FHO+: Agreements and forms

This is an update of a previous contract, which was last drafted in 2007.

The FHO contract (member-only access) binds physicians to the terms and conditions of participating in the FHO. The contract does this by requiring physicians to demonstrate that they will follow the terms and conditions by signing certain forms and other ancillary deliverables (e.g. governance documents, consents, and certificates). The FHO contract is a standard template that includes the same terms for all FHOs.

What’s new

This contract includes updates that spell out the terms of the new FHO+ model (such as the hourly rate and the accountability for continuity of care). It also includes historical updates that were agreed to and implemented in practice over the last 20 years via INFOBulletins but were never drafted into the FHO contract (such as new after-hours requirements or updates to the preventive care bonuses).

The OMA actively participated in the drafting and review of this updated contract. The final version presented for signature has been carefully reviewed and is endorsed by the OMA. FHO leads should have full confidence in signing the new FHO contract.

Who needs to sign

The FHO contract must be signed by the FHO lead, OMA and the MOH, in that order. The FHO lead is signing on behalf of all individual physicians in the FHO.

When it needs to be signed by

FHO leads must sign it by March 31, 2026. The OMA and the MOH also need to sign it on or before April 1, 2026.

Consequences if it is not signed

If the FHO contract is not signed by March 31, 2026, there could be serious implications for the FHO. Although actual implications remain to be seen, it is possible that the group could lose its FHO status. Without a valid FHO contract in place, a group is technically not under the FHO model until its Lead signs. At a minimum, the ministry would not be bound to pay physicians within the FHO group according to the terms of the model until it is signed.   

There is no option to operate under the old 2007 contract. That contract expires on March 31, 2026.

How FHO leads will receive the contract

The FHO contract will be sent by MOH to the FHO leads using the email address that the MOH has on file. Advance emails will be sent to FHO leads with resources and instructions from BMUModelsReporting@ontario.ca. The actual FHO contract will come from “OpenText Core Signature (Powered by OpenText™ Core Signature) no-reply@ontario.ca”.  

This form is essentially a short contract opting the signing physician into the FHO contract. It states that the physician agrees to be bound by the terms of the FHO contract, including service obligations and payment rules. It is how each individual physician is formally linked to the FHO group. Think of it as the equivalent of an individual FHO physician signing the FHO contract directly.

What’s new

The FHO physician declaration is largely the same as before, but it now includes an attestation that the FHO physician will:

• Support the FHO in responding to administrative requests from patients during regular business hours (for example, by email, text, phone, or a mix of these)
• Support the FHO in providing patients with appropriate care access that meets their needs, including after-hours coverage
• Not send patients to the Emergency Department – during regular hours or required after-hours – for issues that a FHO physician can appropriately assess
• Make reasonable efforts to arrange appropriate clinical coverage when away from the practice, which may include coverage by other physicians in the FHO

Who needs to sign

All individual physicians in the FHO, including the FHO lead, must each sign a FHO physician declaration. Locums do not sign a FHO physician declaration. The FHO lead must also co-sign each physician declaration.

When it needs to be signed by

All individual FHO physician declarations must be signed within 90 days of the FHO contract being signed. In other words, they must be signed by June 30, 2026.

Consequences if it is not signed

If a physician does not sign the declaration (and does not intend to), there could be serious implications for participating in the FHO, including payment impacts and potential expulsion from the group. The declaration is essentially a contract tying the individual physician to the FHO contract and to abiding by other important terms within it, such as governance obligations. While actual implications remain to be seen, it is possible that the individual’s status in the FHO would be in jeopardy. Not signing could also have implications for the FHO as a group.

There is no option to continue to operate under the existing declaration. That declaration expires on March 31, 2026, along with the 2007 FHO contract.

How FHO physicians will receive the declaration

FHO leads and associate leads will be provided with a fillable PDF by the ministry via email.

FHO leads are responsible for distributing the FHO physician declaration to all FHO members and collecting signed copies. FHO leads are then responsible for providing digitally signed copies (e.g. scanned documents) of each declaration to the ministry. They should be sent to the ministry in a single batch.

This states that the locum (the contracted physician) agrees to be bound by the terms of the FHO contract. It also registers the locum to the FHO.

For the signatory physician, having the locum registered to the FHO is important because it means that in-basket services they provide to rostered patients will contribute positively to the signatory physician’s continuity of care measure. If the locum is not registered to the FHO, then these services would actually count against the signatory physician’s continuity of care.

For the locum physician, being registered to the FHO entitles them to hourly payments and various premiums.

Note that locums with pre-existing terms do not need to submit a fresh declaration. A declaration is only required for locums who start after April 1, 2026.

What’s new

The FHO contracted physician declaration is largely the same as before, but it now includes an attestation that the locum will:

• Support the FHO in responding to administrative requests from patients during regular business hours (for example, by email, text, phone, or a mix of these)
• Support the FHO in providing patients with appropriate care access that meets their needs, including after-hours coverage
• Not send patients to the Emergency Department – during regular hours or required after-hours – for issues that a FHO physician can appropriately assess
• Make reasonable efforts to arrange appropriate clinical coverage when away from the practice, which may include coverage by other physicians in the FHO

Who needs to sign

It must be signed by all locums contracted to the FHO. The FHO lead must also co-sign each contracted physician declaration.

When it needs to be signed by

Locums who started prior to April 1, 2026, will not need to resubmit their paperwork.

Locums who start on or after that do need to submit the form.

Consequences if it is not signed

If a locum does not sign the declaration, they will not be attached to the FHO. In the eyes of the MOH, hourly payments and premiums are not applicable. Importantly, if they are providing in-basket services to rostered patients, then this work will count against the enrolling physician for continuity of care.

How FHO contracted physicians will receive the declaration form

The locum will receive the declaration form from the signatory physician hiring them.

The governance agreement specifies how the FHO is organized and how decisions are made within the FHO. It outlines how physicians within the FHO will implement the governance requirements set out in the FHO contract. For example:

• The processes for admitting new physicians to the group and withdrawals of existing members
• A process for determining after-hours and on-call service by the physicians
• The selection of FHO lead(s) and associate lead(s)

What’s new

The core governance requirements have not changed in the updated FHO contract. However, given the number of changes to payments in the new FHO+ model, each FHO group is advised to review their governance agreement closely to evaluate whether it needs to be updated. OMA Legal is preparing a checklist to assist in this evaluation and will also have a template agreement that FHOs may want to rely on if and when they determine they need to update their original governance agreement.

Who needs to sign

It must be signed by all individual physicians in the FHO, excluding locums.

When it needs to be signed by

It depends. The requirement for a governance agreement is a carryover from the 2007 agreement. Therefore, all FHOs are already required to have a governance agreement in place.

If a FHO determines that they need to update their agreement due to the changes in the FHO contract (or for any other reason), the group will have one year from April 1, 2026 to execute the agreement and file the certificate attesting to its completion.

Consequences if it is not signed

All FHO physicians are required to sign a governance agreement. The group must certify that all members have signed it, and each physician also confirms this in their physician declaration. Not signing it would be a breach of your obligations under the physician declaration agreement.

How FHO physicians will receive the agreement

The governance agreement is an internal agreement between group members. The FHO should already have one in place. To access a copy of the agreement, speak to your FHO lead.