Clinical & Program Excellence
Strengthening care beyond the traditional clinic visit

Every day, Thames Valley Family Health Team (TVFHT)’s clinicians and program teams found new ways to support patients. This included expanding scope of practice, building evidence-informed skills, and creating pathways to care that meet people where they are. 

Advancing Clinical Practice & Primary Care Leadership  

TVFHT strengthened clinical practice across the multiple disciplines in 2025-2026: 

• Nurse practitioner-led care advanced to the point of teams attaching new patients. Read more.

• RN prescribing started at two clinics. Specially trained registered nurses can now prescribe medications for common, lower-complexity issues. This includes renewing prescriptions or treating a certain ailments and infections without waiting for a physician or nurse practitioner approval. For patients, this means fewer steps and quicker access to needed treatment. 

• Providers in Elgin received stepped care training to help match patients to the right level of service. 

Strengthening Academic Leadership 

To support its growing academic mandate, TVFHT created a new Academic Lead role. This role is dedicated to strengthening collaboration with the local medical school, expanding residency programs, and improving the learning environment at teaching sites. That leadership is already showing results. 

TVFHT’s Academic Detailing service, delivered in partnership with the Centre for Effective Practice (CEP), completed 227 visits over the last year, one of the highest levels of Academic Detailing activity in Ontario. Academic detailers covered many clinical topics including opioids, diabetes, heart failure, and adult ADHD, with positive clinician feedback throughout. 

Resident education also grew through the CEP’s Merging Evidence with Drugs & Skills (M.E.D.S.) Program, a collaborative initiative supporting Family Medicine residents in translating evidence into practical, patient-centred care through interactive, case-based learning. Between April 2025 and March 2026, the program collected 196 participant evaluations. 100% of participants agreed sessions included case-based, evidence-based learning, and 96.9% reported being satisfied or extremely satisfied with the experience. 

Community & Group Programs 

TVFHT expanded access to group-based care and self-management programming over the last year, making it easier for patients and community members to build skills, connect with others, and take an active role in their health. 

Key improvements included a simplified, more user-friendly online registration process, and the introduction of text message reminders alongside email notifications, to reduce no-show rates. In 2025–2026, TVFHT delivered 85 group programs to 675 participants, with a 46.2% increase in patients accepting provider referrals — a sign of growing confidence among both providers and patients that group-based care effectively supports learning and health management. 

Mental health remained the highest-demand area of group programming, with popular offerings including Dream On (cognitive behavioural therapy for insomnia), Introduction to Mindfulness, Living Mindfully, and the consistently waitlisted Mind Over Mood. Building Foundations, a trauma-informed skills program for adults living with post-traumatic stress, was offered seven times over the last year to 53 participants; a new partnership with Woodstock Hospital extended in-person access to Oxford County. 

The South West Self-Management Program continued to empower people across Southwestern Ontario to manage chronic conditions and build confidence in their health. 

• 109 workshops delivered  

• 1,400+ participants  

• 24 health service provider workshops delivered  

• 19 new facilitators trained to support future programming  

The program expanded partnerships with organizations including: the Collaborative Metabolic Dysfunction-Associated Steatotic Liver Disease (COMET) Clinic at London Health Sciences Centre; the City of London; the Town of St. Mary’s; and, the University of Windsor Physiotherapy Program. 

Specialized & Equity-Focused Programming 

TVFHT also grew several specialized programs over the last year to reach patients with specific and often underserved needs. In partnership with Woodstock General Hospital (WGH), TVFHT introduced Binge Eating Disorder programming, and worked with WGH and London Health Sciences Centre (LHSC) to create pathways for TVFHT patients to attend trauma group programming at WGH, and for LHSC to refer patients to TVFHT’s trauma groups. 

The pilot Collaborative Care Model, which aims to improve access to mental health and addictions support at three TVFHT sites, continued and received a grant from the Academic Medical Organization of Southwestern Ontario Innovation Fund supporting two years of outcomes-focused evaluation. 

TVFHT also increased uptake of Noojimo Health, a culturally safe virtual Indigenous counselling and mental health support service, among its patients. This was done through universal screening questions at mental health intake, and raised awareness of the partnership among affiliate physicians. TVFHT staff participated in an in-person Indigenous Cultural Safety Training workshop, and received micro-trainings throughout the year on topics including anti-Black racism and food security, led by the Health Equity and Cultural Safety Committee. 

From RN prescribing to trauma-informed groups to culturally safe mental health support, clinical and program work over the last year share a common thread: meeting patients where they are, with the right provider, program, or partner for their needs. It is how TVFHT strengthened care while expanding what is possible for the future.