NPs in primary care: The innovation we need

Attention has been focused recently on an Ottawa primary care clinic charging a $400 fee – plus a per visit fee – for access to health care. There’s another such clinic in Toronto that promises “all access health care” that comes to you for $1200 + HST. It’s located in Yorkville, convenient for those who can afford to pay such fees. It hasn’t attracted the same attention as the Ottawa clinic – which the government has promised to investigate – but is the product of the same problem: access to primary care. 

The clinical director of the Ottawa clinic tells us that 10,000 people have signed up, ready and willing to pay $400 – and then some – for access to care. It’s no wonder. Recent research tells us that 2 million people in Ontario do not have a primary care provider. In addition, Health Quality Ontario tells us that only one-third of Ontarians have timely access to primary care when they’re sick. It’s one obvious reason that hospital emergency rooms are overwhelmed – the ER is where the vast majority of people have to go when they’re sick. 

What isn’t obvious is why the Ontario government allows this to persist. There’s a solution to Ontario’s access problem – a really good one – that’s staring this government in the face: the publicly-funded nurse practitioner (NP). It’s no coincidence that the Ottawa and Toronto clinics mentioned above are charging for access to NP care. NPs are advanced practice nurses with master’s level clinical education and specialized licensing with the regulatory college for nurses. Given their expertise, advanced education and expanded scope, they have been begging this government for years to put in place public funding models to let them practise independently in
primary care settings. 

To improve health equity and increase access to care, the NP role was established in Ontario in 1997. Over the years, NPs have been deployed in clinical settings across the health system – from hospital settings to nursing homes – with great success. In 2007, the first NP-led clinic (NPCL) in Canada opened its doors in Sudbury. It was an example of innovation in primary care. NPLCs are publicly funded and led by NPs working with an interprofessional health team. Twenty-six of these clinics were established in 2007-2008 – and not a single one since, in spite of the wonderful, holistic approach to care that is the hallmark of NP practice.

For some time now, the government has made vague promises about establishing more NPLCs in the province. Even in the absence of a formalized process, NPs from across the province have submitted applications to the Ministry of Health, investing their own time, energy and resources to demonstrate the desperate need, the value and the potential of NPLCs in their communities. As family physicians continue to quit and retire across the province and waiting lists for care continue to grow, the government still isn’t moving.

More recently, the government solicited expressions of interest for funding innovative models of care. Again, NPs came forward with innovative, practical proposals, responsive to the primary care needs of their communities. Some expressions of interest point to the need for NPLCs based in marginalized populations such as First Nations. Others highlight the need for mobile clinics for dispersed communities that have a history with the health system that is rooted in trauma. Still, no response from the government as the waiting lists continue to grow. 

What is clear is that NPs, deeply rooted in and committed to their communities, have answers to the government’s calls for innovation. Indeed, they are the answer. They have the education, skills and ambition to wrestle Ontario’s primary care crisis to the ground and respond to the primary care needs of all of us who live in this province. There are 10,000 people on the list for privatized health care at an Ottawa clinic because there has been no new funding for NPs in primary care, and no new funding models for NPs in primary care, since 2007. Enough talk of innovation in health care. Let’s “do” innovation and fund NPs to provide primary care.