A United Front: Tackling Ontario’s primary care crisis through innovation, collaboration, and Healthcaring

This crisis impacts all areas of service provision and health human resources. There are currently conversations in the media about refugees, homelessness, and healthcare workers, but we must increase the focus on the overarching challenges within primary care at a systems level. The lack of primary care attachment and provision in communities has a cascading effect on population health, rippling through hospitals, overwhelming emergency departments, causing closures, dangerously long wait times and an absence of continuity of care. Our decisionmakers and funders tend to distribute resources reactively and in isolated bursts, rather than through a systems lens, and this does not lend itself to sustainability and solutions for the ailing primary care system and the communities we are here to serve.

Our two clinical sites, formerly known as the Kitchener Downtown Community Health Centre and Sanctuary Refugee Health Centre integrated in 2021. After an extensive rebranding process, we selected the new name Community Healthcaring Kitchener–Waterloo. The concept of healthcaring resonated with our community and team. Healthcaring has three key features: embodiment (internalizing healthcaring), facilitation (awareness of others’ goals and helping them reach them), and selflessness. It can be summed up as “exhibiting positive attitudes and behaviours towards the health and wellbeing of oneself and others.”

Community Healthcaring K–W provides integrated health and wellness services utilizing the Community Health Centre model of care, to anyone facing barriers to health services, including newcomers, refugees, people experiencing housing or mental health and addictions challenges. Now, as one of Canada's largest refugee health providers, serving over 6000 clients from 64 countries of origin speaking more than 55 languages, we must call attention to the urgent issues in our community.

Our newcomer and refugee population is projected to grow over 200% in the next five years. Without significant additional supports, innovative advocacy and a level of collaboration between organizations and governments that transcends partisanship, our primary care crisis is going to get worse. Refugees arrive with trauma, medical complexity, chronic conditions, and acute health needs. Without the primary care attachment available to support them, they often end up in our Emergency Departments where they wait for hours, and due to language and cultural barriers, often leave without having their needs met.

In response, we have submitted two innovative, collaborative Expressions of Interest proposals to the provincial government. Our two proposals aim to bolster primary care for refugees and pioneer a Solo Practitioners In Need (SPIN) model to enhance care and reduce system costs. If approved, both proposals will divert patients from hospital emergency rooms and increase attachment while freeing up capacity for Community Healthcaring and our partners to accept new refugee and newcomer patients who would otherwise have no access to primary care.

Our research predicts that, in K–W this year, homelessness will double, and healthcare visits will triple, with the fastest-growing segments of our homeless population being refugees, youth, and seniors who, previously living in poverty, can now no longer afford rent. We have an interprofessional team of just 12 providers to service upwards of 1600 clients in local encampments and shelters. Increasing the scope, coordination and flexibility of outreach and primary care services is essential as we work to address the complex needs of our rapidly growing homeless populations in ways that respond to their unique and varied needs. At a time when our communities are facing increased isolation and our food banks are experiencing the highest need in history, we must come together in new ways to care for our communities.

Another step we have taken is to challenge societal food system narratives and normalize food access as a human right. Our new pay-what-you-can Community Food Market, launching January 25, 2024, is one initiative to shift the paradigm to meet this critical need. Evidence shows that Community Health Centres keep people healthier, out of emergency departments, and save health system resources and money. The combination of primary care, health and wellness services, and social prescribing is central to the concept of healthcaring.

While our community of providers is coming together to collaborate, innovate and share resources, more advocacy is needed. The current system is unsustainable, and it is time to have a serious conversation with our funders about what is necessary to ensure all marginalized populations receive the care and resources they desperately need, both now and in the future. 

As a result, our team recently created an innovative new tool, The Healthcaring Pulse, an essential (and free) monthly advocacy e-briefing with input from our community. The Pulse is not just a newsletter. It’s a platform for action, focusing on practical strategies and inspiring case studies to galvanize providers, advocates, and leaders in our communities and beyond. While the the Pulse may be rooted in the experiences and challenges of K–W, its contents are universal in the realm of community health. We believe that the insights, stories, and strategies shared can benefit community health leaders across Canada.

Through innovative collaboration and advocacy, we can improve outcomes for the vulnerable people we all serve and care deeply about.

Tara Groves-Taylor is the Chief Executive Officer of Community Healthcaring Kitchener–Waterloo.