FHO+: Progress Toward a Stronger Future for Family Medicine

Dear SGFP Members,

Your SGFP has been asking for change and today, there is real progress to share.

Over the past several months, the Ontario Medical Association and Ministry of Health have been engaged in mediation and are now in arbitration. At the heart of these discussions is one of the most pressing challenges in our profession: the decline in family doctors providing comprehensive, longitudinal care.

A key step in addressing that challenge has been modernizing the nearly 20-year-old FHO agreement. For the first time, SGFP representatives served as advisors to the OMA’s Negotiations Task Force (NTF), bringing firsthand expertise and insight directly to the table.

FHO+ is the result: an important enhancement to the original FHO, updated to reflect how family medicine is practiced today. It’s not a panacea for every issue we face, but it marks real progress and sets us on a stronger path forward.

The model introduces meaningful investments, improved revenue streams, and long-overdue recognition for the time we spend on both clinical and non-clinical care. Importantly, it also opens additional space for physicians to join FHOs, broadening access to comprehensive primary care across Ontario.

If you’d like a quick overview of the arbitration highlights included below, I’ve also recorded a short video message: Watch my video message

What’s Changing with FHO+

FHO+ introduces meaningful updates that better reflect how family doctors provide care and reduces longstanding barriers to joining a FHO:

• Elimination of negation – No more financial penalties when patients access care outside the FHO group.
• New $80/hour time-based payment – Applies to both direct and indirect care, recognizing work like charting, forms, inbox management, and other “invisible” administrative tasks.
• Shadow billing increases – Raised from 19.41% to 30% for in-basket services, and up to 50% for certain procedures.
• After-hours premiums – Increased from 30% to 50%, better aligning with the realities of extended care.
• Capitation rates – Remain stable, ensuring continuity and financial predictability.
• Access Bonus and CCM funding – Reinvested into the hourly payment structure, better aligning resources with the time physicians invest in patient care.

FHO+ reflects what many family doctors have said for years: that existing remuneration hasn’t captured the full scope and intensity of our work. This model begins to change that.

A Step Forward. But Not the Finish Line

Your SGFP Executive sees much to be hopeful about in FHO+. It has the potential to stabilize practices, ease burnout, and make family medicine more appealing to those entering practice. It’s a step toward retaining the skilled and passionate physicians already doing this essential work, and a chance to finally tackle the crisis of unattached patients in Ontario.

But let’s be clear, it doesn’t address everything. Key questions remain about how accountability and continuity will be built into the model. The Ministry is seeking new accountability measures. The SGFP and OMA have made it clear that any such measures must be fair, evidence-informed, and focus on true outliers—not the overwhelming majority of physicians providing strong and accountable care.

These matters are now before Arbitrator William Kaplan, with a ruling expected in the fall. The OMA’s NTF continues to work toward outcomes that support and protect the future of family medicine.

SGFP remains deeply engaged with the NTF and will continue advocating for a model that reflects what we value most: access, relationship-based care, and community accountability.

Where We Go From Here

FHO+ is something to celebrate. It reflects what’s possible when we come together, raise our voices, and push for meaningful change. But it’s also a reminder that our work isn’t done. We still need to:

• Continue working on solutions for family physicians outside of the FHO model and ensure pathways into FHO+ are open to all.
• Support doctors serving in high-needs and underserved communities.
• Tackle the administrative burden that continues to weigh heavily on our profession.
• Ensure that implementation of the new model is smooth, fair, and equitable across the province.
• Partner with Dr. Jane Philpott and the Primary Care Action Team to help attach more patients to family doctors and expand access to funded team-based care.

Thank you, as always, for your ongoing commitment to your patients and your communities. Your resilience and advocacy brought us to this point, and it’s going to take that same energy to keep moving forward.

Family doctors are the heart of Ontario’s health care system. This agreement signals that government is finally beginning to recognize that. Let’s make sure they never forget it.

We welcome your thoughts and feedback: ChairLetterSGFP@outlook.com

Warm Regards,
Dr. Dave Barber
Chair, SGFP

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