1. Identify the need and gather a sufficient number of physicians and other health care professionals to service the need. If it is 3 or more physicians form a FHN (Family Health Network) and apply for the capitation model. Remember FHG’s are not eligible to run a FHT
2. Develop and submit an initial application to the Ministry of Health indicating that you wish to form a FHT. While the first three waves have already been approved, it is likely that there will be a fourth wave next year. Be sure to involve your community groups in the application, as the greater the community support that you have the more likely that the application will be approved. By the way, on the first three FHT rounds you were allowed $2,000 seed money for the initial FHT application. It is not yet known if this will be permitted on the fourth round.
3. After receiving initial approval to form a FHT, speak to your colleagues to get recommendations and interview a sufficient number of consultants to ensure that you are getting the best possible. Use your colleagues’ references to your best advantage and do not be afraid to ask questions. Hiring a good consultant or consulting group can make the difference between success and failure. Ensure that the agreement you sign with the consulting group does not require any payment above the costs covered by the Ministry and that payment will be based on deliverables.
4. Ask your consultant or consulting group to develop your Development Grant Application (DGA) and ensure that it includes sufficient funds to complete the analysis. Review the DGA with your colleagues before submission. Remember, the consultant may have developed it, but it is your application and you have to deliver the promised results. The consultant can only assist you in the process, but you and your group are ultimately accountable. Submit the DGA and wait for the Ministry approval.
5. Establish a FHT bank account so that when the DGA moneys are received from the Ministry you can deposit them into a segregated account. This will facilitate tracking the use of these funds and reporting thereon to the Ministry. Any funds remaining either roll into the FHT operating funds or are returned to the Ministry. Be sure to keep all receipts and track your lead-physician’s time and expenses to make reimbursement and accounting for advanced funds easier.
6. Identify your FHT steering group, which should include physicians who are committed to the FHT and schedule regular weekly or bi-weekly meetings. Be sure to adopt a governance model identifying who is in charge of which activities so that you can keep moving forward… If you are already a FHG: Identify if all physicians in the FHG will FHN or will some stay out for an initial period. If all will FHN then fill out the application. If not all will FHN then develop strategies for entry and exit of physicians, Ensure that your governance model also accommodates working together with the FHG physicians. For the physicians who will FHN be sure to submit an application to OntarioMD for IT funding, especially if you are installing a new Electronic Health Record (EHR). Remember, the Ministry expects that you will obtain all available additional funding from other sources initially rather than the Ministry. Your consultants can help you with the FHN form as well as the OntarioMD application. Your OntarioMD representative can also assist and ensure that you do not make some of the common mistakes.
7. Working with the physicians and other health care providers in the “circle of care” including where appropriate, hospital(s), CCAC, Home Care, Children’s Treatment Centre, LHIN, etc. be sure to identify the programs important to your community and ensure that the plan for rolling out improvements to these programs or starting new ones all fit with current initiatives or that you can get support from the other community participants. This has many advantages including but not limited to visible increased community participation and involvement, economies of scale, streamlining current operations or piggybacking on existing operations, substantiation to the Ministry that the plan is do-able, and most importantly it gets the community on your side. Developing the programs to be offered by the FHT also assists in identifying the members of the FHT Board of Directors as well as various advisory committees.
8. Register the FHT as a “not for profit corporation” and ensure that you have adequate directors liability insurance. (Remember that AFHTO can assist you with both the liability insurance required to protect the FHT and its directors, and benefits plans for employees and physicians). At the same time develop a staffing and space plan to ensure that the programs identified in the previous step can be implemented. Remember that your personnel needs should be based on the programs that you wish to implement and the services that you wish to provide. To maximize the support that you can expect from the Ministry, identify the results you expect to achieve for the staff that you are asking to receive. Be sure to have thought through your fall-back position and the related,  revised measures of performance if you do not (and this is a likely scenario) get all that you ask for. Your consultant can help you develop both the initial and fall-back positions as well as assist in your negotiations with the Ministry. After full discussion and agreement by your Board, submit the business and operational plan to the Ministry. Ensure that the proposed start date and deliverables proposed in your plan are do-able. Your business and operational plan should be in the format and order dictated by Ministry publications so that questions are kept to a minimum. If your consultants have done a good job, the only questions from the Ministry should be on points of clarification.
9. After you have submitted your plan, which needs to include job descriptions, be prepared for a couple of weeks of questions from the Ministry on the plan. Their prime concern is to ensure that you know what you are doing and understand what you are committing your team to delivering. This is a two-edged sword, in that the Ministry will provide funds for staff so that the number of rostered patients can increase. At the same time as allowing physicians to increase their capitation income by having more patients, they want to be sure that the physician knows what he or she has promised to deliver and can do it. This is why you must ensure that your performance measures are reasonable, attainable and backed by sound information. Once the “horse-trading” is basically complete, the Ministry will authorize your FHT staffing levels as well as funding for other costs. Remember, if you do not get all that you ask for, that is OK as long as what you have to deliver for the funding is manageable and do-able. This is where your measures of performance become critical.
   
   Most of the time, the staffing levels are authorized before the remaining operating budgets. This is normal. As soon as you have reached agreement on your staffing levels, establish a mutually acceptable commitment on your starting date. (Again your consultants can help you with the implementation) Once this date has been set, you can start hiring staff with a scheduled start date just prior to the scheduled opening. The first staff you should consider hiring is an executive director or manager to undertake the administrative duties that have been driving you crazy until now. Be sure to check the references carefully and ensure that the individual you hire is on probation until they prove themselves. Also make certain that all hires and fires are approved by the Board of Directors.
10. After you have set the operational commencement date, identify the tasks that have to be completed before the FHT doors can be opened. In some instances this may just be a transition from a currently operating medical clinic, whereas in other instances it may require major renovations, relocation, systems set-up and other capital expenses. If your consultants have done their job correctly, this should all be mapped out and charted, or they should continue to work with you until the implementation is complete. Either way, you should be in a position to delegate the administrative chores and focus on providing the best possible continuing care to you patients.

Afterthought:

Starting an FHT is not easy, but it is rewarding. By bringing together community health care providers to work on joint projects, you can do more despite a shortage of physicians. This is the major benefit of FHT’s and this is why the Ministry wants to maximize the amount of care that can be received at the primary point of contact