Something remarkable is happening in Canadian health policy right now. After decades of incremental change, provinces and territories are making serious, sustained investments in primary care. These bilateral health agreements represent a genuine federal-provincial commitment – billions of dollars directed toward the kind of team-based, patient-centred care that Canadians have been asking for.
The people designing these investments care deeply. The intent is right. But when the accountability reviews come, how will we know if it worked?
An unfortunate pattern has emerged across Canadian health systems that is worth naming. When a province sets out to transform primary care, it consults international models found outside of Canada – Alaska’s Nuka System, England’s Primary Care Networks, Australia’s Primary Health Networks. It convenes researchers, hires consultants, builds something thoughtful and locally responsive.
And then the province next door does the same thing. Starting fresh. Learning the same lessons from international models but not from models within our own country. Building something no one in Canada can easily learn from.
This is not a failure of effort or intention. It is what happens when a system navigates without a shared reference point – when flexibility, which is genuinely valuable, has no common language alongside it.
Canada’s bilateral agreements are designed to honour provincial autonomy. That is right and appropriate. Provinces should choose their own paths. But Canadian provinces and territories need a North Star for primary care – a common definition of what good primary care looks like for patients – that sits alongside provincial/territorial flexibility, rather than constraining it.
This is not a new idea. We have built this ‘North Star’ infrastructure in other sectors without controversy. The National Building Code does not tell a contractor how to pour a foundation. It tells them what the foundation must accomplish. Provinces adopt it, adapt it, enforce it as they choose. But a building inspector in Halifax and one in Vancouver are working from shared expectations about what safe 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 across the world – is built on common ground.
Healthcare 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 to build from.
First, the Health Standards Organization’s (HSO) Primary Health Care Services Standard – currently in public review until April 29 – defines quality primary care around what patients experience: whether they can access care when they need it, whether that care is continuous, comprehensive and coordinated.
Second, the OurCare initiative has produced rich, nationally grounded insight into what Canadians actually want from their primary care system. Third, the College of Family Physicians of Canada has shared its Patients Medical Home vision.
These efforts represent years of careful work. They do not need to compete. They could, together, inform a shared reference point – a North Star – that any province, health authority or practice team could voluntarily draw on 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.
Federal-provincial bilateral accountability reviews are underway. 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 again 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. National organizations – such as Health Standards Organization (HSO), and the new collaboration between Healthcare Excellence Canada (HEC) and the Canadian Institute for Health Research (CIHR) 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 further 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.
Photo courtesy of Robert Linsdell from St. Andrews, Canada, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons
