June and early July 2026 brought a cluster of regulatory and policy changes that affect virtually every Ontario physician practice. eReferral has crossed from optional into mandatory. Two CPSO policies were updated with specific new obligations. Lung cancer screening eligibility expanded to younger high-risk adults. And ER overcrowding has reached a new threshold across the province. This roundup covers each development and what it requires of your practice.
eReferral Is Now Mandatory Across Ontario
Ontario Health has confirmed that eReferral is now mandatory for all Ontario physicians making specialist referrals within the Ontario eServices program. Paper-based referrals are no longer an accepted alternative for services where an eReferral pathway exists.
The change is significant in scale: more than 4.3 million referrals are processed annually across Ontario’s health system. Centralizing this volume through a digital pathway is intended to reduce lost referrals, eliminate duplicate submissions, and give referring physicians visibility into where their patients are in the specialist queue. For patients, particularly those with multiple complex conditions requiring referrals to several specialists, the system creates a single trackable record rather than a patchwork of faxed documents.
For most Ontario physicians, the practical question is not whether to use eReferral but whether your current workflow is set up to use it efficiently. If your practice has been using eReferral for some years, the mandatory status formalizes what you were already doing. If your practice has been relying on fax-based or paper referrals for some specialties or geographies, you need to address that gap now.
The most common operational challenges practices encounter during the transition include: staff who are unfamiliar with the platform or have not been trained recently, specialist recipients who are not yet fully configured in the system, and referral workflows that were built around paper and have not been redesigned for digital submission. Each of these is solvable, but each requires deliberate attention rather than the assumption that it will sort itself out.
If you practice in a region or specialty where eReferral coverage is incomplete, that is not a reason to delay. Contact Ontario Health’s eServices support to understand the current state of eReferral connectivity for your most common referral destinations, and document the gap in case you need to demonstrate a good-faith effort to comply.
CPSO Prescribing Drugs Policy: Three New Provisions Effective June 2
The CPSO’s Prescribing Drugs policy was updated effective June 2, 2026. Three new provisions were added specifically to the safer supply section of the policy, with direct implications for physicians managing patients with opioid use disorder or prescribing controlled substances in that context.
The first new provision requires an in-person assessment before initiating a safer supply prescription. The policy previously allowed more flexibility in how the initial assessment was conducted. Under the updated language, physicians must conduct a face-to-face clinical encounter before writing a first safer supply prescription for a patient. Remote assessment alone is not sufficient for the initiating encounter.
The second new provision requires that physicians offer opioid agonist therapy before or alongside safer supply. Where OAT is clinically appropriate, the policy now requires that it be actively offered and the patient’s response documented, not simply noted as an option that exists. If the patient declines OAT, the physician’s records should reflect the discussion and the patient’s stated reasons.
The third new provision requires in-person reassessment of patients receiving safer supply at a minimum of every three months. This is a standing obligation that applies for as long as the prescription is maintained. Telephone or virtual reassessments do not satisfy this requirement.
These provisions reflect the CPSO’s response to ongoing public and regulatory concern about safer supply programs. They do not prohibit safer supply prescribing. They impose structure on the clinical and documentation process that surrounds it. Physicians currently managing patients on safer supply should review their patient panels and their documentation practices against these three requirements. Practices that have been operating with less frequent in-person contact will need to restructure their follow-up schedules.
CPSO Delegation of Controlled Acts: Two Key Changes Effective June 2
The CPSO’s Delegation of Controlled Acts policy also took effect on June 2, 2026 with two substantive changes that affect how physicians manage delegation timing and hospital-based care.
The first change involves the two-business-day clock. Under the previous policy, the two-business-day window within which a physician must initiate a controlled act after delegating it ran from the first clinical encounter with the patient. Under the updated policy, the clock starts from the moment the controlled act itself is initiated, not the first encounter. This distinction matters in clinical settings where there is a gap between when a patient is seen and when a delegated procedure actually begins. Physicians need to ensure their delegation records reflect this revised starting point.
The second change broadens the hospital setting exception. Previously, the exception that allowed delegated controlled acts to proceed differently in emergency department contexts applied only to the emergency department. The updated policy extends that exception to all hospital settings. This provides more flexibility for in-hospital care across wards and units, not only the ED, which removes a significant source of administrative friction in hospital-based physician practice.
If you delegate controlled acts, review your delegation protocols and documentation templates in light of these two changes. If your practice operates across both community and hospital settings, make sure the staff involved in delegation understand that the hospital exception now applies to all hospital settings.
Lung Cancer Screening Now Available for High-Risk Adults 18 and Over
The Ontario Lung Cancer Screening Program expanded eligibility in June 2026. Low-dose CT screening is now available to high-risk adults aged 18 and over who meet the clinical criteria, which include smoking history and other identified risk factors. Previously, the program had an age floor of 55 for high-risk screening.
This expansion means the eligible population for lung cancer screening referrals from primary care is meaningfully larger than it was six months ago. If you have patients in the 18-to-54 age range with significant smoking histories or other risk factors, review whether they meet the updated eligibility criteria and document that review. Early detection of lung cancer has a substantial impact on outcomes, and the program expansion creates a new referral pathway that did not exist before.
ER Overcrowding and the Windsor-Essex Context
ER wait times in Ontario reached a new threshold in the spring of 2026. More than 75% of Ontario emergency rooms are reporting overcrowding, defined as hospital occupancy at or above 100% of funded capacity. The OMA has identified this as a systemic failure that requires structural intervention, not incremental improvement.
In Windsor-Essex specifically, Windsor Regional Hospital is managing significant infrastructure pressure alongside a major capital expansion. Construction on the Fancsy Family Hospital, a new acute care facility in north Windsor that will replace aging infrastructure, officially broke ground in June 2026. The project, supported by a $14 million government investment, is intended to address long-term capacity constraints in the region.
For physicians in the Windsor-Essex area, the ER overcrowding data is relevant context for patient conversations about urgent care access. It is also relevant for practices with hospital privileges who are managing admitted patients in stretched capacity environments. The systemic investment in Fancsy Family Hospital is a long-term solution; the pressures of the next 12 to 24 months require near-term operational planning at the practice level.
OMA Leadership: Physician-Led Interim CEO
The Ontario Medical Association announced a leadership transition in June 2026. Dr. Andrew Park, a practising Ontario physician and OMA Board member, has been appointed Interim CEO as the association conducts a search for permanent leadership. The decision to appoint a physician to the interim role rather than a professional administrator reflects a deliberate signal about the direction the OMA wants to project to its membership and to government.
The leadership transition coincides with a period of significant advocacy pressure on ER overcrowding, primary care funding, and physician wellness. The OMA’s positions on these issues are not expected to change. What may shift is the tone and tactical approach, given that a physician in the CEO seat brings a different credibility posture to government and media interactions than a career executive.
What You Should Do
The most time-sensitive items from this roundup are the CPSO policy compliance reviews. Both the Prescribing Drugs and Delegation of Controlled Acts policies took effect on June 2. If you have not reviewed your practice protocols against the new provisions, that review should happen this week. Document it.
For eReferral, audit your referral workflows and identify any remaining paper-based pathways. Address them before the end of July.
Check whether any of your patients aged 18 to 54 with significant smoking histories now qualify for the expanded lung cancer screening program. And if you practice in Windsor-Essex, the Fancsy groundbreaking is useful context for longer-term planning conversations with your team and patients.
How MAP Can Help
If CPSO compliance reviews or operational practice management are areas where your team needs support, MAP Healthcare Consulting and Management works with Ontario physician practices across our Risk and Compliance and Practice Operations service lines.