At a community meeting on January 28, Dr. Taylor Ferrier updated residents on plans to build a primary care health hub for Kanata-Stittsville. He’s part of a group of doctors that has submitted an application to the Ministry of Health for provincial funding to establish a Family Health Team (FHT) in Kanata-Stittsville.

Similar projects in other municipalities have been successful in attracting physicians, registered nurses, and other health care professionals, allowing them to quickly scale up primary care access in their communities. The project in Kanata-Stittsville would provide multi-disciplinary care to nearly 50,000 residents in the west end and across Ottawa.

We’ve identified a large piece of municipal land at 1655 Maple Grove Road in Stittsvillethat could be home to the health hub. City staff are now going through due diligence to determine if the land is suitable for the building, and to work through the finances and legalities of making the land available for community medical use.

You can watch video from the meeting here courtesy of iSILIVE, or read the edited transcript of the discussion with Dr. Ferrier below.


Q: Tell us about who you are, and what is your background.

Dr. Ferrier: I grew up on the East Coast. I found my way down to the United States where I started my early training in my first bit of exposure to healthcare and I really kind of gained a passion for healthcare delivery there. That was during a real tough time in healthcare in the United States so there were lots of movies and shows coming out and that really kind of drew my interest.

I was brought back to Canada, where I went on to study clinical epidemiology healthcare delivery. I achieved a master’s in medicine there and then I went on to do medicine.

If anybody gets to know me, they know I love to talk often and always, and primary care just offered that opportunity to really connect with people. I’m sure we’ll talk about that a lot more today but I found my way into primary care because I love just chatting with people, getting to know people, and then just seeing them through their life’s journey..

And so we’re here today because I love what I do and I found my way into kind of growing that landscape for a lot of other providers, and that’s why we’re here today to talk about what that will look like.


Q:  Why is it so difficult for people to access a family doctor in Ontario?

Dr. Ferrier:  I think this is the $1,000,000 question that we’re all trying to solve. First and foremost I think this has kind of been in the works for a long time. When I first started in medicine, this wouldn’t have been something that people would have seen in the public.

But in the rural areas we noticed that a lot of family doctors out there that needed that extra bit of training just to do a little bit more in the emergency department, a little bit more obstetrical care. So a lot of people started offering what we call these “plus one” programs, this extra year or even extra three months of training. So hospitals and other groups in the cities started gobbling up more and more of these comprehensive doctors, bringing them into more focused practice.

And while that was happening over the last decade or so, what we’ve noticed is we’ve seen a spike in the complexity of care. We’re an older population now than we were 5-10 years ago and that means that you may be looking to see your family doctor a lot more often now than you did before. And now when you multiply that for a particular physician who used to carry 1000 or 2000 people in a practice, they can no longer service that many people.

So we’re seeing fewer doctors enter into primary comprehensive care, we’re seeing now the physicians that are in comprehensive care taking on fewer people, and all of a sudden we’re seeing this dramatic rise in the number of visits.

When we look at what the background of that looks like on the provider sense, is that we’re seeing escalating amount of paperwork.  It’s not the forms. It’s actually the labs. It’s the consultant’s reports.  We ultimately have to be the people who store all that information. And 10 years ago that was something that took me two hours a week to do, now it takes me 20.

So that’s all that time that I otherwise would have been putting towards a larger patient population, is now stuck behind a desk sorting out where the best place is for all this work to go.

I think one other piece that we don’t talk about a lot is that, a lot of my mentors growing up in medicine they graduated with $1500 worth of debt, maybe $3000 worth of debt. The average doc now is $300,000 plus of debt. I remember when that used to be what we would say about our neighbors to the South. “You don’t want to go there, look how expensive things are.” Well it’s just like that now (in Canada).

And on top of that before we would see our mentors actually take that risk as an entrepreneur being a new doc and they would take that that first step and make more investments into new practices, modernizing their approaches. But they simply just don’t have the funds to do that now. They need to get right to work, and they have to start bringing down mountain load of debt.

So we have this like perfect storm that’s all of a sudden happened that’s been building up over the last decade or so. It’s not necessarily one group’s fault, it’s just the way things just kind of all merged all at once.


Q: You had recognized this issue in Perth, where you were living previously, and you established the Tay River Health Center. What would people see if they visited that facility?

Dr. Ferrier: I was first approached in early 2019 by a couple town councillors. Believe it or not Perth is obviously a small town, but our catchment area is about 75 to close to 100,000 people. So this small little town was the main center for all these other small little villages all the way around. We had 13 doctors for the better part of 100,000 people. Now what was so incredible was that this tsunami had not quite hit yet, but we had a couple councillors who were saying, “we’re getting some grumblings that there are some issues”.

So a couple colleagues, we got we got together, and we said maybe this is something we need to look at. There is no space for new doctors to come and we also knew they didn’t have the money to make any new investments. But we’d be in practice, and we knew we were a group and we could probably put something together.

So we found a piece of land, and sure enough, just like it’s happened to you already and many of you out here are probably in those different types of industries, a lot of people came knocking on our door. And they said, well you know if you’re building a clinic here you know we’re physiotherapy group we want to be there too, we’re radiology we would love to be there, and all of a sudden this 3,000 square foot small little clinic that we wanted to build is now 30,000 square foot. And instead of just a couple 1000 people we’re now 15,000 people.

We’ve been fortunate to treat everything from your newborn care right to end of life care. If you have autoimmune diseases, if you’re immunocompromised, if you have cancer, we treat it all.

So it’s a place that if you can think that there’s something that you do need under the umbrella of healthcare, that’s ultimately what we are aiming to provide. We’re seeing a lot of other municipalities take a look at what we’ve been able to achieve.

Over 6,000 to 8,000 people that never had a family doctor, that never had basic preventative care screening, that have missed out on some really important opportunities… We’re starting to see the dividends of that now pay off for our community. This past year we had over 50,000 visits. If you think about it, just a few years ago none of those visits existed.

My wife and I and our two kids moved to Stittsville this past summer, and I’m still blown away. The communities are beautiful, the people are amazing, my kids go to school here now. There is no reason why this particular area should struggle. It’s got all the right elements to be incredibly successful.


Q: And you’ve got some students at Tay River as well?

Doctor Ferrier: Think about when you see doctors at a hospital setting or they’re in an academic field. What we know is absolutely key is that we have to mirror those same training facilities. Because, think about it, you’re a new family doctor. Not only you burdened with debt and just the overwhelming concern about the complexity of care, basically the overwhelming nature of the job right now, you want to make sure that you’re moving into an environment that’s really well supported.

So what did we do? We created a facility that would actually be architecturally geared towards team-based care. So, when you came by, you could see that if I opened up my door and the patient is sitting next to me like this, I could open up the door and I can see seven other providers.

Let’s say somebody comes in with a rash or something that’s a little bit outside of my comfort zone. I have a group of 10 other doctors that I can actually literally bring in the room and draw on their experience. So what does that mean for the patient at the other end? Well, that means that I’m not saying, well I better just refer you to a dermatologist or a geriatrician or a psychiatrist, because we have those providers right on hand to help us with that care.

So we became a teaching site where half of our recruits actually were people that either trained under one of us or myself and that’s what really bred a lot of our success.

All of these elements are what we want to bring to the forefront here.


Q: Describe what this model would look like in Kanata-Stittsville. 

Doctor Ferrier: We’re being pretty ambitious. We want to try to provide a structure that doesn’t feel too sterile. We want it to feel comforting. We want it to feel less and less like a hospital but much more like a community home. That’s first and foremost.

I want you to think about it from two different lenses. What this may mean for a provider, because that’s actually going to be important, because we’re going want to attract them in here. And then, what’s it going look like from your lens as a patient. When we’re approaching this, we really want to see it from those two lenses.

We know your first point of contact is through primary care and that’s your first gateway into the health care system. So the pillar of this entire proposal is going to be a primary care team.

It’s also about a number of other allied health members. When we talk about this increased complexity that’s happened, what we do know is that physicians are not the be all and end all of care that’s provided. It’s not uncommon that if I see somebody for heart failure, diabetes, and depression, I can’t be all of those things to all of those items, so we need to start surrounding ourselves with other valued allied health members.

We need nurse practitioners surrounding us, we need pharmacists surrounding us, we need mental health workers surrounding us, and again that’s all backed on these partnerships that we’re only in the early stages of bringing forward but partnering with to bring in their resources and their expertise into this as well.

So what do we want to do? We want to bring a primary care home that all of you may find a place at. So we attach you with a primary care provider whether it be a physician or nurse practitioner.

What would you see there as a patient? Well not only would you be connected with somebody that’s going to oversee those important aspects, you’re also going to be connected with a number of other allied health service members. So if you do have diabetes, we will have a dietitian, we’ll have a nurse practitioner diabetic educator.

These are really the first steps from the primary care place.

On top of that, we’re going to be a little bit more ambitious because I think we can do better than that. This is definitely where we can expand further upon what we’ve been able to do in a place like Perth.

We’ve had an absolute outpouring of interest from specialists that really are looking to get out of a particular scenario where they’re in a hospital. They want to get out to the community because that’s where they’re already living and they’re forced to go into a hospital setting which is maybe not where they want to be. They want to actually come into a place where they’re actually not just the pediatrician or respirologist just one off. They want to actually group together, just like the family doctors are able to do.

So we envision a site that’s not just about primary care, but that’s also coupling the great work that a lot of our specialists do.

If you’re a patient, you’re not being sent all the way around the city for all those different healthcare services that you need. So the idea is that we’re going to try to walk you down the hall, get you connected, without leaving the site. We know that gives us better uptake. We know that it’s better patient care. We know that a lot of people who may be immunocompromised, who may have real complex care, being close to home is really important.

On the back end of things from a providers lens, not only are we creating now a collaborative environment where both primary care and specialists can work hand in hand, which I can tell you will be a real game changer for both sides, but we’re also going to work towards backing a lot of how we communicate with a centralized electronic medical record.

\Well no matter who you communicate with on site, whether it be an independent pharmacist, whether it be a primary care physician or a specialist, they’re all communicating on the same record. From a provider’s lens that makes me more safe. That means that I know the medications that you’re getting are dispensed by the right person, in the right place, the right time. I can see real time what the specialists are saying. The communication is improved.

And if we’re really getting ambitious, which I hope we do one day, is now think about that railroad path like we talked about. Maybe you’re in Merrickville one day and then maybe you’re in downtown Ottawa and all of those records are now amalgamated. Everybody can see what’s happening so no matter if you’re at the cottage for a weekend or you’re at home. Wherever you’re at, you’re connected. I think that’s ultimately where we want to go long-term.


Q: Where are you at so far with the project?

Doctor Ferrier: We’ve put forth I think a fairly ambitious application to the provincial government to support us with the endeavor of a family health team. These are those allied health resources that we talked about. We’re a group of physicians and nurse practitioners and specialists that all want to come here and we want to be surrounded by those allied health services that are ultimately going to provide that level of care that we’re really hoping for.

On the backside of that, what are we doing as providers, well we’re connecting right now. What we’re not wanting to do here is just do kind of like a rearranging of the deck chairs. We don’t want to be just taking some doctors from here and taking some doctors from here.

We know that 30%, right now, of our fully trained comprehensive-based family medicine practitioners and nurse practitioners are now doing focused care. But what they have come back to tell us is that the grass isn’t always greener on the other side either. We have had an outpouring of interest from people that were only doing something two or three days a week saying, “wait a second, you’re telling me that I could practice with a number of competent doctors, that are going to have all these partnerships with all these different agencies, that may offer the opportunity for me not just practice the comprehensive care but also be able to work with colleagues such as in pharmacy and other nurse practitioners and dietitians. That means I could take on more patients. That means I’m going to be doing exactly what I’m trained to do. I want to be a part of that.”

We were very fortunate, and in a very short amount of time since we started chatting in June and July, we’ve already had a start of about 15 to 20 primary care and specialists and nurse practitioners that have all come out and said we want to be a part of this.

We haven’t put a shovel in the ground yet, and I think the old adage goes ‘build it and they will come’. I think that when you start to make the connections and you start to provide the vision that people want to be a part of, I think it really will attract. And again we’re just talking about what people where people are currently located that are there that we’re trying to bring it back into comprehensive medicine. If we take the long view, we’re going to see ourselves recruiting more and more residents as a teaching site and then we’re going to try to bring in and grow more and more providers.

Councillor Glen: And then from the City side, our city staff is going through a due diligence process. We’ve identified a piece of land that we think would be ideal for this. If I could describe it, the address is on Maple Grove Road, but it’s actually a piece of land that extends from Maple Grove Road all the way up to Palladium Drive. We’re actually looking at the northern portion of that land. The best way to think of it is next to the Canadian Tire Center parking lots that are kind of on the south side of Palladium. There’s I think there is 7 or 8 acres in total.

It’s really accessible to the highway, to future transit, it’s near a future light rail station. I say it’s in the middle of the three wards out here Stittsville, Kanata North, Kanata South. It’s very accessible to residents in all three wards.

Believe it or not there’s a little bit of process required on the municipal end in order to designate that land for healthcare, so our city staff is going through that process. There’s other municipalities, Carleton Place for example, that have gone through that process and we’re looking at how they were able to meet all of the provincial requirements around that.


Q: What can people do here to help support what you’re working on? 

Doctor Ferrier: We’re going to launch a website and we’ll have an e-mail as a point of contact. We’ve had an outcry of support from pharmacists, physiotherapists, we have radiology labs already all interested. All want to be there. We have a number of healthcare providers that want to be there.

We do have to be very strategic about that because, again, we don’t want to just rearrange the deck chairs. This health centre is not meant to take from other groups, this is truly meant to support a lot of the work that’s already existing in the community.

The programming that we’ve put forward, the allied health members, it’s not just going to be for physicians of this facility. We are going to be opening it up for everybody in the Kanata-Stittsville area because this is your facility, whether or not you’re a member of this future health hub or if you are at another site, this is something that everybody needs to have access to.

And now what can you do to hopefully advocate for that, well I think there may be an election coming up and I think it’s important that you speak to people and let them know about what we’re putting forward, that this is something that we want to get behind and support, and I think that would go a long way.

Councillor Gower: Tell your friends and neighbors. Let them know about this. But if you have a candidate knocking on your door in the next month, just tell them health care is really important to you. Primary care. Tell them you attended this meeting. And I think there’s a lot of support across the, we’re not trying to make this a partisan issue, I think every party at the provincial level knows how important primary care is. But I think it would help if you mentioned this project and told them about your experience with health care, whether it’s at an emergency room or whether it’s with primary care. It really does make a difference at the door.

Doctor Ferrier:  I’m honestly overwhelmed by meeting a lot of our representatives. Often they are really well connected into their communities, they care a great deal and this is, regardless of party affiliation, I feel it. I mean I feel it with the council, I feel it with the members here, I mean this is not the first time that I’ve heard from these members that are here today. I think actually all of them have supported this project and so I’m extremely grateful to you all for doing that. I think they really understand the needs of our community. I think the government is getting behind it in the right way, so I would echo that not only is this a provincial mandate to try to solve, but I think the people that are here representing us I think they genuinely care and if you tell them that this is an important issue for you it does work its way up. I’ve seen it and so I think that would be just reinforcing it.


Resident question: The scary part is we’re going to lose our 42-year family physician in April and I didn’t quite get the message on how that solves that problem for us. Is there going to be, ‘we just stopped taking patients yesterday’ when we show up? How does that piece really play out?

Doctor Ferrier: So my understanding is, we have a family physician retiring, you’re a member of that roster panel of patients, and how does this project potentially alleviate that?

Timeline-wise, the goal is not for doctors just to come in with already a roster of patients, but we are actually looking to take people who are not attached to a primary care provider. Our first and foremost mandate is to attach you to a primary care provider whether it be a nurse practitioner or a physician.

The bigger goal is how do we bring in those providers? We have to create the environment that they want to practice in. And so as much of this talk has been about the environment that we’re trying to create, it’s ultimately the goal is to alleviate that particular burden.

So if somebody’s an established physician and they’re moving over we’re going to be less interested in creating room for that particular party, but rather if a new nurse practitioner says ‘look I really want to be a part of this. I want to start taking on patients’, that’s who we’re targeting.

We know that there’s a groundswell of interest of people who do not have a primary care provider right now and we are going to start laying the foundation as we prepare. We want to be ready to go and so that also means ensuring that there are patients that are ready and triaged appropriately as per what we call our college standards of triaging that they are ready to be connected with a primary care provider on day one.

We do not want to create an environment where people are waiting in -10° or-20° for hours on end. That’s an unpleasant experience that nobody wants to create. We will have this well-communicated in advance and that is a part of the opportunity that we do have. We will create everything from online tools to other forms of accessing to get your name on that list.

The College of Physicians and Surgeons has an outline about how we are to triage those. There is a first come first serve mandate when we do go through those but there are individuals who will be recently diagnosed with cancer, they will have to be triaged very quickly. We’ll have an appropriate formula and way for everybody to apply in a way that’s fair and equitable and the best way we can.

In Perth, we were very fortunate because we had a very ambitious town council and a lot of support and high degree of need. We built Tay River Health Center in nine months.  In terms of the timelines, two years, to be fair I’d be a little frustrated with two years. I want to be more ambitious than this and I think this goes back to previous questions about being prepared to hit the ground running. We really can’t afford a moment’s loss here. People are really suffering without a primary care provider.


Resident question: Do you envision any aspect of urgent care in this facility?

Doctor Ferrier: One of the programs that we put forward [in our application] was an urgent care program. I want you to go back to the two lenses here as both the provider and the patient. It’s not even just enough anymore to have access to a primary care provider, but timely access. Many of my colleagues have three month wait lists, even though their patient is attached. If you have to wait three months it doesn’t sound very good, certainly not if you have something acutely that needs to be addressed.

So not only are we seeing the burden at the hospital level, which many of us have experienced, but we’re also seeing that, ‘well I don’t need to go to a hospital, but I think I could really be managed by a nurse practitioner or primary care provider here or even pharmacist at that point’ to be managed in a way that I don’t have to sit in for hours and hours in a hospital.

So we did endeavor to put forward a program that would aim to provide urgent care for a large swath of patients across the region.

Why is important the providers perspective? Well, now I am not only able to practice comprehensive care, but maybe I have a real interest in practicing more acute level care. But maybe I don’t want to intubate patients today, but I prefer if you have a broken bone, or you have some acute illness, maybe you have a small degree of heart failure, or emphysema, these are things that we can help with without you spending hours and hours in a waiting room around much more sick patients who actually need not to wait and to get that care where they need to get it.

These programs will be done in partnerships with groups like our hospital partners because they may actually be able to direct us towards the best times to run these clinics. They know where the data are and what the data are telling us. So if the data is speaking to us in a way to say ‘look you really don’t want to be running this urgent care from 7:00 in the morning till four in the afternoon. You really should be targeting 1:00 to 9:00 PM because that’s when we’re seeing people really tumble into the emerge on these, let’s say, points where they could be better served in urgent care setting that emerge setting’, then that’s what we’ll do.


Resident Question: I know you are looking at incorporating a lot of resources. Will that include things like addiction or, are there aspects that go along with that, like injection sites, is that part of the plan?

Doctor Ferrier: IFor a very long time mental health and addictions has been front of mind. I want to speak more on a larger scale. The province has it is a huge priority. We know that. We have a lot of agencies in our region right now that have it as a mandate.

What is this particular site going to be used for just beyond the primary care? We want to work with those partners in the community to use this site so they are able to fulfill their mandate. Again, we’re probably not the best people to be doing addictions from a primary care perspective.

So our goal in this will be to not just provide those preventative care measures, the urgent care stuff, but also to be expanding beyond and bringing in those mental health workers, connecting with other resource centers, who honestly are better tasked to do that work. This needs to be a site, again you may see one building, but it’s going to have a myriad of different partners within it.


Resident Question: Just wondering if eventually charting will be included to go to the hospitals?

Doctor Ferrier: I will say that is the goal.


Resident Question: Within the clinic, would you have clinics for outpatient dialysis or outpatient chemo?

Doctor Ferrier: These particular specialized services have to be done in specialized facilities with special licenses that oversee those facilities. Without getting too much in the details on this, those services are really best provided by those who have the experience to provide them and oftentimes they are already located in hospital settings.

If our partner is a hospital group, which we hope that it will be and we’re working towards those things, then we want to be a site for those things. If the data show that that’s where it needs to be and that’s best for patients. We want to be that avenue so those particular agencies and institutions have a place to provide those services.

We were able to do that in Perth with infusion medicine for autoimmune conditions, things like that, so I fully suspect that we’ll be able to. But again getting into the who, the what, the when, the why, that that will take time to kind of work through, but I suspect that will be the case and I would think beyond that. I would hope to see orthopedic things that are done here, some scopes, things like that that are really important.

Councillor Gower: About seven years ago former Kanata Councillor Marianne Wilkinson started talking about the idea of a health hub modeled after the one that’s in the east end in Orleans, which is basically an extension of the Montfort hospital. One of the goals was to bring more hospital services into the community. We’ve had a number of discussions over the last six years or so with different hospitals and healthcare providers and most of them do have that goal.

They want to get off of campus to improve their accessibility, so I think earlier tonight you mentioned CHEO. That’s an organization where they’re looking for opportunities to provide services not just on their hospital campus but in Kanata, Stittsville, or in Barrhaven, so that it’s more accessible for residents in the west end or in the south end.

So a lot of times the barrier is having an appropriate space to do that and so a facility like this opens up a lot of those possibilities.

Doctor Ferrier: We have to dream big and we have to know that we can do this. This is certainly achievable. There are a lot of people who want to see these special programs that you just mentioned come to fruition. They just need the right site, they need the right level of support, and if we lay that foundation to make it easy for people to see some of these goals and objectives fulfilled, then ultimately I think this will be the home site for it this.


Resident Question: Will it be more like a drop in and get checked up, or will it be more like you are attached to the hub and then you can see your doctor only?

Doctor Ferrier:  The way I envision care being provided is that I get a family doctor. I’m attached to a particular individual and that individual is also attached to a greater team. I want to get to know my patients and I think my patients are trying to develop that relationship with me, so they feel comfortable, that they know they can build trust in me, that I can provide that level of care. If we’re providing episodic care then we’ve really missed the mark on what we’re trying to do there and family medicine in terms of a longitudinal care approach.

So while urgent care is something that has been discussed, that is just going to be another avenue to support that patient, even though they may have a doctor in the building. They just may have urgent care downstairs where you know if their doctor isn’t available that day, or they’re out doing something else, they have urgent care access that same day.

And even more, all the other physicians within that facility will also do something called cross coverage and we currently do that. Even amongst 10 providers, we provide over 300 appointments in a month of just cross coverage. So if your doctor isn’t in because they’re doing something else that day then they can see me. Today I saw two people in my clinic, one for a simple ear infection, one for a COPD exacerbation. Both were not mine and both were extremely grateful that they didn’t have to wait 10 hours in an emergency department.

So you’ll be connected, and then on top of that you’ll be able to have the opportunity not just to see your provider for those long term appointments and those long term relationships, but also care again not just access but timely access.


Resident Question:  Is this clinic going to be public health care as in OHIP based, or is it going be privatized healthcare?

Doctor Ferrier: This is a completely publicly funded service here. Two things, first is that it’s not really legal, it would be against the Canada Health Act to start providing private-based medicine certainly from a physicians’ perspective and how we’re legislated.

But again, this is not to create barriers. We want to start breaking down barriers. We have been overwhelmed by the number of individuals who actually want to get back to the basics. To see several nurse practitioners who are just on the cusp of graduating say “this is where I really want to be”’.

I’ve not had anyone approach me with an interest of providing a private based care nor is it an interest of ours to bring that forward and it won’t be a part of the site.


Resident Question: How many of these types of facilities exist across the province?

Doctor Ferrier: Generally speaking, there are not many. There are really good fundamental reasons why there are not many. I think I touched on some of them. We’re seeing less investment from the primary care providers themselves. We’re also seeing  our landscape is quickly changing.

There are a number of elements that have to be ingrained in this type of project to see it successful. There’s a number of different elements as to why it’s really hard to put it together.


Resident Question: So having done this once, what I’m hearing is you’re one of the experts in the province. What did you learn that you’re going to be able to bring to us, what would you do same, what would you do differently?

Doctor Ferrier: I’m probably 10 times more efficient at this process than I was before. You learn about what are actual mountains worth crossing and what are literally just speed bumps. The expertise really extends right from the development of the land itself, right to how paper is going to transition throughout the entire center, to how it’s going to be disposed of in a safe manner. You learn to wear a number of different hats that I had to learn all at that moment in time where I had to learn it. I think in that regard, the efficiency piece, and understanding how processes that happen at the city level and the provincial level really work.

A big mistake is when you don’t understand necessarily how the system is funded, you also may not really appreciate how to create those partnerships strategically. You don’t necessarily want to trample on other people’s toes so to speak, and you want to start to build bridges.

If I could change anything, our front desk. The way patients actually enter into, and experience, the front face of our staff, I would shift. It’s just most people want to be greeted by a smile, they want to be greeted by people who want to be there, who love being there. We built this during a pandemic and so it was built with glass up and a lot of barriers. Now that we’re on the other side of that I would really like to work towards breaking down those barriers and really getting back to that connection. I want people to be able to start addressing our staff by name because they they’re not just seeing them through a mask and a glass, and ‘what was that? I can’t hear you’.


Resident Question: Is there any consideration for telehealth? And there’s another thing I follow quite closely which is narrative medicine. That’s been very effective because often people don’t have to physically go somewhere to see a doctor or a nurse practitioner, they can simply ask and often just talking them through that in itself is the medication they needed.

Doctor Ferrier: In short, telehealth yes. It’s part of the fabric of the care that a lot of primary care physicians now provide and it gets easier and easier to provide to patients that we have long term relationship with and that’s where I think it’s been done very well with just my own experience.

In terms of input, this sounds kind of hokey but this really is your facility that we’re trying to build. One of the committees that we’ll be looking to put forward is a patient family advisory committee, PFAC. We’ll want to have that as part of this facility and there will be a call out that will be made for applications because we’ll want people to become part of the board. Many of you have a large number of skills, whether it be just how to operate a board, or in healthcare, or a certain set of skills like you’ve said that could really benefit our community.

So the vision is not going to just start and stop which is primary care, it’s going to expand, it’s going to grow and we want to make sure that we’re building a site that’s going to fulfill those needs and we can’t fulfill the needs unless the people themselves are the ones that are telling us what the needs really are because that can really change from one community to another.


Resident Question:  We moved here around 2 1/2 years ago so we’re pretty new to the community. We were in an area that had a generous amount of services and we came here and we’re quite shocked that wasn’t something that we experienced once we moved here. It took Ontario Health about 6 to 9 months for us to get a primary care doctor for our family and we have to travel about 20 to 25 minutes to get to his office. I wanted to know, as someone who has a primary care doctor some distance away, would we be able to participate and get one closer to home?

Doctor Ferrier: First and foremost thanks for sharing your story. I wish it were a little bit more uncommon to hear that story but it’s one that I hear every day and I’m glad that you were able to get connected with someone at a time where many people in similar circumstances are still struggling to find one. So I’m grateful for that. Technically, it’s difficult to say this, you’re connected to care and that is a lot more than 2 million people right now are able to say.

Now, one can still dream and I think that the first conversation I would always suggest that you have is one that starts with your own primary care provider and letting them know some of the barriers that you are experiencing in that relationship, even if it’s just distance. Because you’ll be very surprised at some of the barriers that, again, if you’re in a team-based model that they can start to offer you to decrease that burden of transit and travel. So that’s number one.

Number two, I would be a little worried to tell you, “yes you can de-roster yourself from your family doctor and then join us here” because I suspect that we will be inundated with requests. And if we were to start just lining up outside I think it would wrap around the future building you know 20 or 30 times and we just don’t want to see that.

I suspect that we will be moving towards, and I think we’re seeing this with Jane Philpott’s goal, which is if you’re in this particular region, we want you connected, no different than the school system would have you connected. I’m hopeful that that goal gets seen by the time and met by the time you know you need it.


Resident Question: Our primary doctor is so overwhelmed that we waited two hours after a scheduled appointment for her to actually be seen. I can’t even go into his office because I need a handicap bathroom, which doesn’t happen to be there.

Doctor Ferrier: Without jumping too much into it, that is an unspoken burden that again is not acknowledged a lot. But we did put a lot of time and effort into creating a space. If you’ve been into old clinics you can actually reach out and touch your hands on each side of the wall. How is somebody in a wheelchair actually supposed to get in there? But if you think about it, if you’re in a hospital, you can’t do that because they have to be able to get two beds passing each other in a hallway, there’s no way you can touch each other.

Our primary care clinic has to deliver the care to the same group of people and yet we don’t have the structures to actually support the people that need the care.

This became a very real issue: When I put a soap dispenser on the wall at head height. People who are in a wheelchair can’t get at that. We have to be very conscientious about the facility that we set up so that it does work for everyone. This means ramp access, this means elevators where appropriate, and plenty of elevators with appropriate size. We don’t want people feeling like they’re in a tight box or a tight squeeze.


Resident #10: You touched earlier on the College of Physicians and Surgeons and how they have a little bit of a triage system  for how you take on people.  Is there anything in place that would prevent or triage an order for someone like that gentleman who lives in our region to have access to this before someone who is coming from Orleans or Rockland?

Doctor Ferrier: The College of Physicians and Surgeons is an organization to ensure that public trust is upheld, and to ensure that any provider doesn’t just take two thousand 18-year-old men, who they won’t see until they’re 50 unless somebody’s dragging them in or they’re dying! When we talk about a mandate and meeting the mandate that the government is putting forward right now, if we want to be successful we really need to target people who actually have no primary care provider.

The situation that many of you are experiencing, there may be people in this audience or people who are watching at home right now who are immunocompromised, they may have cancer, they may be on chemotherapy agents. I’m sure many are actually experiencing that and do not have a place to be discharged to. That is frightening. It really bothers me and it really keeps me up at night. And the idea that we could create something that if you’re unattached and you live in our region there is going to be a place for you, that is our absolute goal.

I think that we’re going to create a system that is going to be able to triage it so if you have a new baby out there, if you have a new cancer. I know the criteria because I helped set up the system early on. If you have a new diagnosis of mental health that’s what we deem as serious mental illness, so that would be a new diagnosis of schizophrenia or bipolar, these are items that are all triaged very high. Unattached is again of course a part of it.

We also want to avoid doctor shopping. Sometimes we’ve been fooled where people say ‘I’m not attached’ and they’ve been through two or three providers. We will ultimately have to say ‘I’m sorry you are connected, we do have to put the unattached first’.

It’s a great question and we’ll be working with a number of different providers to sort out what that map is going to look like and what those boundaries are.

 


Resident Question:  What is your experience integrating long-term care and senior care into this kind of family health team concept?

Doctor Ferrier: We’re talking a primary care home, but we’re also talking about a health hub that’s going to service beyond just your primary care needs and we’re hoping to have other services there. We are in discussions with certain groups about considering things like long-term care like a retirement home, convalescent care, things like that, that allow us to triage through this system. Again, through the lens of the patient, you could be a primary care patient but then you may find yourself in one of these homes as well and it could be all on one site. That’s very handy from a providers’ lens. This allows us to practice in multiple different landscapes while also supporting the continuum of the patient as well.

We want to be supporting healthcare providers, and I say that generically, either physicians or nurse practitioners to come into this health hub and be able to practice not just the comprehensive family medicine, but maybe they’re going down the road even a little bit to an already existing long-term care facility.

We want to be a group that supports our community and all facets. I think when we provide those number of services and we start building those bridges and those relationships, that is actually the attractive piece. That’s something that a lot of primary care providers want to provide well.


These questions and answers have been lightly edited for length and clarity.