Advancing a Public-Centered Vision for Primary Care-Lessons from Ontario and Inspiration from the Netherlands

Primary care reforms often proceed without a clear articulation of what patients and the public expect primary care to deliver. In Canada, nearly six million people lack access to a regular primary care clinician despite universal health insurance. Through the OurCare initiative, nearly 10,000 people across Canada participated in a structured, deliberative process to define what primary care should provide. The resulting OurCare Standard articulates six expectations for a publicly funded, relationship-based, timely, culturally safe, and accountable primary care system. Ontario has recently embedded these priorities in legislation through the Primary Care Act and committed to achieving universal access to primary care by 2029. Yet longstanding variation in team implementation, inequitable distribution of resources, limited evidence of expanded physician capacity, and increasing movement of family physicians toward focused practice complicate this goal. Experience from the Netherlands-where near-universal access to primary care has been achieved-highlights several design features that support timely access at scale, including stronger demand management in practices, substitutive team roles, an educated public and family physicians working at top of scope. Achieving primary care for all will require not only expanding teams but redesigning how care is organized, delivered, and kept accountable to meet the needs of the communities primary care is meant to serve.