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Family Doctors and Primary Care — Playbook

How many Torontonians have no family doctor, why the shortage keeps growing, and what levers the City actually has.

DRAFTThe playbookThe evidence file

What Toronto can do about a problem the province holds almost every lever on — offer what the City actually owns, and ask the one question nobody's asked yet.

The honest bottom line

Almost 2 million people in this province don't have a family doctor. That number used to be quoted as 2.5 million, and before that there was a forecast of 4.4 million by this year. None of those numbers are wrong exactly — they're measuring slightly different things, at different times, with different counting rules. What hasn't changed is that this is still one of the most concretely felt failures in daily life, and Toronto carries a disproportionate share of it. Ontario's own health ministry, working with a research network called INSPIRE-PHC, rebuilt how it counts who has a family doctor. Using the new count, as of June 2025 there were about 1.98 million people in the province without one — lower than the roughly 2.3 to 2.5 million figures that have circulated for the past few years, and much lower than a 2023 forecast that predicted 4.4 million people, 1 in 4 Ontarians, would be without one by this year. That worst-case number didn't happen — genuinely good news, though part of the improvement is simply that the province started counting differently, not only that more people got attached. Toronto's own numbers, from a 2024 release, showed more than 516,000 Torontonians without a family doctor, on track toward nearly a million by 2026. Within the city, the gap isn't even — team-based care, where a doctor works alongside nurses, pharmacists, and social workers, reaches as low as 6 percent of patients in parts of Scarborough, against a provincial rate where almost three-quarters of patients don't have team-based support at all. This isn't just an advocacy ask sitting in a policy paper. Ontario launched a Primary Care Action Plan with the explicit goal of connecting everyone to primary care by 2029, backed by a $2.1 billion investment that's since grown toward $3.4 billion with this year's budget. It's already produced results that can be checked: 78 new or expanded primary care teams from the 2024 round now serve more than 490,000 people, beating their own target. In the first nine months of 2025 alone, about 275,000 more people got attached to a provider. The province specifically targeted its funding calls at the 125 communities with the highest number of unattached people. Given what we know about Scarborough's numbers, it's a reasonable guess that some of that funding is aimed there — but nothing found in this review actually confirms it. Northwest Toronto has been called a primary care desert. Humber River Health and the University of Toronto's family medicine program built something simple: anyone who shows up at the hospital without a family doctor can now be referred straight to an on-site clinic. By 2026 that clinic is expected to be caring for 10,000 people who didn't have a doctor before — proof the model works here, not just somewhere else. Here's the honest gap in this file: the province holds almost all the real levers — it pays doctors, it regulates who can practice what, it funds the teams. But nothing found in this review shows a specific City of Toronto budget line, council motion, or space commitment aimed at this problem. That doesn't mean nothing exists — it means nobody found it this time. Neither move below requires inventing new numbers or a new program from scratch. Both start from what the province and a Toronto hospital have already built, and ask the City to either use what it already owns or simply ask a direct question it hasn't asked yet.

Note on jurisdiction: like the sibling mental-health-crisis-response leaf, this library's issue index currently has no ratified row (and therefore no Owner column) for this issue; both cards below state jurisdiction based on what this page’s sources directly show — primary care is provincially funded and regulated (OHIP, physician payment, scope-of-practice law), so both cards are structured as City-lever/City-demand cards rather than direct-delivery cards, consistent with the master briefing's own honest jurisdiction framing.

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a recommendation card — City-Owned/Leased Space for Community Health Centre and Team-Based Clinic Expansion, Targeted to Confirmed Under-Served Neighbourhoods

Card id: a recommendation card · Issue: family-doctors-primary-care-crisis · Backgrounder: our research file for that page · Trust: earlier research plus new load-bearing findings (NEW-2026-4, NEW-2026-5, NEW-2026-6)

Problem

Team-based primary-care access is documented (as of a 2024 OCFP release, not yet re-confirmed for 2025-2026) as low as 6% in parts of the GTA, including Scarborough, against a provincial average where nearly 75% of patients lack team-based support at all [NEW-2026-4]. The Ontario government's own Primary Care Action Plan already targets funding at "125 communities... which have the highest number of people not attached to primary care" [NEW-2026-6], but no source located in this page’s backgrounder confirms whether any City of Toronto space, land, or facility commitment currently supports any of these funded or future expansions. The master briefing itself identifies City-provided land/space as one of the City's clearest direct levers, since primary care itself is provincially funded and regulated. This card addresses only the space/facility gap, not physician recruitment, payment reform, or clinical staffing, which remain provincial matters.

Action

The City of Toronto inventories its own underused municipal facilities (community centres, libraries, TCHC-adjacent sites, other City-owned buildings) in neighbourhoods independently identified as under-served by team-based primary care — starting with Scarborough and northwest Toronto, the two areas this page’s sources specifically name [NEW-2026-4, NEW-2026-5] — and offers below-market lease or co-location agreements to Ontario Health-approved Primary Care Action Plan applicants (Community Health Centres, Family Health Teams, Nurse Practitioner-Led Clinics) bidding into the province's own 2026-27 call for proposals.

Jurisdiction split

Cost

Order-of-magnitude: low, relative to a new capital build — the cost is foregone market-rate lease revenue on already-City-owned space, not new construction. No specific dollar figure for a Toronto-specific below-market lease program was located — this card names the mechanism (opportunity cost of foregone lease revenue) rather than inventing a figure.

Funding path

No new City funding mechanism required for the space offer itself; the clinical/staffing funding remains the province's own Primary Care Action Plan dollars ($3.4 billion four-year investment, per NEW-2026-7, itself a search-summarized rather than directly primary-source-confirmed figure). If City capital improvements to a specific site were needed to make it clinic-ready, that would be a separate, site-specific capital request not estimated here.

Who benefits, and how

Residents of confirmed under-served neighbourhoods (Scarborough, northwest Toronto, and any other area the province's own targeting data names), via a faster path to a functioning clinic site once provincial funding is secured — removing site-acquisition delay as a bottleneck; Ontario Health/Primary Care Action Plan applicants, via a stronger, lower-cost-to-operate proposal when bidding for provincial funding.

Who bears the cost, and how

City taxpayers, via foregone market-rate lease revenue on municipal space that would otherwise generate revenue or be used for another purpose — the opportunity cost is real but is not itself a new cash outlay.

Financial ROI

Not separately estimated — no source quantifies the value of City lease concessions specifically. Directionally low-cost relative to a new capital build, since it uses existing municipal assets. Confidence: low — no comparator program of this specific type was located.

Economic ROI

Not yet estimable. No source models the broader economic effect of faster primary-care site availability specifically, as distinct from primary care generally. Confidence: low.

Social ROI

Directional: consistent with this page’s inherited evidence that team-based care improves access, outcomes, and satisfaction, and that access is currently worst in the neighbourhoods this card specifically targets [NEW-2026-4]. No source quantifies the social-ROI effect of the space-offer mechanism specifically, as distinct from the clinical service itself.

Environmental ROI

Genuinely environmentally neutral to modestly positive — reusing existing municipal buildings avoids new-construction emissions and land-use change relative to a greenfield clinic build. Confidence: medium — high confidence the direction is correct; no source quantifies the specific magnitude for this action.

Evidence

Confidence & uncertainties

Medium confidence on the problem (the under-served-neighbourhood gap is well-documented). Low confidence on cost and Financial/Economic ROI, since no comparator lease-concession program was located. This card does not resolve whether any City space is currently actually offered to Primary Care Action Plan applicants — that is a genuine open question, not assumed to be zero.

Status

DRAFT — blocked on: fairness and legal review; a real City of Toronto real-estate inventory to confirm which specific sites are actually available and appropriately zoned for clinical use.

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a recommendation card — City Advocacy Motion Naming the Primary Care Action Plan's Own Toronto-Specific Targeting Gap

Card id: a recommendation card · Issue: family-doctors-primary-care-crisis · Backgrounder: our research file for that page · Trust: New load-bearing findings (NEW-2026-3, NEW-2026-4, NEW-2026-5, NEW-2026-6)

Problem

The province's own Primary Care Action Plan targets funding at "125 communities... which have the highest number of people not attached to primary care" [NEW-2026-6], and Toronto's own OCFP-documented unattachment figures (516,000+ in 2024, forecast toward 1 million by 2026) and Scarborough's specific ~6% team-based-care access rate [NEW-2026-3, NEW-2026-4] make a strong prima facie case that Toronto neighbourhoods should be prominently represented among those 125 communities. No source located in this page’s backgrounder confirms whether Scarborough or other identified Toronto under-served areas are, in fact, among the funded 2025-26 or 2026-27 sites — this is a genuine, unresolved data gap, not a confirmed omission. This card addresses only that transparency gap.

Action

City Council requests, via formal Council motion, that the Ontario Ministry of Health and Ontario Health publicly disclose which of the 125 targeted communities (and which specific 2025-26/2026-27 funded primary care teams) are located within Toronto, and specifically whether Scarborough and northwest Toronto — both independently documented in this page’s sources as high-need — are represented, so that the City, residents, and future research passes can verify rather than assume the Plan's Toronto-specific reach.

Jurisdiction split

Cost

Negligible — a Council motion and formal transmittal is a standard governance action with no material budget line, comparable in scale to any other single-item advocacy motion Council routinely passes.

Funding path

None required; this is a governance/advocacy action, not a funded program.

Who benefits, and how

Toronto residents in under-served neighbourhoods, via better public information about whether provincial funding is actually reaching them — enabling more targeted future advocacy if it is not; City Council and future this library's internal records efforts, via a factual baseline that does not currently exist in any source located in this review.

Who bears the cost, and how

No identified payer class beyond ordinary Council administrative time — this is a negligible-cost governance action.

Financial ROI

Not applicable in the conventional sense — this is a transparency/advocacy action with no direct fiscal flow.

Economic ROI

Not yet estimable — no economic modeling applies to a disclosure request itself. Confidence: low — the action type has no plausible economic-impact pathway of its own.

Social ROI

Directional: enables better-targeted future advocacy and community accountability if Toronto's under-served neighbourhoods are found to be under-represented in provincial funding — no source quantifies this since the disclosure itself has not yet occurred.

Environmental ROI

Genuinely environmentally neutral. A governance/disclosure request has no material environmental footprint. Confidence: high.

Evidence

Confidence & uncertainties

Medium-high confidence on the problem (the Toronto-specific need is well-documented from multiple independent sources) and on the action's low cost and clear jurisdiction split. This card does not assume the Plan is failing to reach Toronto — it proposes the disclosure that would establish whether it is or isn't, since no source in this review confirms either direction.

Status

DRAFT — blocked on: fairness and legal review; confirming whether Ontario Health already publishes site-level funding data that would make this motion redundant (this review did not locate a public site-level breakdown, but cannot rule one out).

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Production record

Drafting record

Status: DRAFT · Version: v1.0 · Date: 2026-07-14 · Written per this library's standard page structure. Every factual premise traces to the page’s carried-forward master briefing or a NEW-2026-# source quote in the backgrounder — no figure here is invented. Per the costing bar (Q-06), all costs are order-of-magnitude ranges anchored to named comparators.

Playbook conversion (2026-08-11, Lane L3a): opened with "The honest bottom line" adapted from archive/dayone/family-doctors-primary-care-crisis.md (a recorded standing decision retired day-one memo, kept as history in archive/); ROI sections tightened, repeated "not yet estimable / genuine gap" boilerplate collapsed to one honest line each, matching that page's recommendation cards's playbook shape. No a formally registered claim tokens present in this file; all NEW/carried-forward citations preserved unchanged.

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