Thank you Peter [Deimling-President OCFP] for that very kind introduction.

It is a great pleasure for me to be here, sharing in what is clearly a celebration of family medicine, and what is also a celebration of 50 years of invaluable service by this great organization.

You came together in the late 1950s in response to a clear need…to protect and promote the interests of family medicine, and obviously of Canadian patients.

That need still exists, and you're still out there fighting, and this country's health care is better for your efforts.

Now before I go any further I would like to lodge a complaint :

Whose idea was it to make me follow Stephen Lewis?

I mean… how am I supposed to compete with that?

Actually, I want to say that like so many Canadians, I admire Stephen Lewis more every time I hear him speak.

As Health Minister it is my privilege to meet many people – doctors, nurses, other health care professionals – not to mention people in my own field, politics, who have an enormous amount of passion and commitment to helping others.

Stephen Lewis stands out even in that crowd.

He is also the most articulate proponent of something I think we all in this room understand perfectly : working together for a critically important cause.

…we are never so strong, and we never accomplish so much, as when we work together.

Premier McGuinty says that often, and it informs his approach to government. It certainly informs my approach to health care, and it's pretty clear to me that it informs yours.

Earlier this week I picked up the Globe and Mail. Now I have to tell you the Globe is a newspaper I like very much – well, most days anyhow – but on this particular occasion I thought I'd died and gone to heaven.

I mean, their special report on family medicine was as good an argument for the kind of health care change we're trying to drive here in Ontario as anything I have ever read.

Then I realized the report was an insert put together by you guys.

So… rather than send a glowing letter to the editor of the Globe, I'll just tell you… good job!

The report points out a couple of basic, impossible to dispute facts about health care in this country.

• There is a nearly critical shortage of doctors, and
• Throughout our history, the backbone of medical care has been the general practitioner or family doctor… and this remains so today.

The report also heralds the arrival of group or network practices, where family doctors work as part of a team, including nurses, nurse practitioners, pharmacists, physiotherapists and other health professionals.

Anyone familiar with what we are doing here in Ontario will understand why I took such interest in reading that report.

Nearly one year ago today our government began negotiations with the Ontario Medical Association.

It's fair to say that we both shared a powerful sense of purpose to reach an agreement that would restore the vitality of comprehensive family medicine.

In fact before those negotiations ever began, I had a discussion with Larry Erlick – and this was just my third day as Minister – and then followed that up with a similar conversation with John Rapin when he became President.

What I discussed – and what I gained their agreement on – was the principle that would lie at the core of our negotiations with the OMA, and would underlie every public pronouncement I made during those negotiations.

The principle is as follows :

Both the government and the OMA agree that our first priority in these negotiations is the revitalization of the comprehensive family practitioner.

That is the foundation of the deal we made.

From that time on I have taken every opportunity in speeches and during scrums and interviews to talk about the virtues and values of family medicine…the irreplaceable connection between the family doctor and his or her patients.

I suspect most people here have been following our negotiations with physicians – and will know about what happened this past weekend.

The tentative agreement we had reached with the Ontario Medical Association was not ratified by this province's doctors when it was put to a vote.

Well I have a couple of things I want to say about that.

The first is that we were obviously disappointed and, to be very honest, somewhat surprised at the outcome.

But despite this set back, we will not be deterred. We will not be thrown off course – not even a little.

What happened is that nine months of very hard, very collaborative work led to an agreement that both the government and the OMA thought was a good one.

The OMA negotiating team endorsed it unanimously.

Over 9 months, our negotiations team met 120 times with the OMA team - a group of family doctors and different specialties, 4 of whom sit on the OMA Board.

Throughout the negotiations there was continual feedback between the negotiating team and the Board, including updates at every Board meeting.

Four side tables were set up with physicians to support the negotiations - side tables for primary care, hospital issues, Academic Health Sciences Centres and other key issues.

We tabled an offer in May. Through the summer we worked together to respond to the OMA's demands and reached consensus on an agreement on September 16.

The agreement then went out to OMA members for their consideration.

In the end, 41 percent of this province's doctors who voted also thought it was a good deal.

59 percent had problems with it…  enough to cause them to vote against the deal. Fair enough. But let's be clear :

There's no indication that these problems are not solvable.

How do I know this? Because Ontario patients, communities and doctors have long been asking for the kinds of the initiatives and improvements in this agreement.

This is an agreement that contains real and measurable enhancements to the quality and accessibility of the health care patients receive.

Our government is extremely proud of the initiatives in this agreement.

They reflect and support the priorities in our government's comprehensive plan for health care… the very plan that Ontarians overwhelmingly elected us to fulfil.

That's why we are as committed as ever to moving forward on our plan for health care.

We are going to work with doctors and all other health care providers to deliver to patients the best possible access to the health care they need.

We're going to deliver that care where they need it, when they need it, and we're going to ensure that the system is sustainable so that our children and grandchildren benefit in the same way.

Somehow I doubt anybody in this room thinks that's a bad idea.

The agreement we reached with the OMA was driven by a simple truth :

More of the same isn't going to cut it.

More of the same is not going to fulfil our responsibility to 12-million Ontarians who are looking to us to protect, and improve, their health care system.

And I need to make something very clear, and I say this carefully though I'm not really worried that anybody will take offense.

Our government has a big responsibility to this province's doctors, to see to it that they are properly compensated for the critically important work that they do.

But our main responsibility… the covenant we share with doctors…  is to see to it that doctors have the opportunity to work within a system that provides patients with the kind of care they need and deserve.

I don't believe for a second that those two things are somehow mutually exclusive – that one responsibility can only be fulfilled at the expense of the other.

I believe our agreement with the OMA is proof of that.

It is an agreement that is absolutely not more of the same.

It breaks with the status quo by encouraging doctors to work in new and better ways, and providing patients with more access to better health care.

I'm not going to revisit every detail in the agreement. Most of you probably know them already.

But it is built around two basic realities.

There are fundamental inequities in the way doctors are paid. Doctors call this relativity.

It is also true that doctors are in too many cases not compensated and supported to provide the kind of care their patients need.

Our plan contains significant rewards and incentives for doctors work in underserviced, northern and rural communities across the province where they are so badly needed.

Let's look at some of our signature initiatives in our plan :

• Our plan rewards and supports doctors who work in teams with other doctors, nurse practitioners, pharmacists and others… to give patients easier access to comprehensive care after hours and on weekends, 24/7.

As the report in the Globe & Mail shows, more and more doctors are seizing on opportunities to practice in team models.

We are investing $600 million over the next four years to create 150 Family Health Teams in communities across Ontario. 2.5 million patients will be cared for by these teams. They are in many ways the cornerstone of our plan for reforming primary care. And they are both badly needed and eagerly anticipated.

We have already received 90 unsolicited expressions of interest from communities who want a Family Health Team.

We understand that they represent a significant change in how things are done, and we understand the need to reward and support doctors willing to make that change.

And to the people who insist that only younger doctors would ever be interested in working in these kind of group models, I say that simply is not so. More than a quarter of the doctors in Ontario today who are working in group practices are over the age of 55.

For doctors choosing to work in under-serviced communities, there will be Alternate-Funding Plans. There will be Retention Funding.

And for doctors coming into Ontario to practice, there will be return of service arrangements that will see them work in communities where they are desperately needed.

• Our plan pays doctors to spend more time caring for senior citizens in their communities, in long-term care and in their own homes. As well, it provides doctors with special incentives to work with people suffering from chronic diseases like diabetes, heart disease, HIV/AIDS and mental health problems.
• There are additional complexities and time requirements involved in providing these types of specialized care, and our agreement recognizes those with enhanced fees for doctors who provide chronic disease management services and on-call services in long-term care and community settings.
• There are various incentives and supports for specialists to reduce wait times for key medical services such as hip & knee replacements, cataracts, MRI and CT scans, and cardiac and cancer care.
• It rewards doctors for providing preventative services like helping people stop smoking and screening for cancer. It goes upstream to transform the behaviours that fuel the grave epidemics of obesity and diabetes.

This deal definitely represents a new way of doing things.

It is about driving care down to the community level, which everyone agrees has to be the next evolution in health care.

It's about incenting new doctors to practice in Ontario… something we badly need in this province.

Our agreement with the OMA is about building the medical profession for the future.

In truth, everything we have done in health care in the year since we became the government has been about building for the future.

I don't intend to throw too many more quotes at you, but there's something that Albert Einstein said that I use a lot in talking about health care. He said that :

"Problems cannot be solved by the same level of thinking that created them"

That's perfectly true, but it would take a Pollyanna of the very highest order to claim that there are no problems at all. There are problems, and they will not be solved by the same level of thinking that created them.

That's what lies behind our unprecedented investment this year in community-based primary care. I'm not going to list them all here, but we are flowing record amounts into everything from community mental health to public health to long-term care…

…and of course the Family Health Teams I have already spoken about.

Many of the problems we face in health care will be solved by this drive to community-based care.

Patients will benefit from the comfort and dignity of receiving better care closer to home, and hospitals will benefit from having the pressure on their budgets, personnel and emergency rooms eased …

…and of course, in the circular way these things work, patients will benefit when hospitals benefit, gaining better access to the kind of acute care that only hospitals do well.

Many of the problems in health care will be solved by our Wait Times Strategy, which I announced last week.

Our strategy features an immediate investment of $107 million to increase the number of procedures performed in five areas associated with a high degree of disease and disability – cancer surgery, cardiac procedures, hip and knee total joint replacements, cataract surgery and MRI/CT exams.

Many of the problems in health care will be solved by our investments in nursing… kick started by $50 million in targeted funding to create new full time nursing positions in our hospitals. To date at least 638 positions have been filled.

Finally, many of the problems we face in health care will be solved by doctors and government working together towards a common goal, and that is exactly what is going to happen in this province.

I said a moment ago that none of the problems raised by physicians are unsolvable.

We listened very carefully to the concerns some doctors brought forward. They were very legitimate concerns and we take them very seriously.

And I'm here to tell you that our government has wasted no time in moving forward to resolve those concerns.

This morning we sat down with the current OMA President, the Past President and President-Elect to discuss the weekend's events. We indicated to them that we understood the concerns raised by OMA members …

…and then we brought forward solutions to each of those concerns.

We brought solutions forward while reinforcing two undeniable realities :

• Improving patients' access to the care they need is our government's top priority.
• We put significant dollars on the table and the province has no more money to give.

The OMA had 6 specific concerns and we have proposed adjustments to resolve each of them :

• First, we are providing more recognition of senior family physicians. Even though there are benefits in the agreement for every physician, we propose to reallocate funding in the agreement to provide a greater and earlier fee increase for family physicians. This results in a total increase of $30 million or 13% over the term of the agreement.
• Second, we heard that some physicians in solo practices would have difficulty providing 24/7 access to services. We have proposed greater flexibility for these doctors, by replacing the 24/7 provision with a commitment that they provide after-hours care 3 hours per week.
• Third, we addressed the concerns of family physicians and specialists who wanted to see more money on the front end of the deal by offering to bring forward $15 Million in fee adjustments from 2005/06 to 2004/05. We are also willing to listen to any other suggestions the OMA might have for shifting fee increases forward.
• Fourth, we have heard concerns from specialists that want to see billing thresholds eliminated earlier. In addition to eliminating billing thresholds no later than January 2008, we are prepared to provide exemptions from billing thresholds starting this year to physicians providing services targeted at wait list priorities – hip & knee replacements, cataract surgery, cardiac and cancer care, and MRI/CT scans.
• Fifth, will eliminate the process that would have seen us revisit and re-evaluate the deal, and we will reallocate the funding that has been set aside for that process.
• And finally we have taken care of worries about our drug therapy initiative by making provision for a process that absolutely ensures patient safety – and this process would include a third party panel of experts including a medical ethicist — and we are willing to explore targeting some savings that accrue to education initiatives to support seniors' safe use of medications.

At our meeting this morning, we underscored to the OMA that, with only 4 months left in the year, Ontario patients cannot wait any longer for us to move forward.

We will be moving forward, and we are very hopeful they will do the right thing and work with us to implement the initiatives in this agreement… to fulfil our commitments to Ontarians.

Ladies and gentlemen, our plan today is the same as it was last week, and the same as it will be two years from now.

We are convinced that if the Ontario public were given the chance to vote on what we have proposed to the OMA, their answer would be a resounding "Yes".

Who doesn't want more doctors in the communities that need them?

Who doesn't want doctors to spend more time with patients and to work in teams delivering care after hours and close to home?

Who doesn't want shorter wait times?

And ladies and gentlemen, who doesn't want the comfort and security of a family physician, delivering the kind of comprehensive cradle-to-grave care that has defined your profession for generations.

I can tell you these are things I want.

They are things my government wants, they are things Ontarians want and I suspect they are things you want too.

They are things that we not only believe in, but understand fundamentally are key to the kind of health care system Canadians from coast to coast want and deserve.

I can only speak for this province, and this government, but we won't rest until we have them.

Thank you.