The Canadian Health Care system is viewed by many to be in a state of crisis. One area of stress involves timely access to primary health care. The CMAJ, (Canadian Medical Association Journal), published a commentary by Tara Kiran that proposes steps that can be taken to ensure access to primary care in Canada. The article is written around several key points.
Larger family physician workforce needed if primary care is not changed
Interprofessional team-based care to improve primary care
Payment reform to improve access, outcomes, provider well-being
Neighbourhood-based clinics that employ physicians accountable to the local population
Regionally organized after-hours care to obviate the need for walk-in clinics
Canada’s health systems needs to reimagine how family doctors work and are integrated into the system. All family physicians should work collaboratively in teams that include skilled office assistants and nurses, nurse practitioners, social workers and pharmacists. Team-based care is better for patients, clinicians and the system. Our research in Ontario found that patients of team-based practices were more likely to get recommended chronic condition care and less likely to use the emergency department. Sharing the care in a team can also enhance joy in work for clinicians and, when done right, could increase the number of patients a family physician can care for. Similar primary-care workforce challenges have led thought leaders in the United States and United Kingdom to call for expansion of interprofessional teams as part of the solution. A recent survey of family physicians in British Columbia found that physicians ranked options to be in a team and direct funding for team roles as priorities for primary care reform. Team members with different expertise are especially critical as patient complexity and disease comorbidity trend upward. (Kiran, 2022)
The Nova Scotia Health Authority provides health services to Nova Scotians and some specialized services to Maritimers and Atlantic Canadians. It operates hospitals, health centres and community-based programs across the province. The team of health professionals includes employees, doctors, researchers, learners and volunteers that provide the health care or services, including primary health care.
You may have heard discussion of family practice teams. This is an approach where not all of your primary care comes from your doctor. Instead, your doctor is part of a team that could include a nurse practitioner, family practice nurse, social worker, dietitian, physiotherapist, or a range of other health professionals.
As a patient of a family practice team, you can get support from the person with the right skills to meet your needs. And with several professionals available to support patients, a team can take on more patients and provide quicker access.
As we work to attract and hire new doctors, we’re hearing from them that working in a team matches what they want to do—working and learning from colleagues, spending time with the patients who need them most, and drawing on the different skills of others to provide the best support to keep patients well.
There are a number of these teams already in the province, and we are working to create more, by adding nurses and other health care providers to existing family practices to work with doctors. Following this team-based approach will help Nova Scotians see the benefits that people in other parts of Canada and around the world are enjoying, including better care for patients, more satisfaction for providers, and improved overall quality and functioning of the whole health care system. (About Primary Health Care, n.d.)
Marsha Lederman and the Editorial Board of the Globe and Mail comments that Ottawa should say no to the request from the provinces for a blank cheque.
In that light, Ottawa’s position that ties new funding to a national health data system makes sense. So does its push for goals in key areas of reform, including family health and long-term care. Such a system need not be run by Ottawa. The Canadian Institute for Health Information could administer the data system, avoiding any intimation that the provinces require the supervision of the federal Liberals. (Lederman, 2022)
The continued support for provincial health care budgets by the federal government is essential. The citizens of Canada deserve clear plans to use these funds to increase access to primary care by transformation to community based interprofessional health care teams.
References
About Primary Health Care. (n.d.). Nova Scotia Health Authority. Retrieved December 14, 2022, from https://www.nshealth.ca/about-primary-health-care
Kiran, T. (2022, December 12). Keeping the front door open: ensuring access to primary care for all in Canada. CMAJ. Retrieved December 13, 2022, from https://www.cmaj.ca/content/194/48/E1655
Lederman, M. (2022, December 14). Globe editorial: Provinces want a blank cheque for health care. Ottawa should say no. The Globe and Mail. Retrieved December 14, 2022, from https://www.theglobeandmail.com/opinion/editorials/article-provinces-want-a-blank-cheque-for-health-care-ottawa-should-say-no/
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