Teams are key to family-care crisis

·5 min read

When Eastern Health announced a new collaborative care clinic for St. John’s in June 2020, everyone seemed to breathe a sigh of relief.

Health Minister Dr. John Haggie was happy, the Newfoundland and Labrador Medical Association (NLMA) was happy, nurse practitioners were happy.

More importantly, patients were happy.

Here was a shining example of what could be done to help patients who didn’t have a family doctor, at least in the short term.

A lot has happened since then.

“We used to say we’re the clinic for people without family care providers, but we are sort of packed to the gills like everybody else is nowadays,” Margot Antle, one of two full-time nurse practitioners at the Churchill Square clinic, said Aug. 3.

“We’ve got just about 3,000 patients rostered at the clinic … and we have 2,000 people on our wait list.”

Don’t bother calling if you’re looking for primary care. They aren’t even taking names for the waiting list.

Antle is president of the Newfoundland and Labrador Nurse Practitioners’ Association (NLNPA), which advocates for the approximately 230 nurse practitioners in the province.

Apart from the two full-time staff, the clinic runs with the help of physicians and nurse practitioners who work part time for various stints. Many of them already work full time elsewhere.

But Antle says the team hopes to take names again soon.

“We’re hoping to be able to open up the wait list again in the next couple of months, because the plan is we do have approval for some extra positions — two more permanent nurse practitioners and three permanent physicians.”

Antle believes the solution to a crisis in primary care in the province is to encourage more creative solutions.

“I really do have very bright views on the Health Accord talks,” she said, referring to an arm’s-length task force charged with completely re-envisioning the province’s system. “The NLNPA has been a part of that as one of the key stakeholders, as has the NLMA and the nurses’ union and a bunch of other people.”

The province needs to be more proactive, Antle said.

“It’s great to look at the 10-year goal, but we are in a dire situation right now,” she said.

“I think there’s probably a lot of out-of-the-box solutions that are just not being explored.”

One of those might be showing flexibility with the current MCP fee structure to allow nurse practitioners to avail of it.

“Right now, the only way a member of the public can access a nurse practitioner on the public purse is if that nurse practitioner is being paid by a health authority or if they are in a facility, for example, in long-term care and hospitals,” she said.

“It’s a huge, huge barrier to accessing primary health care services.”

One possibility is to allow nurse practitioners to fill in as locums for family doctors, she said, especially since their roles have become almost synonymous in the current climate.

“A family physician could have a break, even if they knew they could have two weeks off during the summer to recharge.”

Haggie said Aug. 3 he agrees the system has to change fast.

“The challenge at the moment is moving from a system of providing care and funding care that is really locked into the 1950s and ‘60s to a new one at a time when we have all the fiscal challenges that we do at the moment,” Haggie said in an interview.

But change has to involve more than just tweaking the fee system, he said.

“Everyone’s agreed that fee for service does not work for primary care.”

As well as embracing team-based care, Haggie says he’s also on board with allowing other health-care professionals such as pharmacists more latitude to exercise their scope of practice, adding that he’s waiting on a joint paper from the pharmacy board that got sidetracked by the COVID-19 pandemic.

“My druthers, if I had my way, would be that primary-care services would be shared amongst a whole variety of providers,” he said.

“We’ve done it with optometrists very recently. We expanded their scope to follow people with glaucoma, to examine for minor eye irritants, to prescribe for pink eye, this kind of thing.”

Haggie also said the responsibility for recruitment and retention is slowly starting to shift.

“In the past, the recruitment piece for office-based family medicine has been left to the offices themselves, and they haven’t had the connections to do that as well,” he said.

“I do take the point that we need to do recruitment differently. One of the things that’s made a big difference, particularly in my own district, is where communities themselves at the municipal level have gotten involved. You’d be amazed at the long-term effect that a small welcome basket for a new family coming from somewhere else has.”

He said the Department of Health has a role play, but it can’t do it all.

“At the end of the day, family medicine, or surgery as I did, is what it is. It’s where you go home to live at night, it’s where you spend your weekends that matter,” he said.

“Money may be an attracter to some, but it’s not a retainer.”

Meanwhile, Antle was clear when asked if more care teams would help.

“I hope so. I hope so. By my count … we need at least 10 collaborative team clinics provincially,” she said.

“We have to make some changes in the existing system that we have, or we’re just going to crumble.”

Peter Jackson, Local Journalism Initiative Reporter, The Telegram

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