On Wednesday, Doctors Nova Scotia, the professional association that represents all of the province’s physicians, released its position paper, including 11 major recommendations, on fixing the primary health-care problem in Nova Scotia.
In its introduction, the paper stated: “It is not possible or feasible for every service to be available in every community; however, every Nova Scotian should be able to access a primary health-care team that includes a family physician. Today, this is not the case in our province.”
It went on to suggest that the primary health-care system needs to be restructured: “Attempts have been made in the past to improve access to services, but barriers to providing the best possible care to patients remain.”
Cape Breton family physician Dr. Monika Dutt, a member of the DNS Policy and Health Issues Committee that provided the concepts behind the document, said the position paper and its recommendations are the results of a desire by Nova Scotia doctors to have a collective voice in the process of change.
“Doctors Nova Scotia wanted to have something on paper to be part of the discussion that is happening right now and there is a lot of discussion around how to reform primary care and make it better,” said Dutt, who recently took on new duties as the executive director of Upstream, a movement dedicated to creating a healthy society through evidence-based, people-centred ideas.
“We just want to put something out there to show that we are interested, we want to be involved, here are some thoughts, so it seems like a good time as the province and the health authority are looking at a lot of these issues.”
The DNS recommendations are based on the feedback provided by the organization’s Policy and Health Issues Committee, the General Practitioners Council, family physicians, and the study of primary care models in other provinces.
The DNS recommends:
• That physicians be given the opportunity to choose what type of practice they want to work in and develop.
• That the Department of Health and Wellness (DHW) and the Nova Scotia Health Authority (NSHA) implement patient rostering as part of a new payment model for primary care.
• That the DHW and NSHA work with DNS to develop a new blended-payment model to better support patient care, fair compensation and good stewardship of public funds.
• That the DHW ensure that compensation is not a disincentive for physicians to provide non-face-to-face services, and that physicians leverage opportunities to provide non-face-to-face services in their practices.
• That the DHW and NSHA support family physicians in implementing same-day/next-day access in their practices, and that physicians use this support to improve access for their patients where appropriate.
• That the DHW, NSHA, physician recruiters and Dalhousie Medical School work with DNS to develop a recruitment and retention strategy.
• That the DHW, NSHA, physicians and other providers develop creative and flexible solutions that produce timely results for patients.
• That walk-in clinics be maintained during the transition to a better primary health-care system.
• That alternative payment plans (APPs) be maintained during the transition to a new primary health-care system with opportunities to evolve to a blended payment model mechanism.
• That the DHW, NSHA and IWK prioritize and invest in the development of a secure electronic health record that is accessible to all healthcare providers.
• That the DHW, the NSHA and the IWK engage physicians in transforming the primary care system in Nova Scotia.
Dutt, who will continue her family practice on a one day per week basis, said the recommendations reflect the concerns of Cape Breton residents.
“The access to primary care is a big topic of conversation in Cape Breton,” she said.
“Cape Bretoners talk about the need of having a family doctor, some have them, some don’t, and this paper is in support of everyone having access to a primary care health team that includes a family physician.”
In acknowledging that access to a family doctor is a critical component of a primary care system, the DNS paper notes that while Nova Scotia has the highest physician-to-patient ratio in the country (260 physicians per 100,000 people as of 2014), “the distribution (by specialty and geography) of these physicians remains unbalanced.”
There are an estimated 90,000 Nova Scotians without a family doctor. The province’s physician resource plan recently identified the need to recruit 512 full-time family doctors over the next 10 years. The plan suggests that 465 doctors presently practising will need to be replaced in addition to the need for about 50 new doctors.