Open Letter to The Honourable Christine Elliot

OPEN LETTER

April 15, 2020

The Honourable Christine Elliott
Deputy Premier and Minister of Health
5th Floor, 777 Bay St.
Toronto, ON M7A 2J3

Dear Minister Elliott,

We are writing to you on behalf of the members of the Association of Family Health Teams of Ontario, the Nurse Practitioners’ Association of Ontario and the Ontario College of Family Physicians, who are caring for patients in communities across Ontario in the midst of COVID-19. We are seeking your urgent assistance in ensuring access to appropriate personal protective equipment (PPE) and ultimately safeguarding patient access to primary care.

We recognize there is a current shortage of PPE for healthcare providers in every part of our healthcare system. And we know that you are working hard to get frontline workers the PPE they need to do their jobs properly in hospitals, long-term care, home care, community institutions and elsewhere.

Our plea to you today – please do not forget about the critical needs in primary care and the broader consequences of PPE shortages. While the sector has quickly adapted to virtual visits, which is appropriate for most clinical issues at this time, patients still need in-person assessment and care – for sudden back issues, abdominal pain, anti-psychotic injections, pre- and post-natal care and immunizations, to name a few.

The unfortunate reality is that primary care practices are under imminent threat because of the ongoing shortage of masks and other PPE caused by the pandemic. Most family doctors and nurse practitioners currently or will soon have insufficient PPE to see patients for in-person care when necessary, and at the same time keep their staff, patients and themselves safe. As well, house calls for those with mobility challenges, for palliative care and declaration of death for home deaths are risky without appropriate PPE.

This shortage is compounded by the fact that PPE in primary care is purchased by each individual clinician or group practice/team through private companies. Procurement is extremely challenging given scarcity of stock and some members are resorting to buying their own supplies – sometimes at inflated rates – to ensure they can continue to operate.

Ontarians should not feel reluctant to visit their clinicians who can take the precautions necessary for that visit. Our members are working hard to keep the business of primary care open in spite of PPE shortages. They are running community drives, among other grassroots efforts, to secure needed PPE. They do so because they know the work they do is incredibly important, and perhaps have never understood this more clearly than in these difficult days.

Minister Elliott, we are quickly reaching a breaking point in primary care. Without the PPE to keep everyone in our medical offices and clinics safe, some will be forced to close their doors to in-person care. This may prompt some patients to go to the ER for care, or worse, not seek care when needed and risk delaying significant diagnoses. Our members cannot practise while risking catching and passing COVID-19 along to others, and this includes the care they deliver in long-term and home care settings.

We are recommending the following step be taken immediately to give our primary care clinicians sufficient PPE and other needed supplies to maintain necessary in-person assessment and care:

• Streamline procurement of masks, goggles, gloves and gowns through one central source for PPE distribution for primary care through Ontario Health/regions and not leave primary care clinicians to have to find PPE on their own. There must be a simpler way for clinicians in primary care to manage and procure inventory.

Ontario’s focus is rightly on the pandemic at hand, but we cannot lose sight of ensuring a healthy population. This means making sure patients who have illnesses do not deteriorate and that those who are healthy do not become sick. Illness is often spotted early in primary care because of continuity of care through a trusted relationship between the family doctor/nurse practitioner and their patients. But to do this, they must have the equipment needed to keep their patients, their staff and themselves safe.

We are grateful to all those on the frontlines who are doing their jobs and working tirelessly to curtail this pandemic. Let’s ensure they are fully supported in their vital roles and that their patients receive the care they need.

We welcome an opportunity to discuss our considerations with you and are also very pleased that you have now struck a Primary Care Advisory Table of frontline family physicians and nurse practitioners so you can also hear their concerns. Thank you for the work you are doing to keep Ontarians safe and healthy amidst this pandemic.

Sincerely,

Dr. Tom Richard President & Board Chair AFHTO

Mr. Shawn Dookie President NPAO

Dr. Jennifer Young President OCFP

cc.      

Robin Martin, Parliamentary Assistant to the Minister of Health Helen Angus, Deputy Minister, Ministry of Health

Melanie Fraser, Associate Deputy Minister, Health Services, Ministry of Health Heather Watt, Chief of Staff, Office of the Deputy Premier and Minister of Health Leif Malling, Office of the Deputy Premier and Minister of Health

Harpreet Bassi, Director of Policy, Office of the Minister of Health

Laurel Brazill, Director, Stakeholder Relations, Office of the Minister of Health Matt Anderson, President & CEO, Ontario Health

Sudha Kutty, Secretariat, Health System COVID-19 Oversight Table, Ontario Health David Hallett, Supply Chain, Health System COVID-19 Oversight Table

Clint Shingler, Director, Health System Emergency Management, Ministry of Health