Evidence from around the world, and Ontario, demonstrates that the introduction of primary care teams is providing patients with better care, at the best value. But one of interprofessional primary care’s biggest barriers is to attract and keep skilled providers. The key issue? Inability to offer competitive compensation to the non-physician health professionals and administrative staff who work in our community health centres, family health teams, nurse practitioner-led clinics and aboriginal health access centres. Funding for these positions has not changed in well over 7 years.
“To ensure these clinics (CHCs, NPLCs, FHTs, AHACs and nursing stations) can effectively recruit and retain qualified interprofessional staff in primary care settings, Ontario will invest an additional $85 million over three years.” - 2016 Ontario Budget.
Effective April 1, 2016, this investment will certainly help CHCs, FHTs, NPLCs and AHACs retain staff so as to better serve their patients and communities. We are pleased to have this financial commitment in place and look forward to working quickly through the implementation details; however, the AFHTO-AOHC-NPAO proposal as summarised below remains our goal.
In June 2013, the three associations that jointly represent all interprofessional primary care organizations in Ontario – the Association of Family Health Teams of Ontario (AFHTO), the Association of Ontario Health Centres (AOHC) and the Nurse Practitioners Association of Ontario (NPAO) – released their joint report to the Ministry of Health and Long-Term Care. It presented indisputable evidence that:
- Compensation levels in primary care are below market – averaging 15.6% for all non-physician positions, and ranging up to 30% below market.
- The gap between market and actual compensation is growing – it has increased by an average of 4.9% from 2009 to 2012.
- Lack of pensions is a key barrier to labour mobility – primary care organizations cannot provide both the HOOPP plan and a reasonable benefits package within the imposed financial limit of 20% of salary.
- Pay equity challenges are a real risk – two types of positions (registered dietitians and nurse practitioners) have been consistently found to be funded at a salary grade below that of comparable health professions. These positions also post the highest vacancy rates in primary care – 19% and 14% respectively. Health promoters were also found to be in the wrong band.
Rigorous market study conducted by the Hay Group established a recommended salary structure. It placed all positions into 13 pay bands, with 3 market exceptions. Each band has a recommended salary range and steps for proceeding from minimum to maximum within the range. Full implementation across all of the interprofessional primary care organizations would require a funding increase estimated at just over $120 million. Recognizing the need to phase in such an increase, the three associations recommended:
- An immediate increase of 2.5% in benefits funding to enable all to participate in HOOPP;
- Funding that would place all professions in their appropriate salary band; and
- Funding to reduce the gap between the current and recommended salary rates in steps over four years.
We continue to advocate to achieve the 2012 recommended salary rates for all staff (IHP and admin) in primary care teams, to be implemented over 4 years. The Ministry recognizes this $85 million commitment is the first step in a process and is committed to working with us to achieve our overall goal. Two years from now, the opportunity for further increases is likely to open up. The Government is committed to eliminating the deficit by the end of 2017-18 and some of the compensation constraints may be lifted for the following fiscal year. This will provide opportunities to address the remaining gaps.
- Toward A Primary Care Recruitment and Retention Strategy for Ontario — Primary Care Compensation Structure – June 2013-updated January 2014
- Toward A Primary Care Recruitment and Retention Strategy for Ontario – February 2012
- Ensuring access to team-based primary care- February 2015
- Minister Hoskins commits $85 million over three years to interprofessional primary care- February 2016
- Minister Hoskins affirms his $85 Million Funding Commitment to Primary Care Teams over the Next Three Years - September 2016
- Minister Hoskins has signed the funding compensation letters - October 2016