are practising as part of collaborative teams, with family physicians as members of that team.
We support collaboration and not competition because we believe that collaboration is what will help in the end to deliver better, timely access to patient care.
I want to provide a few examples that demonstrate this, coming mainly from Ontario.
In London, for example, the family health team reported there an approximate 20% reduction over one year in the proportion of patients with chronic obstructive lung disease who had at least one exacerbation. In 2011, the Petawawa family health team reported a 30% improvement over one year in the proportion of diabetic patients with solid evidence of improved blood sugar control. Also in Ontario, there have been some excellent examples of collaboration between family physicians and psychiatrists in a collaborative model of care, where the psychiatrist actually comes to a family practice to really provide consultation and support to the providers of that practice, thereby enhancing access to care and quality of care in the area of psychiatric health services.
Regarding the ongoing learning of family physicians, we believe the federal government has a role. The college does provide guidance and creates standards for residency programs, so family doctors can begin practice anywhere in Canada. We know that the federal government has actually provided some targeted funding and initiatives in the area of rural and remote training. The government has aimed policies toward loan forgiveness in exchange for practising in rural communities. We would encourage us to measure the impact of those incentives on retention. We do hear of rural communities being able to recruit but having great difficulties with retention.
A pan-Canadian approach is needed to help train physicians not only in hospital settings but also in community settings where so much of that care that we all get is provided.
Once in practice, family physicians need to be supported to maintain the knowledge and skills required to meet the needs of their patients. An emerging issue that you are going to be hearing from all of us is the maintenance and enhancement of physician competence and performance. We believe the federal government can signal the importance of this issue by supporting credentialing bodies, of which we are one, in looking at this more closely, and to adopt policies that best serve the needs of all Canadians.
Rural and remote practitioners, among others, face a particularly difficult situation. Their patients need them to be knowledgeable and skilled across a very broad scope of practice while building and reinforcing this scope. This can be more difficult if one practises in rural parts of this country. The broad generalist training family doctors receive help to make family medicine one of the most nimble of medical professions. We are trained to care for you from the earliest stages of life to the end of that life.
In conclusion, we're committed to working with you, with the federal government, to ensure that family doctors continue to provide optimal primary care and sometimes secondary care, when appropriate, for everyone in Canada.
Thank you once again for inviting us to speak with you today.