Your Experience Is the Evidence: Why Governance Matters to All of Us

Dear SGFP Members,

For most of you, clinic days are spent immersed in patient care rather than navigating questions of system governance or strategic leadership. In contrast, these topics are part of our daily responsibilities and ongoing conversations at the SGFP. The absence of clear, purposeful, shared governance is one of the reasons Ontario still doesn’t have a true primary care system, and why so many of the pressures you feel in practice continue to build.

This week, I’m passing the pen to our Digital Health and Policy Leads, who are deeply engaged in strengthening system governance and advocating for the structures family physicians need to deliver care without unnecessary barriers.

Warm Regards,

Dr. Dave Barber

Chair, SGFP

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Dear Colleagues,

Across the world, one thing is clear: no jurisdiction is successfully reforming primary care without family physicians in accountable leadership roles. Shared governance with family physician leadership isn’t a technical detail, it’s the foundation of a functioning primary care system. When family physicians are absent or positioned only as advisors, it permits decisions to drift and accountability to become ambiguous, with consequences compounding at the front line.

We hear from you that technology, PCNs and programs like central intake don’t feel like the promised solutions, but rather added layers that aren’t improving your day-to-day work, and in some cases are adding to it. You may not always name governance as the reason, but the pattern is unmistakable: without accountable structures, these efforts cannot function as true system supports.

Two weeks ago, our Digital Health team introduced their position paper A Foundational Reset: An Actionable Roadmap for Ontario’s Digital Health, outlining six pillars to strengthen Ontario’s digital health environment. The first pillar is simple and urgent: Fix the Governance. Ontario needs structures where family physicians hold decision-making roles at the table with the Ministry of Health, not as observers, but as leaders accountable to their peers through election, formal appointment, or clearly defined representative roles.

The position paper outlines three practical steps to get there:

• Mandate unbiased clinical expertise at the top, including nominated family physicians in provincial data and digital governance.

• Implement a clinical workflow quality check, requiring family physician sign-off before any new cybersecurity, digital tool or data initiative moves forward.

• Build transparency into data use, so physicians understand how their contributed data is used and can trust the system they are expected to rely on.

The same principle applies to system design. Our Policy team’s work on PCN governance and specialty access (e-referral, e-consult, central intake) shows that accountable governance is the missing foundation. You’re telling us these tools and structures aren’t functioning the way they should. Accordingly, the SGFP is delving into the root cause, and the underlying issue is clear: without defined accountability, clinical leadership, and decision-makers responsible to their peers, these initiatives cannot come close to their potential.

We say to government: we cannot build province-wide, connected, accessible, inclusive, empowered, and responsive care without fixing governance first. 

And we say to you, our members: this is the work we are doing because you’ve told us the system isn’t working the way it should, and you deserve better.

SGFP will continue to advocate for accountable, transparent structures that embed clinical leadership and reflect the realities of front-line family medicine.

Sincerely,

Dr. Kevin Brophy, Digital Health Physician Lead

Dr. Beth Perrier, Policy Physician Lead

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