Building on one of the best delivery systems in the world

Rosser and Kasperski build upon and consolidate several earlier reports to put forward a "bottom-up" model for the integration of health services for Ontario that establishes the family physician as the focal point of entry to the healthcare system. The essential features of this model are as follows: 1. Each person in the province should choose a family physician and formalize a partnership with this physician. 2. Each family physician should be in some form of group practice or practice network ranging in size from 7 to 30 physicians. 3. Urgent care would be provided by the members of the physician group on a 24-hour-a-day/7-days-per-week basis. 4. The family physician would be responsible for maintaining a comprehensive record for each patient through the use of information technology. 5. All providers in the system with whom a patient had contact would be required to forward copies of all reports and associated information from that contact to the family physician. 6. The group model will be characterized by collaboration, with the use of nurse practitioners and family-practice nurses to provide preventative and chronic care, the use of midwives to augment the provision of obstetrical, prenatal and postnatal care, and community access and hospital-in-the-home services. 7. Family physicians would be supported by a geographically defined group of specialists providing secondary care, such as psychiatrists, pediatricians and obstetricians, who would also coordinate tertiary care. 8. Every family physician should be an active staff member of his or her local hospital. 9. At some level of aggregation a family physician would be responsible for facilitating/implementing quality-improvement programs for community physicians. 10. Family physicians would be supported through a blended funding model.