Models of Care Toolkit

Connecting unattached patients to the cancer system

Health system partners report that the shortage of primary care providers impacts the cancer system’s ability to deliver efficient, equitable care.

New models of care for unattached patients are needed as navigation programs designed to help patients transition in and out of the cancer system reach capacity. Specific models of care for unattached patients may reduce the burden on existing navigation services and ensure continuity of care throughout their cancer journey.

A rapid review conducted by McMaster Health Forum identified two broad and overlapping approaches to supporting all patients who are transitioning into and out of the cancer system and may have specific benefit for unattached patients:

• Patient navigation approaches in which nurses provide clinical consultation, advocacy, coordination and scheduling, and health monitoring help continuity of care and are particularly beneficial to patients unattached to a primary care provider or team.
• Multidisciplinary team care models improve communication, care coordination and case management between cancer specialists and primary care providers. For patients without a primary care provider, they reduce the risk of gaps in care.

The rapid review found limited evidence and few programs designed specifically for unattached patients in the cancer system, and no programs to accelerate access to a primary care provider for patients with a suspected or diagnosed cancer.

Long term solutions to close the primary care attachment gap

A growing number of people in Canada do not have regular access to a primary care provider. Even people who have a primary care provider cannot always get a same or next day appointment when necessary.^11,14

Cancer system partners indicate that a lack of access to primary care services has led to an upward trend of cancer diagnoses in emergency departments or when patients are seeking care for unrelated health issues.

Jurisdictions across Canada are implementing solutions to ensure everyone who wants a primary care provider has one, but it will take time.

• In February 2023, British Columbia introduced a new funding model that compensates doctors for time spent on paperwork to attract and retain family doctors in comprehensive primary care practice.
• Ontario is removing supervision and assessment barriers for doctors trained and certified in the United States, Australia and Ireland to practice in the province and has a practice ready assessment program specifically for internationally trained family physicians.
• Many jurisdictions also maintain registries that match doctors and nurse practitioners with unattached patients. Some registries, including Québec, prioritize patients based on urgency, such as a new cancer diagnosis.

Increased funding for nurse practitioners to work in primary care is improving access to primary care services in some jurisdictions, but not all jurisdictions have deployed nurse practitioners in this way.

In 2023 only 5% of all Canadians who reported having a regular primary care provider indicated that their provider is a nurse practitioner.¹¹ Developing policies that allow nurse practitioners to roster patients and bill for services may support attachment in jurisdictions with a shortage of family doctors.