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07 February 2025 | Country Update
An action plan to connect two million people to primary care -
05 February 2025 | Country Update
Expanded public coverage for non-physician primary care providers -
14 June 2024 | Country Update
Matching unattached patients to primary care providers in British Columbia, Canada -
29 July 2021 | Country Update
Expanding primary care coverage through contracts with private providers of virtual care
5.3. Primary care
Primary care is defined as the individual’s first point of contact with the health system and, at its core, involves general medical care for common conditions and injuries. It can, and should, involve some health promotion and disease prevention activities, although, unlike the public health services described above, these will be provided at the individual rather than population level.
The traditional model of primary care in Canada has been one based on individual GPs or teams of GPs providing primary medical services on a FFS basis (as described in Chapter 3). Most GPs or physician groups have a relatively stable group of patients after the initial period required to build up a medical practice. And while patients are free to change GP, most choose to have long-standing relationships with one physician or physician group. While the requirements for patient registration vary considerably by province and territory, no jurisdiction has implemented strict rostering (Peckham, Ho & Marchildon, 2018). There has been a gradual shift away from the traditional model of primary care, as evidenced by the decline in the proportion of physicians providing “comprehensive” or “full-service” primary care in British Columbia (from 1991/1992 to 2009/2010) and Ontario (from 2003/2004 to 2013/2014) (Lavergne et al., 2014; Schultz & Glazier, 2017). Similarly, there has been a decline in the percentage of Canadians who report having a regular family doctor (from 87.7% in 2001 to 83.6% in 2015) (CIHI 2019e; Statistics Canada, nd), and an increase in supply of walk-in clinics (Izenberg & Buchanan, 2018).
PT governments have established a number of initiatives to improve primary care starting with the establishment of community-based primary care clinics in Ontario and Quebec in the 1970s and 1980s. In Ontario, Community Health Centres were introduced in the 1970s, a salaried team-based model that services lower socioeconomic status populations. Although this model has expanded to 101 centres across the province, they serve less than 5% of the population of Ontario. By the 1990s, there were a number of primary health care reforms initiated on a pilot basis. Despite this activity and earlier reforms, there was limited change by the end of the century (Hutchison, Abelson & Lavis, 2001).
Since the early 2000s, there has been some experimentation with different models of primary care delivery, but most of the reforms are more evolutionary than revolutionary (Hutchison et al., 2011). Private FFS physician practices remain the dominant model of primary care in Canada outside Ontario, though all provinces and territories have made some move towards team-based primary care that brings physicians together with other health professions. These models vary in team composition, governance structure and population coverage, and include Family Medicine Groups in Quebec, Family Health Teams in Ontario, Primary Care Networks in Prince Edward Island and Alberta, among other PT initiatives (Peckham, Ho & Marchildon, 2018). In addition, there has been a slight shift away from FFS remuneration of physicians over the years since the late 1990s. However, among provinces with available data (all but Alberta and Northwest Territories), only Ontario has moved significantly beyond FFS to the extent that the majority of payments made to GPs are now through an alternative payment programme (such as capitation and salary). There has also been a gradual increase in non-physician primary health care providers, with expanded training and employment opportunities for midwives, NPs and physician assistants (see Chapter 4). Nurse-led primary care is the dominant model of care in northern regions and in First Nations communities (see section 5.11). For example, in Ontario there are 43 nursing stations providing primary health care in the north of the province funded by the provincial government and 29 funded by the federal government (Lavis & Hammill, 2016).
Box5.2 describes strengths and weaknesses of primary care in Canada.
Box5.2
