Invest in Health Human Resources and Operations for Comprehensive Primary Health Care a strong foundation for an integrated health system
Primary health care is in crisis. The situation is now dire.
Alliance members are losing primary health care staff to other sectors and parts of the health care system. When Ontarians cannot access primary health care in their community, it causes strain on other parts of the health care system, such as emergency and acute care.
Alliance members are doing everything they can to keep doors open to provide services to those who face the most barriers to primary health care, ensuring the most marginalized people in Ontario have access to a doctor or nurse practitioner to keep them healthy and well and out of emergency departments. Our members ensure people in communities can see their primary care provider when they need to, or their social worker or mental health counsellor if they need supports, or a dietitian/nutritionist to help manage chronic health conditions through diet. However, the funding and human resources challenges impacting members threaten their capacity to deliver on the promise of providing the communities they serve with comprehensive primary health care to ensure people are connected to convenient care in their local community, no matter where they live in Ontario.
We believe investing in and adequately funding comprehensive primary health care is critical to sustaining it as the foundation of an integrated and sustainable health system. Ontario needs to make significant investments in health human resources for comprehensive primary health care to continue supporting an integrated health care system. A fully staffed primary health care system can keep people in community and out of emergency rooms and hospitals while ensuring efficient use of healthcare funding towards equitable health outcomes.
The Alliance for Healthier Communities (Alliance) represents a vibrant network of 114 community-governed primary health care organizations serving communities across Ontario. Together, we have a common vision towards equitable health and wellbeing for everyone living in Ontario. We strive for this by advancing comprehensive primary health care and advocating for changes in Ontario’s health and social systems to address inequities. Alliance members include community health centres, nurse practitioner-led clinics, community-governed family health teams, and Indigenous primary health care organizations.
The people and communities in Ontario who face the greatest barriers to health care rely on our members to provide primary health care, mental health, community services, and supports. We cannot let them down now.
Ontario must address the human resource crisis in primary care by properly funding recruitment and retention as well as operations. With sufficient funding, Alliance members can attach more people in Ontario to primary health care, starting right now.
# Invest in Health Human Resources and Operations for Comprehensive Primary Health Care a strong foundation for an integrated health system
For the Ontario Budget 2025, the Alliance recommends the Ontario Government focus on wage parity by appropriately funding health human resources, stabilizing operations and implementing social prescribing province-wide. These investments will keep people in community and out of emergency rooms and long-term care.
Summary
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Budget Request |
$430.9 million over five years Ontario needs to invest approximately $430.9 million over 5 years, including an annual adjustment of 2.90%, in the primary care sector in Ontario to close the significant wage gap. Of this ask, Alliance members require a Government investment of $164.5 million to reach the 2023 recommended salaries to ensure a fully staffed primary health care system that can support people and communities and ensure the whole health system is not overwhelmed. | ||
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Budget Request |
$33.7 million Ontario needs to invest in a base budget increase of 5% or $33.7 million for community-governed comprehensive primary health care organizations. Members have only seen a 6% increase over 27 years. This investment will maintain and improve service delivery, keep the lights on, and meet the growing needs of clients and communities as they grow and age. | ||
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Budget Request |
$9.7 million Social prescribing connects people in Ontario to non-clinical programs and services that support their health and wellbeing. Social prescribing relieves administrative burden for doctors, nurse practitioners, and inter-professional health providers, as the link worker connects clients with community-based programs such as food security supports, physical activity, arts and culture, and social connection. Ontario needs to invest $9.7 million so that primary health care teams in Ontario can implement social prescribing. Social Prescribing programs operate in diverse communities that serve people who are Francophone, Black, Indigenous, and seniors, among others. In the Alliance’s Rx: Community Social Prescribing Pilot, 42% of providers reported that they observed a decrease in the number of repeat visits among their clients who participated in a social prescribing program. According to a recent survey, 59% of family doctors stated that social prescribing can help reduce their workload. This will enable primary care clinicians to increase attachment for people without a primary care provider.
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TOTAL INVESTMENT: $ 474.3 million |
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# INVEST IN HEALTH HUMAN RESOURCES FOR INTER-PROFESSIONAL PRIMARY HEALTH CARE TEAMS
We call on the Government to invest approximately $430.9 million over five years, including an annual adjustment of 2.90%, in the primary care sector in Ontario to close the significant wage gap. Of this ask, Alliance members require a Government investment of $164.5 million in Health Human Resources to fully staff inter-professional primary health care teams. The inter-professional teams practicing within community-governed comprehensive primary health care organizations need to be properly staffed and resourced to deliver primary health care for those who need it the most.
We appreciate the Government of Ontario's investments in new teams to expand access to primary health care across Ontario. However, these investments are not for existing teams that continue to provide care and service to communities in Ontario. Therefore, we call on the Government to provide additional investments that are targeted to increase wages and address the health human resource challenges that impact organizations’ ability to recruit and retain staff to support existing teams and connect Ontarians who do not currently have access to teams to primary care providers.
For years, healthcare providers and administrative staff in community-based non-profit primary, community, mental health and addiction, and long-term care have faced lower pay grades compared to other parts of the healthcare sector, including newly created Government healthcare agencies. The current level of funding is inadequate and does not keep up with inflation or the increasing cost of living, which makes recruiting and retaining staff a significant and historic challenge.
We applaud the Government for repealing Bill 124, which the Ontario Superior Court of Justice ruled unconstitutional. This Bill capped healthcare workers’ salary increases at 1%, which did not even keep up with inflation. Since its repeal, the Government has paid up to $7 billion in retroactive payments to public sector employees. Healthcare workers in primary care, however, have yet to see any retroactive payments since the Bill was repealed.
Primary health care staff have been paid at or below 2017 salary rates and are leaving the sector as the cost of living rises. If this continues, with compensation being years behind other parts of the healthcare sector, we will see increases in hospitalizations and emergency department usage as primary care will be unable to sustain care for Ontario’s most complex patients. The consequences of inaction are dire: service cuts, longer wait times, and increased overcrowding in emergency departments and hospitals in communities throughout Ontario.
The Ontario Community Health Compensation Market Salary Review showed that despite the rising cost of living and a competitive healthcare job market, community health sector staff experienced an average salary increase of only 1.53% in 2023, with some roles projecting a 0% increase. This pales in comparison to the 11% increase awarded to hospital nurses, the 8% increase for emergency medical services, and the 9.95% increase doctors were awarded for year one of a four-year agreement, further exacerbating the wage gap.
As a result, the community health sector is witnessing an exodus of workers to other fields, making it increasingly challenging to recruit and retain essential health workers. Primary care organizations are having to make cuts to service to retain staff or recruit new staff to meet the growing needs of their organizations and communities.
The community health sector faces a critical wage gap compared to other sectors (such as hospitals and schools), which currently amounts to more than $2 billion. A recent survey issued to more than 1,300 community health agencies reveals that 94% of respondents identify compensation as the single most significant challenge for recruitment and retention. The community health workforce remains steadfast in their commitment to support the wellbeing of Ontarians, but in light of the rising cost of living, a sustainable approach to addressing the wage gap is critical to ensure the continued delivery of safe and high-quality community health services and to continue providing the right care in the right place for Ontarians.
We call on the Government of Ontario to provide funding targeted to compensation so that community-based primary health care organizations can offer competitive compensation packages that make it possible to attract and retain critical health human resources.
# INVEST IN COMMUNITY PRIMARY HEALTH CARE ORGANIZATIONS THROUGH BASE BUDGET FUNDING INCREASES TO SUSTAIN HEALTH FOR COMMUNITIES IN ONTARIO
We call on the Government of Ontario to invest $33.7 million or 5% base budget funding increases to community-governed comprehensive primary health care organizations so they can maintain and improve service levels, keep their lights on, and meet the needs of their clients and the communities they serve. Alliance members have only seen an increase of 6% over the past 27 years. The Government has invested $20 million or 1.9% in budget funding for two years, after no investments in base budgets since 2017. We sincerely appreciate the Government for providing this much needed investment in base funding. However, we call on the Government to continue providing these investments in base funding.
Alliance members serve communities that face the greatest barriers to care and poorest health outcomes and that have been disproportionately affected by chronic diseases, respiratory illnesses, mental health and addictions, among others.
Alliance members divert people away from hospitals and emergency rooms while ensuring they get the right care they need when they need it and in the right places. Additionally, they alleviate pressures on the rest of the health system by managing complex clients in the community and close to home.
Community health organizations provide care for populations that are 68% more complex, on average, compared to the average Ontarian. Despite this complexity, clients served go to emergency departments less than expected - resulting in over $27 million saved every year.
Comprehensive primary health care providers need sustainable resourcing to maintain the capacity to deliver primary health care, mental health, community supports, and the innovative services that help end hallway health care.
We need sustainable and adequate funding to maintain our capacity to deliver primary health care, mental health services, health promotion, and community programs and services to keep people healthy and well in their homes and communities and out of the hospital.
# INVEST IN SOCIAL PRESCRIBING LINK WORKERS TO CONNECT PEOPLE TO EQUITABLE, CULTURALLY SAFE PRIMARY CARE
We call on the Government to invest $9.7 million in equitable, culturally safe inter-professional team-based care through social prescribing. Social prescribing bridges the gap between clinical and social care by referring patients to local, non-clinical services that are chosen according to the client’s interests, goals, and gifts. It allows doctors, nurse practitioners, and inter-professional health providers to formally refer patients to community-based programs. It empowers clients to improve their health by developing new skills, participating in meaningful activities, and becoming more connected to their communities. Social prescribing increases primary care capacity and decreases repeat client visits, as well as emergency department visits.
Strong Evidence Supporting Link Workers
Social prescribing link workers do this work by developing trusting relationships and providing personalized support. As a result, their work:
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Strengthens community resilience;
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Reduces health inequalities by addressing the wider determinants of health;
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Increases people’s active involvement with their local communities;
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Provides highly personalized and patient-centred collaborative support and service that reflects individual goal-setting priorities;
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Focuses on gradual and holistic change dealing with social issues beyond health; and,
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Increases primary care capacity and decreases repeat client visits, as well as emergency department visits.
Alliance members provide comprehensive team-based primary health care through the Model of Health and Wellbeing or the Model of Wholistic Health and Wellbeing. Whether in community health centres, nurse practitioner-led clinics, community-governed family health teams or Indigenous primary health care organizations, clinicians work together in teams to meet the needs of the community and tackle population health issues through a health equity and community focus.
Health equity is a cornerstone of effective social prescribing. Investing in social prescribing link workers means removing the barriers clients experience, such as economic, geographical, interpersonal, or psychological barriers. Over 60% of Canadian health outcomes are determined by social and environmental factors (such as income, education, working conditions, housing, and the environment.)
Primary care clinicians, such as those working in Alliance members’ teams, continue to play an integral and multi-faceted role in Ontario’s health care system, taking on new roles, innovating and responding to urgent and new needs, while also continuing to provide primary care services like prevention, acute and chronic care.
With the support of a link worker, primary care clinicians can provide referrals for clients to a wide range of local, non-clinical services to address their social, physical, and mental health and wellbeing needs. Link workers are an integral part of the inter-professional primary health care team and are essential to addressing the social determinants of health.
In the Alliance's Rx: Community Social Prescribing Pilot study, 42% of primary care providers reported that they observed a decrease in the number of repeat visits among their clients who participated in a social prescribing program. According to a recent survey, 59% of family doctors stated they think that social prescribing can help reduce their workload.
Community-governed comprehensive primary health care organizations help alleviate pressures on the rest of the health system by managing clients in the community and close to home with services rooted in the determinants of health, anti-oppression and cultural safety. Social Prescribing programs operate in diverse communities that serve people who are Francophone, Black, Indigenous, and seniors, among others.
Alliance members provide culturally safe primary care services, health promotion services, and community development services that help address the social, economic, and ecological determinants of health. Investing in social prescribing can embed link workers in comprehensive primary health care teams and address health inequities that impact hospital system use.
We call on the Government to invest $9.7 million in equitable, culturally safe inter-professional team-based care through social prescribing link workers.
# CONCLUSION
Evidence provided by the Institute for Clinical Evaluative Sciences (ICES) found that, even though the majority of Alliance members serve people with more socially and medically complex needs, they do a significantly better job than other primary care models at keeping these people out of hospital emergency rooms and helping to end hallway medicine.
Alliance members serve populations who face the most barriers to health: Indigenous peoples, Francophones, Black populations, people with disabilities and mental health challenges, other racialized groups, recent immigrants and refugees, people who are 2SLGBTQ+ and people living in Northern, rural and remote areas.
We call on the Government to invest $430.9 million over five years to address the HHR crisis impacting the primary care sector, a 5% increase or $33.7 million in base budget funding for community-governed comprehensive primary health care organizations, and $9.7 million to fund social prescribing link workers for equitable, culturally safe inter-professional team-based care to improve population health for everyone living in Ontario, to ensure Ontarians have access to the right care, in the right place, and at the right time close to home.
Contact:
Marie-Lauren Gregoire Drummond
Director of Communications and Stakeholder Relations
Alliance for Healthier Communities