The move towards oversight through accountability was accompanied by a novel governance structure (see Fig

The arrival of governance and integration

2 ) that had, at least in part, its origins in what might be mistaken for Frontier Era policy generation. A physician leader described generating a rough draft of what would become the governance structure.

And [the zonal committees are] looking at it from the perspective of some very specific populations

on a paper napkin for the deputy minister [of AH] in a cafeteria [and then turning it] into something concrete and then, socializing [it] and getting it ratified and voted on and accepted. (P6)

Sold as being a combination of integrative co-planning and a representative voice locally and provincially, the governance structure that was once merely a paper napkin attained more than 80% support from the 3800 family physician members of the PCNs in 2017. It created a structure in which AHS and the PCNs would co-plan their service delivery. The new governance structure includes a Provincial level PCN Committee – providing governance, leadership and strategic priorities – and five Zone level PCN Committees. The MoH, AHS, PCN physician leads, and a non-voting AMA representative are members of the Provincial PCN Committee. The sub committees are positioned at the AHS zone level, and so representatives from PCNs within each of the 5 AHS zones are now regularly drawn together with AHS personnel and community members to plan.

For their part, the cross-cultural meetings of Zone PCN Service Planning committees that bring together primary care and health system personnel, are, in their infancy. As one participant noted:

They’re just in the initial phases right now of starting to look at [co-planning].