| Summary: | Introduction: Central Toronto has 1.2 million people, 17 acute, specialized and chronic care hospitals serving both local and regional populations and approximately 1400 family physicians. Primary care in Toronto (and Ontario) is largely unorganized with groups or individual family physicians and nurse practitioners providing care under a variety of payment mechanisms to rosters of patients in very diverse neighbourhoods with significant health inequities. Access to primary and specialist care as well as social services is fragmented and overly reliant on provider relationships. As the foundation of well functioning health systems, it was recognized that primary care needed to be better vertically and horizontally integrated to both health and social services. For the past three years, with the ongoing advice, input and guidance of local primary care leaders , the Toronto Central Local Health Integration Network (LHIN) has been co-designing system wide and local initiatives aimed at improving access to primary and specialty care in five Toronto sub-regions. This engagement and input from primary care providers as well as broader system wide reforms aims to create local geographic systems of care. Description of policy context and objective: The strategy developed from broad based consultations with patients and providers to dentify the health and social needs of patients and the challenges in meeting these needs experienced by primary care providers. Mission, goals and objectives were developed and five priority projects for immediate change initiatives and investments were identified: Attachment, Access and Continuity; Access to Interprofessional Teams; Access to Specialists; Discharge Planning; and Secure Communications. The policy premise was that by addressing long standing issues identified by providers and establishing local staffing and governance structures it would be possible to engage physicians (even during a time of difficult central bargaining) to improve their practices and care for their patients. Target population: The target population was 1,400 family physicians practicing comprehensive primary care within Toronto, Ontario. Highlights: The strategy underwent several stages of development; all were underpinned by ongoing collaborative consultations and co-designed with system leaders and front line providers. Neighborhood level data provided local information on social determinants of health to bring an equity lense to planning. Local structures and staffing were established in 5 sub-regions, extensive data analysis was conducted in partnership with local researchers to inform the change process, collaborative local committees and working groups were struck to analyze, propose changes and oversee implementation, initiatives were aligned and integrated with broader system reform and the LHIN provided overall guidance and strategic funding. The strategy is led by a group of dedicated clinicians who work with the LHIN and local providers to design and implement change. Engagement of physicians (on a defined continuum) has been steadily increasing and each of the targeted areas of change is in the process of implementing large and small scale initiatives toward achieving the stated goals and objectives. Transferability: Elements of the strategy and initiatives will be transferable to health systems facing similar challenges.
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