Purpose
Accurate measurement of primary care attachment should reflect the provider who is actually responsible for a patient’s primary care, regardless of the organizational model through which that provider practises.
Where a Nurse Practitioner (NP) is the patient’s Most Responsible Provider (MRP), attachment reporting should recognize that relationship in the same manner that it recognizes attachment to a physician. The patient’s attachment should follow the provider relationship rather than being determined by the organizational model in which the provider practises.
Current Data Gap
Current Primary Care Attachment Methodology List (PCAML) reporting does not directly capture patients whose MRP is an NP practising within a Family Health Team (FHT), unless the patient is also attributed to a physician through formal enrolment or the derived attachment methodology.
As a result, a patient may have an established and ongoing primary care relationship with an NP and still not be represented as an attached patient in the provincial attachment data.
This creates an important measurement gap. The absence of an attachment designation in the methodology does not necessarily indicate the absence of a primary care relationship; rather, it may reflect how that relationship is currently defined and measured.
Equity in Measurement
Excluding NP-MRP attachment within FHTs creates a model-dependent approach to measuring attachment. Patients receiving primary care from an NP through an FHT may be treated differently in attachment reporting from patients receiving comparable primary care from a physician or NP’s in a CHC or NPLC. Attachment data should reflect the type of care delivered for government investment not the practice setting .
This has implications for the interpretation of regional attachment data. Where NP-led attachment is a meaningful component of local primary care capacity, the current methodology may understate the number of patients who have established primary care relationships and underrepresent the contribution of NPs to attachment efforts.
This is particularly significant for regions that have expanded NP capacity as part of broader primary care transformation and workforce investments. If patients attached to NPs are not consistently reflected in attachment measures, the resulting data may not fully demonstrate the scale or outcomes of that investment.
Position
For purposes of primary care attachment measurement, patient attachment should follow the patient’s actual Most Responsible Provider, including an NP, rather than being determined by the provider’s organizational model.
An NP who is functioning as the MRP is providing a primary care attachment relationship regardless of whether that NP practises within an FHT, an NP-Led Clinic, or another primary care model.
Accordingly, attachment reporting should seek to:
Recognize NP-MRP attachment independently of physician attachment.
Apply a consistent definition of attachment across physician and NP providers.
Avoid using organizational model as a proxy for whether a legitimate primary care attachment exists.
Ensure that patients attached to NPs within FHTs are visible in regional and provincial attachment reporting.
Enable regions to accurately measure the contribution of NP attachment to overall primary care capacity.
Improve the ability to evaluate the impact of investments intended to expand access to primary care through NP and other primary care provider models.
Implications for Planning and Accountability
Reliable attachment data is essential for understanding both the extent of unmet primary care need and the capacity being created through primary care investments.
Where NP-MRP attachment is excluded or inconsistently represented, regional attachment figures may not provide a complete picture of the population receiving ongoing primary care. This can affect how regions understand their attachment gaps, demonstrate progress, plan future capacity, and assess the contribution of different primary care provider models.
A methodology that consistently recognizes the actual provider-patient relationship would provide a more complete and comparable representation of primary care attachment across Ontario.
Requested Consideration
We recommend that the methodology for primary care attachment be reviewed to determine how NP-MRP relationships within FHTs and other primary care models can be directly and consistently captured.
At minimum, the methodology should distinguish between:
A patient who genuinely lacks an ongoing primary care relationship; and
A patient who has an established NP as their MRP but whose attachment is not visible because of the limitations of the current attribution methodology.
Recognizing this distinction would improve the completeness and interpretability of attachment data and provide a more accurate picture of the role NPs are playing in expanding access to primary care.
Download the position statement here.
