Ontario’s primary care system is facing serious strain, with rising demand and a shortage of family doctors leaving millions without timely access. Ontario Health Teams, supported by professional care coordination, offer a promising solution.
Ontario’s primary care system is at a critical juncture. With patient needs intensifying and provider availability shrinking, our ability to offer timely, comprehensive care is under threat. Ontario Health Teams (OHTs) represent a promising solution, enabling collaborative, integrated care at a local level. This blog post explores Ontario’s evolving health care landscape, the objectives of the OHT model, and the role of care coordination in improving outcomes. Through real-world examples and up-to-date research, we examine how this approach may be key to overcoming Ontario’s primary care challenges.
Ontario’s primary care infrastructure is straining under growing demand. As of 2024, more than 2.3 million Ontarians are without a regular family doctor (CIHI). Factors such as provider retirements, physician burnout and the limited appeal of family medicine among medical graduates have contributed to this widening gap. Only 35% of Canadians report being able to get a same-day or next-day appointment with their primary care provider (Commonwealth Fund). As a result, many patients turn to overburdened emergency departments for issues that could be addressed earlier in the continuum of care.
Introduced in 2019, Ontario Health Teams are designed to bring together health care providers—primary care, hospitals, home care, mental health services—into a single, patient-focused network. Under the 2024 Ontario Health Teams: The Path Forward strategy, OHTs are responsible for:
The aim is to deliver more coordinated, efficient care that reflects the needs and values of local communities.
Canada’s primary care crisis is now front-page news. A 2024 report from the Royal College of Physicians and Surgeons of Canada highlights how shortages in family medicine are worsening due to retirements, administrative overload, and changing provider preferences. Meanwhile, the Canadian Federation of Independent Business estimates that Ontario physicians spend over 18.5 million hours annually on paperwork—equivalent to 55.6 million lost patient visits. Addressing these challenges requires more than adding doctors. It demands structural changes in how care is accessed, coordinated, and supported.
Care coordination is increasingly seen as an essential ingredient in modern health care. Rather than duplicating clinical roles, professional care coordinators support them—guiding patients through referrals, arranging follow-ups, and managing transitions between hospital, home and community care.
Emerging evidence supports its value. A 2024 evaluation by Ontario Health found that coordinated care programs reduced emergency department visits by over 30% and significantly improved patient satisfaction in several regions. Care coordinators ensure patients don’t fall through the cracks, particularly those with complex health or social needs.
The connection between care coordination and Health Team objectives isn’t abstract; it’s deeply practical. As Health Teams work to modernize and unify care delivery, care coordination fills in the operational gaps that so often cause friction for both patients and providers. From improving continuity to enhancing cultural responsiveness, care coordination serves as a critical enabler for Health Teams striving to meet their ambitious goals.
Care coordination doesn't just check boxes; it makes Health Team priorities actionable in the lives of real people. By addressing the details that often derail care journeys, it helps ensure that patients are not only connected to services but supported through every step.
The most effective care coordination blends robust digital infrastructure with human insight. While tools like real-time care plans, EMR integration, and secure messaging enable efficient communication, it’s the empathetic, trained professional who provides the continuity and reassurance patients need. This is especially valuable in rural, remote, and underserved communities, where patients often struggle to navigate fragmented services.
As the province contends with a growing shortfall in primary care physicians, one thing is clear: we cannot solve this with more providers alone. Ontario needs a team-based, systems-oriented approach—and this is where OHTs, empowered by professional care coordination, come in.
By reducing administrative burden, streamlining access to services, and improving follow-through on care plans, care coordinators free up clinicians to spend more time with patients. Simultaneously, they help patients navigate a complex landscape—reducing missed appointments, preventing deterioration, and building trust across the system. As more OHTs adopt this approach, the benefits compound: better outcomes, higher satisfaction, and more resilient care teams.
Ontario is not alone in reimagining primary care. British Columbia’s Divisions of Family Practice, launched in 2009, created physician-led networks that support collaboration, shared planning, and local solutions. Alberta’s Primary Care Networks (PCNs), in place since 2003, integrate primary care with allied health teams to provide wraparound services. Recent evaluations in both provinces show reductions in emergency visits, improvements in chronic disease management, and higher patient satisfaction.
As OHTs mature, they are beginning to mirror these successes. For instance:
These examples show how OHTs—when paired with care coordination—can truly act as the scaffolding of a better, more equitable system.
OHTs offer more than just a new structure—they offer the chance to build a system that puts people first. But structure alone won’t solve a crisis. It’s what we embed within these teams—care coordination, equity, trust—that turns vision into reality.
As Ontario charts its next steps, integrating care coordination into OHTs is both a practical and compassionate choice. It empowers clinicians to do what they do best, supports patients in navigating their health journeys, and helps the entire system work smarter and more sustainably.
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