A Comparative Study of England and Canada
Jean-Louis Denis, Sabrina Germain, Catherine Régis and Gianluca Veronesi
Policy Press, an imprint of
Bristol University Press
University of Bristol
1–9 Old Park Hill
Bristol
BS2 8BB
UK
t: +44 (0)117 954 5940
e: bup-info@bristol.ac.uk
Details of international sales and distribution partners are available at policy.bristoluniversitypress.co.uk
© Bristol University Press 2022
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 978-1-4473-5215-0 hardcover
ISBN 978-1-4473-5217-4 ePub
ISBN 978-1-4473-5216-7 ePdf
The right of Jean-Louis Denis, Sabrina Germain, Catherine Régis and Gianluca Veronesi to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Bristol University Press.
Every reasonable effort has been made to obtain permission to reproduce copyrighted material. If, however, anyone knows of an oversight, please contact the publisher.
The statements and opinions contained within this publication are solely those of the authors and not of the University of Bristol or Bristol University Press. The University of Bristol and Bristol University Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication.
Bristol University Press and Policy Press work to counter discrimination on grounds of gender, race, disability, age and sexuality.
Cover design by Gareth Davies at Qube Design
Image credit: istock.com/filo
Bristol University Press and Policy Press use environmentally responsible print partners.
Printed and bound in Great Britain by CPI Group (UK) Ltd, Croydon, CR0 4YY
Contents
Introduction: Medical doctors and healthcare reforms 1
- 1Theoretical framework 8
- 2Research methodology: tracking the role of medical doctors in healthcare reforms 23
- 3The role of medical doctors in healthcare reforms in two Canadian provinces 29
- 4The role of medical doctors in healthcare reforms in the NHS in England 96
- 5Comparative analysis 140
- 6Discussion and conclusion 164
List of abbreviations
AI | artificial intelligence |
AJMQ | Association des jeunes médecins du Québec [Quebec Association of Young Doctors] |
AMQ | Association médicale du Québec [Quebec Medical Association] |
APED | assistant president and executive directors |
APP | alternate payment plan |
BC | British Columbia |
BMA | British Medical Association |
CCG | Clinical Commissioning Group |
CHC | Community Health Clinic |
CMA | Canadian Medical Association |
CMDP | Council of Medical Doctors, Dentists and Pharmacists |
CMP | Conseil pour la protection des malades [Council for the Protection of Patients] |
CMPA | Canadian Medical Protective Association |
CMQ | Collège des médecins du Québec [College of Physicians of Quebec] |
CPSO | College of Physicians and Surgeons of Ontario |
CQC | Care Quality Commission |
DGH | District General Hospital |
DHA | District Health Authority |
DRMG | Direction régionale de médecine générale [Regional Directorates of GPs] |
EHR | electronic health record |
FHN | Family Health Network |
FHO | Family Health Organisation |
FLQ | Front de libération du Québec [Quebec Liberation Front] |
FMG | Family Medicine Group |
FMOQ | Fédération des médecins omnipraticiens du Québec [Association of General Practitioners of Quebec] |
FMRQ | Fédération des médecins résidents du Québec [Association of Medical Residents of Quebec] |
FMSQ | Fédération des médecins spécialistes du Québec [Association of Medical Specialists of Quebec] |
GMC | General Medical Council |
GMS | General Medical Services |
GMSC | General Medical Services Committee |
HSO | Health Service Organisation |
HSRC | Health Services Restructuring Commission |
ICS | Integrated Care Systems |
Local Health Integration Network |
|
MQRP | Médecins Québécois pour le regime public [Quebec Doctors for a Public System] |
MRG | Medical Reform Group |
MSIC | Medical Services Insurance Council |
NDP | New Democratic Party |
NHI | National Health Insurance |
NHS | National Health Service |
NICE | National Institute for Health and Clinical Excellence |
NP | nurse practitioner |
NPM | new public management |
OHIP | Ontario Health Insurance Plan |
OMA | Ontario Medical Association |
OMSIP | Ontario Medical Services Insurance Plan |
ORAS | Organisation régionale des affaires sociales [Regional Association of Social Affairs] |
PC | Progressive Conservative Party of Canada |
PCG | Primary Care Group |
PCN | Primary Care Network |
PCT | Primary Care Trust |
PFHS | publicly funded healthcare system |
PL | projet de loi [Bill] |
PMS | Personal Medical Services |
QMA | Québec Medical Association |
RAMQ | Régie de l’assurance maladie du Québec [Quebec Health Insurance Board] |
RCGP | Royal College of General Practitioners |
RHA | Regional Health Authority |
SHA | Strategic Health Authority |
STP | Sustainability and Transformation Plans |
Acknowledgements
This book required a significant amount of research of primary and secondary sources in order to build solid narratives for the Canadian and UK case studies. It would have been impossible to complete this book without help, and we would like to express our gratitude to the following people. We are extremely grateful to Léa Boutrouille, Clara Champagne, François Lamalice and Susan Usher, who were respectively a Bachelors’ student in Law at the Université de Montréal, a Master’s student in individual study at the Université de Montréal, a Bachelor’s student in law at the Université de Montréal, and a Doctoral student in public administration at the École nationale d’administration publique during their work on this book. Their work was rigorous, meticulous and immensely helpful.
We are also in debt to Susan Usher for editing this book. The version you are now reading results from her amazing editing skills that go beyond what anyone can expect from an editor.
Last, but certainly not least, we would like to thank Johanne Préval for being our trusted collaborator on this and so many other projects.