Scope Expansion Is Not System Reform

Dear SGFP Members,

As the government continues to expand scopes of practice for various health professionals, we recognize this as part of their effort to address the growing crisis in our healthcare system. However, many of you have reached out with concerns, and your SGFP Executive shares them.

Real system capacity is found when care teams are embedded within the clinic, working side by side, building relationships, and fostering trust. This kind of integration supports better communication, shared decision-making, and coordinated care. By contrast, expanding scopes for professionals who are not well connected to the medical home has yet to show meaningful improvements in access, outcomes, or efficiency.

SGFP has consistently contributed feedback on proposed scope changes, including in the most recent round. While we are not categorically opposed to expanding scopes of practice, we remain deeply concerned that these changes are being made without the right supports in place: Supports that protect patient safety, avoid adding costs to the system, and prevent extra work from landing on family physicians.

The government too often prioritizes ease of implementation over meaningful engagement with family doctors, the professionals who are the keystone of the healthcare system, risking further fragmentation instead of building coordinated, team-based care.

One critical enabler missing is informational continuity, the ability for all individuals in a patient’s circle of care to access timely, accurate information. Other jurisdictions cited by government as models for expanded scopes (e.g., prescribing and immunizations) have provincial information systems that allow family physicians to see what was done, where, and when, with just a few clicks. Ontario does not.

Earlier this year, our SGFP Policy Team authored a discussion paper on Access, Attachment, and Continuity of Care, which not only defines the different types of continuity but also presents strong evidence linking continuity to better patient outcomes and lower system costs. The paper reinforces the foundational role of family medicine in delivering care that is coordinated, comprehensive, and cost-effective.

We continue to urge government to move beyond surface-level solutions such as scope increases, and commit to the hard work of system transformation, starting with meaningful collaboration with family physicians.
Warm Regards,
Dr. Dave Barber
Chair, SGFP

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