Note
Emergency department statistics are based on data from Prince Edward Island, Nova Scotia, Ontario, Saskatchewan, Alberta and the Yukon.

Sources
* National Ambulatory Care Reporting System, 2023–2024, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
† Canadian Community ºìÁì½í¹Ï±¨ Survey, 2023, Statistics Canada.
‡ Commonwealth Fund survey, 2023, Canadian Institute for ºìÁì½í¹Ï±¨ Information.
§ Scott’s Medical Database, 2013 to 2022.

Access to primary care requires having a place to go for primary care, having this care available when it is needed, and being able to get this care without major barriers.

However, 17% of Canadians do not have a regular care provider such as a family doctor or nurse practitioner.Reference2 This proportion has been worsening over time. And Canada ranked lowest on this among 10 high-income countries in 2023.Reference3

Canadians were also the least likely, among those surveyed in 10 high-income countries, to say they could get a same- or next-day appointment (26%). Canada had one of the lowest percentages of respondents (23%) saying they found it easy to get medical care in evenings, on weekends or on holidays.Reference3 These proportions have worsened over time. 

More family medicine residency positions are going unfilled and, compared with 5 years ago, growth in family physician numbers has slowed. Family physicians also see fewer patients than they did 5 years ago. While the number of nurse practitioners is growing, that may not be enough to satisfy Canadians’ need for primary care.Reference4 Reference5

Our newest data shows that 15% of visits to the emergency department (ED) in Canada are for conditions that could potentially be managed in primary care. And over half of those are for conditions that might have been managed virtually.

Provinces and territories have different models of how primary health care is delivered, influenced by local context. Some jurisdictions are encouraging multi-provider team structures to provide more flexibility and options for care outside of regular working hours while preserving continuity of care.Reference2 Reference6 Reference7

In areas where there may be resource limitations, especially rural and remote areas, physicians often play multiple roles, including providing both primary and emergency care in one location such as the ED. This may mean that EDs are the place where people regularly access their primary care — and for many, EDs may be the only place to access care.

Innovative approaches are being adopted to address challenges relating to primary care access. While some solutions may not increase access to ideal primary care, they can help improve patients’ experiences, including reduced wait times compared with what they would encounter in the ED:

• Virtual primary care programs can support timely care of many conditions without requiring the patient to be physically near a clinician at the time of their appointment, while still maintaining the patient–provider relationship that is important in primary care.Reference7 Reference8 Reference9 Patients who live in rural and remote areas may benefit the most.
• Urgent care centres or virtual care access points within an ED are available in some jurisdictions to treat less urgent or minor conditions in a timely manner, diverting these patients from the regular flow of the ED.Reference10 Reference11
• Reorientation programs have also been implemented. In these programs, patients presenting at ED triage with minor conditions are redirected and provided an appointment with a general practitioner in the community.Reference12 Reference13
• Policies to increase the number of primary care clinicians, especially in underserved areas, can result in more access for patients.Reference6 Reference7
• Jurisdictions may also consider different models for how physicians are paid, which can affect how care is organized and practised.Reference6 Reference7
• Policies and training emphasizing equity and inclusion may be implemented to ensure that populations that currently have lower care access can receive care that is culturally safe and inclusive.Reference6

Thoughtful design is required to ensure access to care is equitable and enables continuity of care.Reference7 Reference8 Reference9

ºìÁì½í¹Ï±¨

I had excruciating hip and knee pain, but there was no reason for me to go to the ER. An office visit would have been more than sufficient, but I had no choice; the pain had me very worried. Your family doctors know you; they know your history. I would really like to see these community-style clinics or integrated clinics where there’s a doctor, a nurse practitioner, a dietitian, et cetera. — Shelley Petit, Chair, New Brunswick Coalition of Persons With Disabilities

Currently, Canada uses surveys to understand accessibility and use of primary care services, along with pockets of data from local initiatives. While data from the primary care sector is growing over time, there continues to be a need for high-quality data about primary care access that can be routinely generated and compared across the country, especially at the regional level.Reference2

One way to monitor unmet needs in primary care access is by looking at how this may manifest in emergency departments. We found that 15% of ED visits were for conditions that could potentially have been managed in primary care. We also found that over half of these, or 9% of all emergency department visits, were for conditions that could potentially have been managed virtually in primary care. 

While visits for minor conditions contribute to higher volumes of patients seen in the ED, they are not a major driver of overcrowding thereReference14 — rather, such visits to the ED may signal inadequate access to timely or high-quality primary care. 

Examining the reasons why patients visit an ED can provide insights into population-level impacts of primary care access in Canada. Such insights can also support improving access, which could shape the future role of primary care in Canada. 

Read the next sections of the report to learn more about these new indicators of primary care access.

• Better access to primary care key to improving health of Canadians
• CIHI’s information on health workforce
• CIHI: Connected Care

If you have any questions or would like to learn more, please send us an email.

hsp@cihi.ca