Welcome to the Primary Care Expansion 2027–2028 FAQ page for primary care providers in Middlesex London. As part of the provincial goal to achieve 100% patient attachment by 2029, this collaborative initiative focuses on expanding team-based care and improving direct patient-care capacity across our communities. Below, you will find detailed answers regarding proposal eligibility, funding metrics, resource allocation, and practice readiness timelines.
If you are interested in joining this proposal to shape the future of team-based care in our region, we want to hear from you. Please email the Middlesex London Primary Care Network at [email protected] to learn more about the submission process before the November 20, 2026 deadline.
About the proposal and who can participate
- Give more people access to a regular primary care clinician.
- Expand team-based care across Middlesex London.
- Work toward 100% attachment by 2029.
- Total: 87,433 people in Middlesex London as of March 2026.
- Largest numbers: East London (N5V and N5Y), West London (N6G and N6H), and rural Middlesex (N0L and N0M).
- Equity: These areas also have higher levels of marginalization.
- Health Care Connect: Fewer than 1,000 people are waiting through Health Care Connect. The largest group is in North Middlesex (N0M), where fewer primary care physicians practice.
- Key point: The attachment gap is much larger than the Health Care Connect wait-list alone.
- Family physicians and nurse practitioners
- Primary care organizations and hospitals
- Community and social service providers
- Home and community care and community paramedicine
- Other local partners
- Family Physicians, NPs and Primary Care teams will be responsible for attaching the patients
- Indigenous organizations may submit their own proposals.
- A Fee For Service physician will need to join a Patient Enrolment Model (PEM)
- Normally it takes about 3 months for the paperwork to be approved by the Primary Care Branch. Given the timeline from November 20th to April this would give a potential FFS partner a chance to enroll in a PEM.
- For a single FFS physician this could be as simple as becoming a Comprehensive Care Model (CCM) which is a PEM.
- Creation of new IPCTs may be proposed in areas where there are no existing IPCTs and where there is a demonstrated need for team-based primary care or limited access to primary care services.
- Readiness to implement is a priority, leveraging existing infrastructure, human resources and local partnerships.
Resources, funding and patient attachment
- Describe needs in your community and practice.
- Identify the roles or supports that would help your practice.
- Propose a realistic number of new patients you could attach.
- If approved, confirm space, technology, workflows, and data and reporting capacity.
- Sign an agreement and support staff onboarding.
- Meet the agreed attachment and reporting commitments.
- Requests should increase direct patient-care capacity.
- Requests should help attach more patients.
- Each request must be linked to an attachment target.
- Possible roles include:
- Care Manager: Provides proactive, person-centred care management for patients with complex needs who benefit from additional coordination across primary care, health, social and community services.
- NP Most Responsible Provider (NP MRP): Serves as the primary clinician accountable for coordinating and managing a patient’s overall care.
- Physician Assistant (PA): Assesses and diagnoses patients, develops and implements treatment plans, and supports the ongoing management of patients under physician supervision. They may also perform delegated medical activities, such as prescribing, ordering tests, and performing procedures, to support timely access to care and continuity of care.
- Dementia Care Provider: Supports assessment, care planning, education, and coordination for people living with dementia and their caregivers.
- Mental Health Counsellor (MHC)/Social Worker: Provides brief, structured psychotherapy within a stepped care model for mild to moderate concerns.
- Patient Care Assistant (PCA): Provides both direct and indirect care, assisting with routine measurements, assessments, care tasks (including injections), and communications to ensure smooth provision and navigation of care.
- Medical Office Assistant (MOA): Supports patient intake, scheduling, referrals, documentation, and other administrative workflows that improve access to care.
- Interprofessional Health Providers (IHPs): May include roles such as registered nurses, dietitians, pharmacists, occupational therapists, physiotherapists, or other regulated professionals who contribute specialized expertise to team-based care.
- Newly funded positions provide an immediate first step toward team-based care.
- Each position will initially support defined attachment targets while supporting the practice’s full roster of attached patients.
- Partners will have immediate access to the following services:
- Health promotion, chronic disease management, mental health & educational/skills development group programming offered by TVFHT IHPs and South West Self Management.
- Academic detailing and drug information email from TVFHT pharmacists.
- TVFHT is committed to full participation in team based care within 12- 18 months.
- Intended use: New or expanded team-based primary care that improves access and attachment.
- Not intended for: Existing overhead, rent, base staffing, normal operating costs.
- Previous rounds: Major capital and lease costs were not eligible. Minor renovations of up to $100,000 per site could be considered.
- Important: Proposals should identify any required start-up costs to support attachment, including staffing, administrative, space renovations or other readiness costs; however, these costs are not guaranteed and require prior approval from Ontario Health and/or the Ministry.
- This round: Initial guidelines do not specify attachment requirements by role
- Previous rounds:
- One full-time nurse practitioner or physician assistant was linked to 800 new patient attachments.
- One full-time interdisciplinary role—such as a registered nurse, social worker, or care manager—was linked to 225 attachments.
- Shared roles could have a prorated target.
- Important: These figures are examples only until current requirements are released.
- Past focus: Attaching more patients to primary care.
- Planning benchmark: About $10.8 million for commitments to attach 23,000 patients—about $470 per attachment.
- Not a fixed rate: This was an average across the full proposal, not a guaranteed amount for any provider, partner, or role.
- Funding risk: This round may differ, and proposals have historically received only part of the funding requested.
- Strong requests: Keep costs realistic and clearly show how each funded role will increase attachment.
- A documented, ongoing relationship with a physician, physician group, or nurse practitioner in the publicly funded system.
- It may be recorded through formal registration or a signed enrolment and consent form.
- Providers are required to attach some patients from the Health Care Connect list.
How proposals and participants are selected
- Local submission: The MLPCN Executive Council and MLOHT Leadership Table approve the Middlesex London proposal(s), considering attachment commitments, local priorities, provincial Primary Care Action Team principles, and risks.
- Ministry decision: Ontario Health and the Ministry of Health decides whether to approve the proposal(s), how much funding to provide, and the required attachment commitments.
- Local implementation: After the Ministry decision, the local Primary Care Action Team (PCAT) Steering Committee approves the detailed plan and participating providers and partners, using input from submission partners and the lead organization.
- Primary care attachment: Ability to provide net-new, ongoing attachment, with priority to communities with high rates of unattachment.
- Readiness to implement: Ability to begin attaching patients in Spring 2027 and meet attachment targets by Spring 2028. Longer timelines may be considered for new teams.
- Geographic coverage: Alignment with local OHT and PCN priorities and community needs, supporting coverage across Middlesex London.
- Primary care objectives: Alignment with the six provincial principles:
- Province-Wide: Ongoing relationship with a primary care clinician or team
- Connected: Coordination with health and social services
- Convenient: Timely access to primary care
- Inclusive: Care that is accessible and free from discrimination
- Empowered: Access to personal health information through connected digital systems
- Responsive: Services that respond to community needs and demonstrate performance
- Timing: After the Ministry announces the Middlesex London funding and attachment commitments, expected in spring or early summer 2027.
- Lead organization review in consultation with MLOHT, MLPCN and partners: Considers the mix of providers and roles needed, approved funding, local priorities, partner input, and partner readiness.
- Priority: Providers with high attachment commitments, high readiness and little or no team-based support may be given priority.
- Recommendation: The lead organization recommends a final plan and list of participants.
- Approval: The MLOHT, MLPCN and proposal partners (or the existing PCAT Steering Committee) try to reach agreement on the plan and participants through consensus decision making. Anyone with a conflict-of-interest would remove themselves from the vote.
- If there is no agreement: PCAT Steering Committee majority vote.
- Confirmation: Participation is final only when roles and commitments are clear and the Memorandum of Understanding (MOU) and implementation plan are signed.
Readiness, staffing, and working arrangements
- Be ready to start: You must be able to move from approval to implementation within the required timeline.
- Define your plan: Identify the population you would serve, the roles you need, and a realistic attachment commitment.
- Complete documents: Finish the required templates and provide a signed letter of commitment.
- Check your site: Confirm whether clinic space, furniture, equipment, technology, and EMR access are ready or need planning.
- Plan early: If minor renovations may be needed, obtain quotes early.
- Respond promptly: Be ready to answer planning questions and review and sign the MOU and privacy and data-sharing arrangements.
- Support delivery: Help onboard new staff and take part in planning, reporting, improvement work, and governance when requested.
- Role: If funding is approved, the lead organization coordinates funding, agreements, staffing, governance, onboarding, reporting, and implementation.
- Selection process for choosing the lead organization: Local leaders from the FHTs, CHC and NPLC considered the capacity required, experience from earlier rounds, and how to keep participation open to all partners.
- Why Thames Valley Family Health Team: It confirmed that it has the capacity and established infrastructure to continue.
- Local agreement: No other participating organization asked to take on the role, and the group agreed that Thames Valley Family Health Team should remain the lead.
- Yes. While Thames Valley Family Health Team will serve as the Lead Organization for the collaborative Middlesex London submission, the proposal may include opportunities developed in partnership with other Family Health Teams, Nurse Practitioner-Led Clinic and Community Health Centre.
- Funding can flow directly to participating organizations where they are the appropriate organization to receive and administer the funding.
- Providers and physician groups are welcome to build on existing relationships with FHTs, NPLC or CHC and connect directly with them to explore potential partnerships and opportunities to participate in the broader submission.
- Funding: Would flow to the lead organization or to a participating Family Health Team, Community Health Centre, or Nurse Practitioner-Led Clinic.
- Employer: One of the above organizations would employ and supervise the new staff —not an individual physician practice, FHG or FHO
- Before implementation: Employment, supervision, scope, and day-to-day working arrangements would be confirmed.
- Yes. You will keep responsibility for your own clinical care and practice operations.
- The MOU will cover: Roles and decision-making; staffing responsibilities; privacy and data sharing; reporting requirements; funding processes; and how concerns or disagreements will be handled.
- No. Joining now means helping shape the proposal.
- Participation becomes final only after funding is approved.
- Feasibility and readiness must be confirmed.
- Roles must be clear.
- The required agreement and implementation plan must be signed.
Other options and next steps
- Yes. The Ministry has indicated there will be one more call for Interprofessional Primary Care Team (IPCT) proposals in 2027.
- Your patient may be able to access Team Care at London InterCommunity Health Centre if they meet the following criteria:
- Is part of the lowest income quintile
- Lives in East London (preferred, subject to available capacity)
- Has no private health insurance or has exhausted all EAP/benefits services
- Experiences barriers in accessing services due to the social determinants of health
- Contact: Email the Middlesex London Primary Care Network at [email protected].
- Topics: Discuss your practice needs, a possible role or resource request, or questions about participation.
- Submission route: Ontario Health will accept IPCT proposal(s) only through the Middlesex London OHT.
- Deadline: The deadline for OHTs and their PCNs to submit proposals to Ontario Health is November 20th, 2026, at 5PM Eastern Time