Challenges across regions 

A panel discussion gave attendees the opportunity to learn about four team-based health care programs:

My Health Teams in Manitoba, Groupes de Médecine Familiae (GMFs) in Quebec, North End Community Health Centre  in Nova Scotia, and the Toronto Central Regional Cancer Program. 

Community connections  

The panelists noted that working with communities to plan services — and building strong relationships with those communities — is key to providing effective care. “It’s basic, but groundbreaking,” said Jeremy Buchner, Provincial Clinical Services Lead – Primary Care, Shared Health, Manitoba. Creating pathways to health care that are viewed as culturally safe is particularly important for Black and Indigenous communities whose past traumatic experiences in health care institutions has contributed to a lack trust in the system, causing some to put off seeking wait care or avoid following through on treatment that could improve their health. Building relationships with communities, understanding their specific needs, strengths, challenges, and existing support systems is integral to providing holistic care. 

Complexity of needs 

Buchner shared that not one My Health Team looks the same because the needs across the province differ. Being able to adapt and apply cognitive flexibility to different contexts and situations is one of the strengths that social workers bring to team-based primary care settings, said Lana Maclean, Director of Community Health and Mental Health, North End Community Health Centre, Halifax, Nova Scotia.  

Adaptiveness and flexibility are vital as the needs of individuals and families grow in complexity. However, the rise in complex needs is contributing to a tension between the desire to get as many people as possible to see a provider and the desire to ensure high quality care. Patients with complex needs may require monthly, weekly, or even daily visits. Providing quality care to rural communities where populations are less dense and more difficult to access is also a major challenge. Primary health care cannot be well served by a “one size fits all” approach. 

Teaching and training 

Ensuring quality care requires quality training, and training requires time, which can also add to the tension that exists between the number of people one can serve and the quality of care a team can provide. As the pressure to serve more and more patients increases, the time one is able to commit to training future social workers in health care settings decreases. “Government support is needed for teaching roles,” said Louis-François Dallaire, Centre Intégré Universiaire de Santé et de Services Sociaux de la Capitale-Nationale. “Social workers need to advocate for their role in teaching and professional development.” 

Social work leadership 

Unless they have had direct experience working with social workers in a team-based setting in the past, other health care professionals don’t always understand the value and expertise that they bring to their roles. “There are 10 regional Indigenous cancer leads across Ontario and this role has primarily been held by physicians,” shared Joanna Vautour, a Regional Indigenous Cancer Lead for the Toronto Regional Indigenous Cancer Program. “I’m the first social worker.” Social work associations and educational institutions need to support social workers in better defining, communicating and advocating for their essential role in primary care settings.  

Staff wellness 

Primary care teams require dedicated staff, and staff retention is crucial. Staff wellness and the conditions required for social work to thrive must be considered. One challenge is that social workers in primary care settings are inconsistently funded. For example, some may receive funding from separate budgets set up to address mental health and addictions or poverty, but, as Ivy Oandasan asked, “is mental health not part of primary care? Is poverty not part of primary care?” Lack of pay equity in primary health care settings and a failure to consider caseloads can result in social workers leaving primary care for  ther social work roles. 

[Re]defining primary health care 

“Why are social services not considered part of health care? Why is it one or the other?” asked Oandasan. Panelists and Summitt attendees agreed that health care needs to go beyond the biomedical. The development of a national strategy for team-based primary care provides an opportunity to redefine how we approach care and what actually constitutes health. “We need to shift the way that we think about the delivery of care, and why social workers are integral to that, because it’s not just about biomedical capacity. It’s about social capacity.”  

“The evidence is clear…interprofessional primary care teams are the way to go to improve access for our patients in prevention and chronic disease care, and to reduce burnout in our health professional teams… Social workers are a vital part of these teams. They bring that deep expertise in mental health and help us address the social determinants of health.” 

— Shirley Lee, Vice Chair, Education, Department of Family and Community Medicine, University of Toronto