health access

In conversation with partnering primary care providers of Interprofessional Primary Care Team (IPCT) project* – part 1 of 2 (read part two here)

We engaged in a dialogue with two of the key leaders involved in the DET OHT’s IPCT project: Tara Bradford, Executive Director at Inner City Family Health Team (ICFHT), and Maryam Ebrahimpour, Senior Director of Primary Health Care at Regent Park Community Health Centre (RPCHC). These organizations are two of the four primary care providers participating in the project, alongside St. Michael’s Academic Family Health Team and Sherbourne Health. During our conversation, Bradford and Ebrahimpour shared meaningful insights from the early stages of the project’s implementation planning and discussed how the initiative aims to integrate team-based primary care with community services.

In your opinion, what distinguishes the care delivery model in this primary care project from other primary care delivery models?

Tara Bradford: It is important to recognize that we are still in the early stages of the project, so some aspects are what we hope to achieve. I believe the ‘co-design’ approach is a distinctive element that distinguishes the IPCT project from other primary care models. Over the past few years, there have been various efforts to make primary care more integrated with community services, moving away from a silo approach. So this project offers an exciting opportunity to fully embed primary care into people’s care plans and coordinated care networks. The aim is for primary care to be more than just “this is what your doctor says” or “here are your next steps.” Instead, community workers can take that information and do their magic of integrating these services to make them genuinely meaningful and accessible.

Maryam Ebrahimpour: What sets this model apart is the breadth of the partnership. It is a collaborative approach to view the system holistically, at least within the Downtown East Toronto, and explore new ways to approach health and primary care gaps.

We need to shift away from past practices that may have worked historically but created barriers for many communities. During COVID-19, we tested this approach with the Wellness Hub. However, at the time, we focused on responding to daily demands and did not have the opportunity to co-design. Since then, we have learned valuable lessons. Now, we have a chance to slow down and truly co-design a primary care model that incorporates the voices of clients and other community providers.

Could you please share with our audience why we chose to focus on Black and Indigenous communities within our target populations?

Tara Bradford: This project is striving to create meaningful pathways where they may not currently exist, with the responsibility to improve service approaches and delivery. Black-governed and Indigenous-governed primary and community care organizations can likely articulate this better, but from what I understand, trust and cultural knowledge play a huge role. Many Black and Indigenous patients feel they must code-switch to ensure that care providers, who may not share their cultural or community backgrounds, understand, respect, and listen to them. This often places an extra burden on patients, as they must explain their experiences in ways that others will understand.

Additionally, healthcare knowledge has historically been based on research involving predominantly white populations. While health may seem universal, symptoms and conditions can present differently across communities. For example, overdose response training often emphasizes blue skin tone as a symptom – a standard based on one population’s experience of health. This small example highlights how a lack of diversity in healthcare education limits seemingly “neutral” knowledge. These biases permeate the healthcare system, affecting people’s experiences and outcomes.

What key lessons or realizations did you gain while planning to set up this project with various primary care organizations and partners?

Tara Bradford: One of the learnings for me was that there is an unacknowledged or invisible labour that goes into these kind of collaborations and comprehensive designs. The amount of resources, meetings, and time it can take to build something like this is not always considered in the project timelines. When we start consulting across the broader sector, we are working with a lot of interests that both coalesce and compete with each other. It was a surprise to the steering committee how some design elements felt very logical and straightforward and others did not have traction with the larger groups. I think all organizations have a different vantage point in terms of what feels low barrier.

Maryam Ebrahimpour: One of the things I have truly appreciated is the intentional outreach beyond primary care organizations to include other partners essential for the project’s success. We cannot achieve this alone – we need partners to create a primary care system that is built for the community, by the community. There is no one-size-fits-all design.

Through this outreach, one of the greatest lessons for Regent Park Community Health Centre is recognizing that despite our longstanding priority to expand access to Black health, there is still more work to be done. When the IPCT team began working with early adopter organizations, one of the gifts we received was the opportunity of engaging in honest conversations about building trust and partnering on anti-Black racism, Afro-centric care, and Islamophobia training. Initially, we envisioned this training just for the IPCT, but to achieve IPCT’s broader goal, which is embedding care for unattached clients into the larger system, it is important for Regent Park to extend this training throughout our organization.

Given the increasing challenges in resources and capacity within the primary care sector, how can we support the long-term growth and sustainability of projects like the IPCT?

Maryam Ebrahimpour: One of the challenges is the limitation imposed by short-term and restricted funding. It puts a ceiling on our imagination, potential to innovate, and how far we can advance these initiatives. When funding is time-bound or project-specific, it does a disservice to the communities we serve. We invest time in building something, establishing trust, engaging communities, and encouraging them to utilize services. But when the funding ends, those services are withdrawn, creating a cycle of broken promises and eroded trust.

Sustainability, at its core, requires a commitment to developing an integrated model that connects partnerships, systems, and the community itself. I think a huge undertaking like this requires a long runway. A robust framework for evaluation and research must also be built into the process, ensuring that findings inform dialogue about stable, long-term funding. This is not a one- or two-year endeavor but a project that must span several years to truly succeed.

In conclusion, would you like to add something or share a key takeaway from our conversation?

Maryam Ebrahimpour: At the Regent Park Community Health Centre, we are excited to be going through this journey, learning the lessons, making mistakes, and getting up and doing it again. We hope that this is not a time-limited project, and that we can truly see this vision being incorporated into the larger picture of the other work that we do.

*The IPCT project is a primary care initiative of DET OHT, aiming to enhance access and attachment to interprofessional, team-based primary care for individuals in Downtown East Toronto experiencing significant financial and social barriers. These populations include people experiencing housing insecurity, 2SLGBTQIA+ community, refugees, people with disabilities, and individuals who use drugs. The project places a specific emphasis on addressing the unique needs of Indigenous and Black communities.

At the time of this conversation, the project was in its initial launch phase and the four primary care providers were collaborating closely with their referring community partner organizations to establish a strong foundation for success.