Primary care outreach in Markham, Ont.

Historically, Canadian family physicians have operated out of their own clinics, providing excellent primary care to patients who come through the front doors. More recently, health care delivery has moved away from older models of paternalistic, physiciancentred care and toward patient-centred care. At the same time, there are ongoing efforts to maximize efficiency in our resource-limited health care system. One approach that could be integral to the future of health care delivery in Canada is primary care outreach. Health for All is a new family medicine teaching unit in Markham, Ont, affiliated with the University of Toronto in Ontario. In addition to delivering and teaching excellent primary care, the new team is committed to global equity and social justice. When the team is up and running with a full complement of residents, the unit will serve 10 000 patients, and the aim is to proactively seek out patients who would otherwise have difficulty navigating the health care system. In September 2010, as part of my Fellowship in Global Health and Vulnerable Populations at the University of Toronto, I set out to help Health for All identify the underserved populations in Markham and the barriers to accessing primary care that existed. During a 1-month period, I met with representatives of community groups in Markham, senior administrators at the Markham Stouffville Hospital and the Town of Markham, and leading public health experts and primary care advocates in Toronto. Given that up to 75% of the population in areas of Markham are immigrants (and up to 65% speak neither French nor English at home), I expected that these would be the people who had difficulty accessing primary care, and that ultimately they would welcome a presentation on how to access primary care services.1 The reality was quite different.