Primary Care Lead – Integrated Neighbourhood Care, EasT-FPN/ETHP

Description of Organization

The East Toronto Health Partners (ETHP) Home Care Leading Project is scheduled to launch in Sept/Oct 2024. This two-year demonstration project will be a key step in the province’s commitment to integrate home and community care within Ontario Health Teams (OHTs). In the home care leading project in Taylor Massey and Thorncliffe Park, integrated neighbourhood teams will support the home care needs of all adult (non-palliative) home care clients in the neighbourhoods. The integrated neighbourhood teams include dedicated home care nurses, PSWs and therapists from a contracted Service Provider Organization; and Care Coordinator(s) dedicated to each neighbourhood by Home and Community Care Support Services. The home care services for the Leading Project will be provided in the context of a new home care contract between Michael Garron Hospital (on behalf of ETHP) and a single home care Service Provider Organization, selected through a procurement process, concluding in March 2024.

The Primary Care Lead (s) will champion the local co-design and implementation of the Home Care Leading Project. The Primary Care Lead (s) is a representative and change agent, integrator and innovator, collaborator and director, and leader that can build strong followership in East Toronto.

An Interprofessional Primary Care (IPC) Team has been operating in Taylor Massey and surrounding area since 2017. The Primary Care Lead for Taylor Massey will guide and oversee homecare interventions (patient-facing care, systems design and clinical service delivery design) within the scope of the IPC Team. The Primary Care Lead for Taylor Massey will support the integration between the Homecare Service Provider Teams (PSWs, nurses, OT, Care Coordinators) and the IPC Team, to ensure effective and integrated home care service delivery across Taylor Massey and area.

EasT-FPN will support the Primary Care Leads in engaging primary care providers in the Taylor Massey and Thorncliffe Park neighbourhoods. EasT-FPN will link the Primary Care Leads to a network of other Primary Care Leads within East Toronto integrated care initiatives.

Position Summary:

Suitable Applicant(s): Licensed physician currently providing primary care services in East Toronto

Preferred: A physician currently practicing in the Taylor Massey or Thorncliffe Park neighbourhood, and currently involved in one or more local integrated care initiatives.

Position Status: Half Day/Week Per Neighbourhood (Taylor Massey/Thorncliffe Park)

Reports to: East Toronto Family Practice Network (EasT-FPN)

Salary Range: TBD

Roles and Responsibilities:

• Develop and oversee program development to ensure deliverables and metrics, defined by the funder, will be met
• Inspire and guide team members, fostering motivation and effective leadership within the integrated neighbourhood team (including the IPC Team providers, primary and community care providers, and existing home care providers)
• Arrange or deliver patient-facing physician services to individuals without an established primary care provider or those with unmet primary care needs including home-based primary care when required
• Integrate the Taylor Massey and Thorncliffe Park Neighbourhood Care Team (home care nurses, PSWs, OT, Care Coordinators) into the existing neighbourhood care models e.g. Health Access Taylor Massey (HATM), Health Access Thorncliffe Park(HATP), IPC Team & Oakridge Outreach Team
• Co- develop shared-models of care for the above teams
• Expand the existing HATM and HATP governance models, to include governance for Home Care Transitions in Taylor Massey, Oakridge, Crescent Town, and Thorncliffe Park
• Streamline and centralize local providers and partner’s access to the Integrated Neighbourhood Team
• Oversee and develop communication and engagement strategies (across health care providers) to maximize the positive impact of the home care initiatives on population health for the communities living in Taylor Massey and Thorncliffe Park
• Help plan and lead engagement activities with Primary Care and other interdisciplinary providers in the area
• Participate in Home Care Implementation Team meetings
• Provide ongoing support and mentorship to interdisciplinary care team members
• Facilitate a close working relationship between health services providers, administrative, funding and member organizations and patient representatives to ensure the patient voice throughout Home Care Leading Project services

Reporting/Governance

• Provide input into Leading Project quarterly reports
• Inform line items in annual budget proposal in collaboration with EasT-FPN
• Provide oversight for the development and implementation of communication pathways and engagement strategies across family practices and health care provider teams in East Toronto.

Skills and Proficiencies:

• Experience in health systems leadership including planning or implementing services across the continuum of care
• Experience working with home care providers
• Experience in bringing diverse perspectives together to plan and provide care to complex clients
• Experience with quality improvement frameworks and projects
• Experience in primary health care and proficiency in conducting the duties of a primary health care physician
• Excellent communication, diplomatic and interpersonal skills

To apply:

Qualifications/Requirements include:

• Doctor of Medicine degree, currently providing primary care services in East Toronto
• Current registration with the College of Physicians of Ontario (CPSO) and a member in good standing
• Membership and certification in the Canadian College of Family Physicians (CCFP)
• Current liability insurance through Canadian Medical Protective Association (CMPA)
• Credentialed or eligible for credentialing in the Department of Family and Community Medicine at Michael Garron Hospital 
• Understanding and support to implement digital tools for Interprofessional team collaboration

If you are interested in this opportunity, please email your CV and cover letter to contact@eastfpn.org

Thank you in advance. The East Toronto Family Practice Network.

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