Patients waited up to seven months to be accepted, and researchers call the fallout readiness decay
Approximately 6.5m Canadians, more than 15 percent of the population, have no family doctor or nurse practitioner for ongoing care, and those patients often rely on walk-in clinics and emergency departments for basic and preventive services.
A study of primary care attachment in Ontario published in the journal Healthcare, which credited the Canadian Medical Association for the national count, found that attachment often fails or remains fragile unless patient readiness, provider capacity, and system design align at the same time.
Access Alliance Multicultural Health and Community Services in Toronto and the Alliance for Healthier Communities in Toronto led the research, with co-authors from Western University in London, Ontario, and the University of Toronto.
It combined a scoping review of 34 articles with interviews held between October and December 2025 with eight patients, three physicians, and two project managers.
Patients interviewed reported waits of one to seven months between applying and being accepted, alongside limited communication during that period and inconsistent information from front-desk staff.
The authors named the resulting frustration and disengagement readiness decay, and identified newcomers, refugees, and members of equity-deserving populations as most exposed.
Physicians described onboarding new patients as substantial, unpaid, and often invisible work covering chart creation, consent management, portal registration, medication reconciliation, and retrieval of external records.
Capacity limits led some clinics to restrict acceptance to specific groups such as children or family members of existing patients.
It cited the Canadian Health Workforce Education, Training and Distribution Study in putting the national shortfall at about 23,000 family doctors against roughly 1,700 new graduates each year.
“Success shouldn’t be measured only by how many people are attached,” said Sarah Hobbs, chief executive officer of the Alliance for Healthier Communities, in a news release from the organisation.
The release said Hobbs wants the durability and reach of those relationships counted alongside the attachment figures.
The study recommended uniform digital intake processes to cut repetitive data entry, centralized waitlist algorithms refined to weigh clinical urgency and social determinants of health rather than chronological order, and financial and administrative incentives recognising the labour of establishing new longitudinal relationships.
It also proposed readiness key performance indicators, including time from registration to intake completion and patient preparedness scores drawn from pre-appointment surveys.
Facilitators identified in the literature included team-based care, patient navigation, and culturally responsive outreach, along with structured onboarding.
“When patients are ready for primary care, the system needs to be ready too,” Cliff Ledwos, executive director of Access Alliance, said in the same release.
Ontario’s Primary Care Action Plan (2025–2029) aims to connect approximately 2m residents by creating and expanding interprofessional primary care teams, the study noted.
Members of the Alliance for Healthier Communities have built proposals to attach more than 500,000 people since the provincial plan launched in 2024, according to the release.
Jen Rayner, director of policy and advocacy at the Alliance for Healthier Communities, said in the release, “What we found was that community-led primary health care providers already use the recipe recommended for long term attachment and ways to avoid readiness decay.”
