Can you imagine driving down the highway and seeing street signs directing you to your local primary care clinic instead of a hospital? In this episode, Dr. Tara Kiran hops in a car with health economist Tino Marti for a healthcare road trip across Catalonia, Spain, to tour three different clinics. They serve different populations in different settings under different governance models. But all three deliver care to every resident in their surrounding community.

First, they visit CAP Vilafranca North, a clinic run by the public agency that runs 80% of Catalonia’s primary care centres, where rotating "health points" ensure even small rural villages of 1,000 people can get care in their community. Next, they tour CAP Castelldefels, a joint venture between the government and local municipalities that embraces the philosophy of "subsidiarity"—allowing nurses and administrative teams to independently treat minor issues so family doctors can focus on complex care. Finally, they head to CAP Sardenya, an entrepreneurial, clinician-owned cooperative that integrates university research and gives doctors more schedule flexibility. 

Listen in to see how the Spanish model combines performance bonuses, quality dashboards, and community engagement to build a system where nobody falls through the cracks.

Learn more about Spanish primary health care:

Read this four-page summary on primary care teams in Catalonia

Review this comprehensive policy paper to dive deeper into primary care transformation in Spain 

Mainpro+ Credits

Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 

This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 

Listen to More From Our Healthcare Infrastructure Series

In Spain: a primary care centre in every community (Part 1)

In Costa Rica: Integrating Public Health and Primary Care

In Vancouver: A Clinic Accountable to the Community It Serves

More About Primary Focus

Subscribe to our Substack newsletter

Have an idea for an episode? Email [email protected]

Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

Imagine living in a country where no resident struggles to access primary care. There are no wait lists. Everyone can be seen at the local health centre, even if they haven’t registered in advance. In this episode, Dr. Tara Kiran takes you on a journey to Spain—where the right to primary care is guaranteed in law and where every community has a local health centre. Walking through the streets and historic health ministries of Barcelona, Tara speaks with health economist Tino Marti and healthcare strategy director Dr. Rafael Ruiz to understand how neighbourhood hubs bring doctors, nurses, social workers, and even publicly-covered psychologists and physiotherapists under one roof to care for entire communities. Finally, Tara sits down with digital health leader Dr. Oscar Solans to learn about La Meva Salut—a  patient app that has given millions of Catalans easy digital access to lab tests, imaging, medications and more since 2009.Learn more about Spanish primary health care

Read this four-page summary on primary care teams in Catalonia

Review this comprehensive policy paper to dive deeper into primary care transformation in Spain 

Mainpro+ Credits

Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 

This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 

Listen to More Episodes About Community-based Primary Care Models

If you want to learn more about how different jurisdictions organize community-oriented, team-based care models, listen to these related episodes:

In Costa Rica: How a middle-income country built a world-class primary care system

In Costa Rica: Integrating public health and primary care

In Durham: Community Wellness and Black Health

More about Primary Focus:

Subscribe to our Substack newsletter

Have an idea for an episode? Email [email protected]

Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

More than 5.8 million adults in Canada don't have a regular family doctor, nurse practitioner or primary care clinic--and where you live has a lot to do with whether you're one of them. To make sense of the newest research on primary care in Canada, Dr. Tara Kiran flips the script and welcomes award-winning health reporter Kelly Grant from The Globe and Mail to ask her the tough questions.

Together, they dig deep into the newly released 2025 OurCare Survey data, exploring why provinces like Manitoba and Ontario are faring better, why Quebec leads the nation in out-of-pocket medical fees, and why patients in the Territories report being more satisfied with care. The data raises as many questions about healthcare as it answers — which is exactly what makes this conversation worth hearing.

Explore the Data

The 2025 OurCare Survey tracks how primary care is performing in every province and territory. You can dive into the results yourself at OurCare.ca 

Read the reports at OurCare.ca/survey 

Explore the interactive dashboard at data.ourcare.ca 

Read Kelly’s piece in the Globe and Mail summarizing the key findings

Mainpro+ Credits

Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 

This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 

Listen to an episode about the genesis of the OurCare Survey

A historic win for primary care in Ontario with Peter MacLeod

Why millions of Canadians are still waiting for a family doctor with Dr. Danielle Martin

More about Primary Focus:

Subscribe to our Substack newsletter

Have an idea for an episode? Email [email protected]

Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode, Dr. Tara Kiran travels to Durham, Ontario, to visit the Durham Community Health Centre, where CEO Francis Garwe leads a team rethinking what primary care can look like when it is truly rooted in community. Touring a repurposed public school that now houses a wide range of services—from mental health counseling and a regional diabetes team to food security programs, youth programming, and community gardens—Tara sees firsthand how Durham CHC addresses the social determinants of health alongside clinical care. She then sits down with Francis Garwe, Dr. Akeem Stewart, and Dr. Kirk Stewart to discuss how the centre is advancing Black health through initiatives like the Kliniki clinic and a community ambassador model designed to build trust and improve access. Together they explore what it takes to co-create programs with the communities they serve—and what other clinics in Canada might learn from Durham’s approach to equity-driven primary care.

Donate to Durham CHC

Durham CHC relies on private donations, grants, and other sources to fund some of the important services they offer that address social determinants of health. To support the Durham Community Health Centre’s innovative work, visit their website at www.durhamchc.ca.

Podcasthon

Primary Focus is proud to take part in Podcasthon, the world’s largest charity podcast event! We were tasked with creating an episode dedicated to supporting a charity or non-profit that truly matters to us, and we chose Durham CHC. Podcasthon brings together podcasters globally to raise awareness for important causes - without any money involved. It’s all about uniting voices to make an impact, with more than 1,000 podcasts highlighting a charity of their choice. Listen to more episodes as part of Podcasthon here. 

Research and programs mentioned in this episode

Get more information on the Durham Community Health Centre. 

Learn more about Ontario Health’s Black Health Plan, informed by the work done by Francis Garwe and the Durham CHC

Find out about the Black Health Committee, a committee for the Alliance for Healthier Communities

Visit the Black Physicians Association of Ontario website to learn more about their work on Black health

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.

Listen to other episodes of Primary Focus in our series on community-driven health equity clinics:

In Costa Rica: How a middle-income country built a world-class primary care systemIn Costa Rica: integrating public health and primary careIn Vancouver: A Clinic Accountable to the Community It Serves

More about Primary Focus:

Subscribe to our Substack newsletter

Have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode, Dr. Tara Kiran travels to Vancouver, British Columbia, to visit the Umbrella Multicultural Health Co-op Clinic — a clinic built by and for newcomer communities. Umbrella pairs physicians and nurse practitioners with cross-cultural health brokers who act as language and cultural interpreters, helping bridge gaps not just in communication, but in navigating the healthcare system itself. Tara tours the clinic with Naomi Armstrong, Director of Integrated Health Programs, and then sits down with Dr. Mei-Ling Weidmeyer, family physician and clinical lead. Together, they discuss Umbrella’s origins as a mobile clinic for migrant farm workers, its cooperative governance model, and how culturally safe, community-accountable primary care can have a meaningful impact on people’s lives.

Donate to UmbrellaUmbrella relies on donations from the public to continue offering services to newcomers–especially for those without insurance coverage. To donate to Umbrella Multicultural Health Co-op, head to their website umbrellacoop.ca 

Research and programs mentioned in this episode

Learn about the OurCare Standard and how it was developed

Watch this 3-minute video about Umbrella

Read a research paper or short report on how Umbrella is integrating cross-cultural health brokers in primary care

Find out more about national efforts to bring cross-cultural health brokers to primary care

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode, Tara speaks with Dr. Nicole Boutilier, Executive Vice President of Medicine and Clinical Operations at the Nova Scotia Health Authority —  a family doctor leading primary care transformation from within the government. Dr. Boutilier walks Tara through Nova Scotia’s multi-pronged plan to improve primary care access: transforming the province’s centralized waitlist into an active patient management tool, building and strengthening Health Homes (team-based primary care clinics), creating pathways for people without a family doctor to access care while they wait, and modernizing how data flows — so patients can access and share their own health information through the YourHealthNS app.

Research and programs mentioned in this episode

Read the OurCare reports from the Provincial Priorities Panels (including Nova Scotia’s).

Find out more about Nova Scotia’s Need a Family Practice Registry and Health Homes model.

Get more info on Nova Scotia’s Longitudinal Family Medicine (LFM) physician payment model.

Watch a video about how the YourHealthNS app gives patients access to their health data.

Learn more about Nova Scotia’s new pathways for integrating internationally-trained medical graduates and the new Cape Breton Medical Campus training rural family doctors.

Dive into the research on virtual care in Canada.

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design.

Further reading:

Listen to Part 1 of our series on Costa Rica with Dr. Madeline Pesec

Take a look at the research article that first introduced me to Madeline (co-authored by Dr. Atul Gawande) 

Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 

Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande

Read the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenarians

Learn more about rising violence in Costa Rica related to femicide and gang violence

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

This episode is the first in a two-part series on the primary care system in Costa Rica. Dr.Tara Kiran sits down with Dr. Madeline Pesec, an internal medicine physician and pediatrician, to explore Costa Rica’s ambitious primary health care system. They talk about how Costa Rica's commitment to health as a human right and its community-oriented primary care have led to significant improvements in health outcomes. From the concept of "Hospital Without Walls" to the role of community health workers, Madeline shares insights from her extensive research and personal experiences in Costa Rica. Then, join us in our next episode where Tara goes on a tour of a Costa Rican clinic and speaks to members of the EBAIS (Equipos Básicos de Atención Integral de Salud) about both how and why they do their work. 

Further reading:

Take a look at the research article that first introduced me to Madeline

Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 

Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode, we take you to Saint-Hyacinthe to see how a team in Quebec is transforming timely access to primary care. Quebec has more interprofessional primary care teams than anywhere else in Canada — yet it remains one of the provinces struggling most with access. So how do you turn a team into one that actually works? Dr. Kiran sits down with Dr. Isabelle Gaboury, a researcher and QI leader who, alongside colleague Mylaine Breton, has modernized the “advanced access” model for today’s interprofessional clinics. Together, they’ve coached more than 40 practices to redesign workflows, clarify roles, and use data to constantly iterate. Then I take you inside GMFU Richelieu-Yamaska, where waits dropped from 14–16 days to just 3. You’ll hear how receptionists learned to triage using a symptom-based algorithm, how nurses and social workers took on new responsibilities, and how the whole clinic shifted from working harder to working differently. It’s a story about change management, team-based care, and what it really takes to deliver timely, patient-centred access — in Quebec and across Canada.

Resources mentioned in the episode:

An article on why it’s so hard to find a family doctor in Quebec

Isabelle and Mylaine’s contemporary advanced access model

How Canada compares to peer countries when it comes to timely care

An older commentary from Tara that delves into why timely access is such a problem in Canada

A summary of Quebec’s data from the OurCare survey

Explore Quebec data from the 2022 OurCare National Survey at data.ourcare.ca or read this article

Visit the website for GMFU Richlieu-Yamaska

Listen to our 4-part series on The Netherlands (mentioned in this episode when discussing training for primary care nurses

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode of Primary Focus, Dr. Tara Kiran travels to Renfrew County, Ontario, where an innovative team is tackling the family doctor shortage with a new kind of hybrid care - where your doctor is virtual, but your team is on-site. At the Petawawa Centennial Family Health Centre, Dr. Jonathan Fitzsimon shows Tara how patients are matched with virtual family physicians who work alongside local nurses, pharmacists, and other health professionals to provide full-service, ongoing care. The result? More than 6,000 people who once had no family doctor are now receiving comprehensive, team-based care. It’s a story about creativity, access, and what’s possible when rural communities rethink how primary care can be delivered.

Further reading:

Explore more about the Petawawa Centennial Family Health Centre Read a report summarizing Renfrew’s Integrated Virtual Care model 

Dive into research on the Integrated Virtual Care model including papers on early patient outcomes, patient experience, and staff experience. 

See some photos of Petawawa Centennial Family Health Centre (link to post)

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the St. Michael’s Foundation and the MAP Centre for Urban Health Solutions. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.