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Something remarkable is happening in Canadian health policy.
After decades of incremental change, provinces and territories are making serious, sustained investments in primary care via bilateral agreements which represent a genuine federal-provincial commitment. Billions of dollars are being directed toward the kind of team-based, patient-centred care that Canadians have been seeking.
The people designing this care deeply. The intent is right. But when the accountability reviews come, how will we know if it worked?
Canada keeps reinventing primary care reform province by province
An unfortunate pattern has emerged. When a province sets out to transform primary care, it consults international models, such as Alaska’s Nuka system of care, England’s primary care networks and Australia’s primary health networks. It convenes researchers, hires consultants, then builds something thoughtful and locally responsive based on these examples.
However, there is no Canadian forum where this provincial work is gathered, compared and shared. So the learning stays in the province where it happened.
Then, the province next door does the same thing. Starting fresh. Learning the same lessons from international models but not from other approaches within Canada. Building something from which no one in Canada can easily learn because Canada lacks the necessary co-ordination hub.
This is not a failure of effort or intention. It is what happens when provincial systems operate without a shared reference point. Canada’s bilateral agreements are designed to honour provincial autonomy. That is appropriate. Provinces should choose their own paths.
However, provinces and territories need a North Star – a common definition of what good primary care looks like for patients – that sits alongside the provincial need for flexibility.
Such a definition is taking shape. The Health Standards Organization (HSO), an independent body that has set quality standards for Canadian hospitals, long-term care homes and other services for decades, is renewing its primary health care services standard for release this summer.
It is being developed the way HSO standards always are: a technical committee of clinicians, patients, researchers and health system leaders drafts it; a national public review is held with comments from any stakeholders; and the final version reflects what those contributors say.
The standard does not tell provinces how to organize their teams or how to pay their providers. It describes what patients should be able to expect: care that is accessible, comprehensive, continuous, co-ordinated and grounded in community. Standards such as this are traditionally used by organizations seeking formal accreditation, but the same document can be used in other ways.
It can serve as a North Star. Provinces can adopt it as a reference. Regional health authorities can use it to self-assess where they stand. Practice teams can use it to set their own improvement goals. How it is introduced will matter. Used poorly, it generates fear of being judged. However, used well, it motivates better care for patients and populations.
Other Canadian systems already rely on shared standards
We have built a North Star infrastructure in other sectors without controversy.
For example, the national building code does not tell contractors how to pour a foundation. It tells them what the foundation must accomplish. Provinces adopt it, adapt it and enforce it as they choose. But a building inspector in Halifax and one in Vancouver are working from shared expectations about what safety means.
Aviation safety standards do not prescribe how airlines operate. They define what safe flight requires. The result is that air travel across Canada and around the world is built on common ground.
Primary care in Canada has never been treated this way. Not because the idea is wrong, but because the political and historical conditions have never quite aligned. They may be aligning now.
Canada already has promising foundations from which to build.
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First, the HSO standard described above defines quality primary care around what patients should actually experience. Second, the OurCare initiative produced rich, nationally grounded insight into what Canadians want from their primary care system. Third, the College of Family Physicians of Canada has set out its patient’s medical home vision for how primary care should be organized and delivered.
These three efforts converge. They define quality from the patient’s vantage point, name what Canadians say they want and describe how practice teams can deliver it. They do not need to compete. Together, they could inform a shared reference point – the North Star – that any province, health authority or practice team could voluntarily reference as they navigate their own transformation.
A North Star for primary care would not be a mandate. It would not be a new reporting burden. It would not be a federal imposition on provincial jurisdiction. It would provide a common language, a shared departure point and a way of ensuring that what we learn in Nova Scotia can be understood and built upon in British Columbia.
Billions in new funding need a clearer definition of success
Federal-provincial accountability reviews are underway. Current three-year action plans expire in 2026-27 and renewal decisions are imminent – just as early data reveals that provinces may be falling short of their own targets and commitments. Decision-makers will be asked to renew billions in funding without a shared definition of what good primary care looks like for patients. That gap is worth closing now.
The federally commissioned FPT primary care working group is well positioned to explore this. So are the provinces themselves, if given the tools to share implementation work. Pan-Canadian health organizations, such as the HSO and the Canadian Institutes for Health Research, offer real opportunities for more aligned national progress, if encouraged to work together.
Leadership for transformation need not be top-down. But it does require leaders at all levels willing to speak a common language and move in a shared direction.
Canada already has the evidence. We have the goodwill. We also have a once-in-a-generation primary care investment underway. What we need now is a shared sense of where we are going together.
The route is up to each province/territory. But every journey is easier with a North Star.
