Opinion: Finally, a vision for primary care in Quebec

Given the fundamental role that primary care plays in our lives, it’s hard to believe that the new policy announced last month by Health Minister Sonia Bélanger is the first of its kind in Quebec.

Most of us rely on primary care for one reason or another, often at multiple points in our lives — whether for a seasonal vaccination, a medical exam by a family doctor, ongoing care from a nurse to help manage a chronic disease, advice on medications from a community pharmacist, or support for mental health or social problems from a social worker.

Primary care is supposed to be the foundation of our health care system. And yet, since the system was founded in the 1970s, no government policy has presented a clear and comprehensive vision for how primary care should be organized and governed — until now.

Let’s be clear: The policy represents a vision for the future, and changes will not occur immediately. Still, what the government has produced is encouraging in our view. We feel there are two basic things the public should know about it — plus one concern.

But first, a bit more about us. We are both professors and independent researchers, one at Université de Sherbrooke and the other at Université Laval. We co-direct a provincial primary care research network called Réseau-1 Québec, which consists of more than 1,400 members, including primary care clinicians, patients, managers, decision-makers and most of the primary care researchers in the province.

In our roles, we advised the government during the development of the policy and facilitated their consultations of the primary care scientific community. Full disclosure: We were not paid for this work, nor did Réseau-1 Québec receive funding tied to the development of the policy.

So back to what you should know:

First, the policy is the result of an extensive consultation process that lasted more than two years. The Ministry of Health and Social Services solicited input and feedback from a wide range of primary care organizations and partners, including family doctors, other health professionals and citizens.

The scientific community was also consulted on several occasions. Primary care experts produced a report and a collection of scientific briefs with recommendations to help inform the policy’s initial drafts, and detailed feedback was provided on specific policy goals and directives proposed by the ministry. In all, over 200 primary care researchers and other experts from Quebec and across Canada shared their expertise. The end result is a government policy that is largely consistent with the best available scientific evidence.

Second, the policy is ambitious and aims to bring about transformations felt not only in primary care but across the health system. In many ways this policy represents a course correction. For too long, health reforms emphasized solutions that have left our health system increasingly centralized and hospital-focused. Citizen and community engagement in health care has eroded over time, and decisions have been increasingly disconnected from local needs and realities.

The new policy seeks to empower local partners to play a greater role in organizing care for their communities, with resources and decision-making authority to support them. CLSCs are to be strengthened and local governance structures revisited to allow citizens and community organizations to participate in decisions and help primary care providers better understand local community needs and respond to them in a co-ordinated way.

A key goal is for every Quebecer to be attached to a main source of care, whether a CLSC, family medicine group, nurse practitioner-led clinic, or other clinic.

And now the concern:

While the policy has real potential to bring about positive changes to the way we routinely experience primary care, nothing will change without the collective will to see it properly implemented. We worry that the policy may be viewed as the product of a CAQ government on its last breath — something that can be swept aside by the next government.

That would be a mistake. The policy proposes many changes we feel are common sense and long overdue, including a greater emphasis on preventive care and more proactive approaches to care for vulnerable groups, as well as removing barriers to collaboration.

Indeed, the policy has already been welcomed by several professional associations representing family physicians, nurses, social workers, pharmacists, dietitians, and more.

What’s needed now is for all of us to hold this and future governments accountable for seeing this policy through and truly investing in our primary care system. The scientific community is ready to play its part — by ensuring next steps are guided by the best possible data and evidence.

Matthew Menear is a professor in the faculty of medicine at Université Laval. Marie-Eve Poitras is a professor in the faculty of medicine and health sciences at Université de Sherbrooke.

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