The Best Care Takes A Team
Primary care is where we typically turn first when sick, vulnerable, or in need of someone to listen and guide us – it’s there we find comfort and continuity of care, while feeling seen, heard, and valued.
What are Primary Care Teams?
Primary care recognized as the foundation of Ontario’s publicly funded health care system – it is often and should be the first and ongoing point of contact for persons seeking health care within Ontario.
Interprofessional primary care teams are led by family physicians or nurse practitioners, working in a coordinated fashion with multiple other dedicated healthcare professionals to provide care for the whole you. While each team might look a little different, they all share a common goal: timely, comprehensive, high-quality care through strong interprofessional collaboration.
Building a Future-Focused System
We believe in a primary care system that is comprehensive, connected, and centered on people’s needs.
Team-based primary care is the foundation of a strong and sustainable healthcare system.
By working collaboratively, physicians, nurse practitioners, nurses, social workers, dietitians, pharmacists, mental health professionals, and many other important team members create the conditions for people to stay healthier, avoid hospital visits, and receive truly comprehensive care.
We’re committed to building a primary care system that is:
Person-Centred
- Care that addresses physical, mental, emotional, social, and cultural well-being, and is aligned with the patient’s values and preferences.
- Support for self-care and community resources.
- Anticipates changing needs over time to maintain health and prevent unnecessary hospital visits.
Evidence consistently shows that team-based, person-centred primary care improves the patient experience, strengthens relationships, and supports better self-management, especially for people with chronic or mental health needs.
Accessible and Continuous
- Timely and reliable care, available when it’s needed—including on short notice.
- Community-based services that are close to home.
- Providers who know the person, their history, and what matters to them; their care is managed as an ongoing journey, rather than episodically.
Strong, locally accessible primary care increases preventive care uptake and reduces avoidable emergency department use. When patients can see their primary care team close to home, the system functions better for everyone.
Seamlessly Integrated
- Comprehensive, integrated medical records that capture a patient’s full primary care experience, and move with the patient across the rest of the health system.
- Coordinated referrals to specialists, hospitals, and community supports with appropriate communication back to the primary care team.
- Communication and follow-up tracked to prevent gaps in care.
Underscoring primary care’s role as the organizing hub of the health system, when primary care is intentionally embedded in integrated models, access and continuity improve.
Recognizes Primary Care as Home
- Functions as a home base for all care decisions.
- Builds trust and lasting relationships with patients.
- Strengthens the health system, improves outcomes, and reduces costs.
Jurisdictions with strong primary care see fewer avoidable hospitalizations, lower total system costs, and better population outcomes. Investing in primary care pays for itself.
Grounded in Evidence and Experience
- Care is informed by the best available research and data.
- Clinical decisions are guided by provider expertise and interprofessional collaboration.
- Patient preferences and lived experience shape care planning, delivery, and ongoing improvement.
When the best available evidence is combined with clinical expertise, interprofessional collaboration, and patient lived experience, we see high quality care that improves outcomes, strengthens system performance, and remains sensitive to changing needs of the population.
The Evolution of Primary Care
1
Over the past decades, Ontario’s primary care system has shifted toward interprofessional, team-based models designed to meet the complex health needs of patients and communities.
2
While historically, primary care in Ontario relied on individual physicians working largely within fee-for-service models, team-based primary care creates opportunities for greater continuity, access, chronic disease management, and preventive services.
3
Ontario introduced Family Health Teams (FHTs) in 2005, to bring together physicians, nurse practitioners, nurses, social workers, dietitians, and other healthcare professionals to deliver comprehensive, coordinated care tailored to local needs.
4
Since then, other interprofessional models such as Nurse Practitioner-Led Clinics (NPLCs) have expanded the landscape of team-based primary care across the province, in addition to the pre-existing Community Health Centres (CHCs), and Aboriginal Health Access Centres (AHACs).
Primary Care Team Models
Family Health Teams
186
FHTs in Ontario
>3.5 million
Patients being cared for
~25%
Of Ontarians served
Family Health Teams are not-for-profit primary health care organizations. They represent the most common interprofessional model in Ontario, which includes family physicians working alongside other healthcare professionals such as nurses, dietitians, pharmacists, social workers and more, as well as other community providers. These teams focus on health promotion and chronic disease management through a collaborative approach.
As of December 2024, there are 283 FHT locations across Ontario, including main sites and satellites.
Government of Canada, 2024
Community Health Centres
82
CHCs in Ontario
Community Health Centres (CHCs) provide interprofessional primary care specifically for populations that face barriers to accessing healthcare (e.g., newcomers, low-income individuals, or those with complex social needs). They are community-governed, non-profit organizations that focus heavily on the social determinants of health and community-led programs.
As of December 2024, there are 156 CHC locations across Ontario, including main sites and satellites.
Government of Canada, 2024
Nurse Practitioner-Led Clinics
26
NPLCs in Ontario
As of December 2024, there are 26 NPLC locations across Ontario, including main sites and satellites.
Government of Canada, 2024
Aboriginal Health Access Centres
27
AHACs in Ontario
Aboriginal Health Access Centres (AHACs) provide primary healthcare integrated with traditional Indigenous healing and cultural programs. They serve First Nations, Métis, and Inuit populations and are led by the communities they serve. Their services include clinical care, mental health support, and traditional healing.
As of December 2024, there are 25 AHACs locations across Ontario, including main sites and satellites.
Government of Canada, 2024
Investing in Primary Care
Despite the clear value of team-based primary care, Canada’s progress toward high-performing primary care systems has been gradual. We need for clear policy direction, stronger governance, performance measurement, and strategic investments to fully realize the benefits of integrated care.
Primary care teams face persistent funding, operational, and implementation barriers that must be addressed to strengthen access and greater attachment. Learn about how AFHTO and its teams are advocating for system change, today.