Time to establish a successful model.

In response to the articles on primary care reform in the February issue of Canadian Family Physician, we would like to highlight another model. By working with multidisciplinary teams in community-based and community board–directed centres, family physicians in Ontario community health centres (CHCs) have offered comprehensive health care that directly meets the needs of the community for almost 30 years. They provide the “basket of services” identified by both the Provinical Coordinating Committee on Community and Academic Health Science Relations and the Family Health Networks as appropriate for primary care sites. Within the CHC model, family physicians are encouraged to practise in a manner consistent with the four principles of family medicine. They are able to devote their time to fully using and expanding their range of clinical skills within the physician-patient relationship and to being a resource to a defined community. Traditionally, CHCs are well placed to deal with high-needs patients with complex physical and mental health problems, as well as patients who experience barriers to accessing primary care. Health promotion, prevention, and care can be practised in a patient’s environment through use of team models and a community outreach approach. A range of primary care services, including housecalls, nursing home visits, and obstetrical services as well as expanded services, such as chiropody, counseling by social workers, nutrition counseling, and lactation support, can be offered by various team members. Physicians in CHCs also have the opportunity to participate in developing and implementing innovative programs to promote good-quality primary care (eg, the community diabetes education program). This model works well for physicians, patients, and communities. Physicians are paid a salary with stipends for oncall and obstetric and hospital work and receive a full benefit package. Holiday and study leaves are paid. There is administrative support for finding locum tenens physicians. Physicians can work together in larger groups to ensure a range of clinical services and on-call coverage are available. In this era, when new and established family practitioners are moving away from providing comprehensive cradle-to-grave care to a defined population, CHCs offer an attractive alternative. They also offer an alternative for patients who are increasingly frustrated by the fractionation of care inherent in the fee-for-service system. We suggest that it is time to look at an established and successful model. —Dona Bowers, MD, CCFP, FCFP —Alison Eyre, MD, CCFP —Frances Kilbertus, MD, CCFP —Laura Muldoon, MD, CCFP Ottawa, Ont by e-mail