May 21, 2024

New Brunswick has released its long-awaited primary health care action plan, which centres around creating incentives for health-care providers to join team-based practices under the Family Medicine New Brunswick model, which was launched in 2017 and has failed to grow as expected.

Under the model, family doctors work in a collaborative practice with nurses and other health professionals to provide a “medical home” for patients, with extended hours. If the doctor can’t see a patient quickly, the patient can opt to see another member of the team, all of whom have access to the patient’s electronic medical record.

The model was designed to improve and enhance access to primary care while improving the work-life balance of physicians.

But only 55 physicians have enrolled over the past five years — five per cent of the total workforce, with uptake “especially low” in francophone areas, according to the plan, made public Tuesday roughly eight months after it was quietly launched.

More than half of New Brunswick physicians, 55 per cent, continue to work in solo practices — the highest percentage in the country, the action plan says.

Incentives could see doctors reconsider model

Still, Health Minister Bruce Fitch believes the Family Medicine New Brunswick model is a good one, with innovative compensation and increased administrative support, and that the new incentives outlined in the plan for those willing to make the switch will help.

These include a 15 per cent increase in the rate physicians are paid based on the age and gender of each patient rostered to them, and a $15,000 annual stipend to hire a full-time registered nurse and/or a $10,000 annual stipend to hire a full-time licensed practical nurse.

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Health minister says new plan will work in tandem with regional health authorities

The province has released its primary health care action plan to the public, roughly eight months after it was quietly launched

The plan also offers up to $40,000 a year in overhead relief, depending on the number of patients who access care, and a new extended-hours premium, allowing physicians to bill a higher percentage of fee-for-service when working outside the hours of 7 a.m. to 6 p.m., and on weekends.

“I think some of these financial resources will maybe force people to go and look at that a second time and take advantage of what’s been there,” Fitch said.

He expects the required changes in fee structure to be implemented this fiscal, he told reporters, noting government officials will meet with members of the New Brunswick Medical Society this month.

Fitch did not provide any estimated costs, but the Department of Health has committed at least $10.3 million annually toward implementing the plan, deputy minister Eric Beaulieu told a legislative committee in February.

2 new governance authorities

The plan does not appear to have defined targets, despite noting that “primary health care is notorious for its lack of management, oversight, and clear governance.”

Two governance authorities will be created, however. Members of the health department, regional health authorities and Extra-Mural/Ambulance New Brunswick will form a “leadership and accountability table,” which will meet monthly to “find solutions and get results,” the plan says.

This will include identifying and tracking the data needed to inform decision-making. The province “hopes to publish” this data annually to update citizens on progress.

A closeup of the torso of a nurse working on a computer at a desk.
The plan calls for increasing the implementation of electronic medical records, with the goal of a single, interoperable system for practices across the province. (Radio-Canada)

A “health professionals and patient advisors table,” made up of representatives from primary health-care provider groups, as well as patient advocates, will meet quarterly to identify priorities for the leadership and accountability table.

Some of the other strategies designed to address systemic challenges include integrating other health professionals into the teams, such as nurse practitioners, pharmacists, dietitians, physiotherapists, and mental health counsellors.

In addition, the role of pharmacists will be expanded, allowing them to conduct medication reviews, treat more minor ailments and help manage chronic disease, the plan says.

Medical society seeks ‘joint plan’

The New Brunswick Medical Society, which had no formal role in developing the plan, commends the minister for releasing it, but thinks it falls short, according to president Dr. Paula Keating.

The professional association, which represents the more than 2,000 practising, future, and retired physicians in the province, “joins the regional health authorities and other health-care organizations from across the province in their calls for adequate funding to appropriately tackle our primary care challenges,” she said in an emailed statement.

“We all agree on direction” — physician-led team-based primary care — “but we need to accelerate our implementation.”

A woman wearing a pink shirt
Dr. Paula Keating, president of the New Brunswick Medical Society, said the province urgently needs to invest in the ‘stabilization of family medicine.’ (CBC)

As of April, more than 92,000 people are waiting for a family doctor, and more than 30,000 of them have no access to services, she said.

Meanwhile, family doctors continue to leave their practices, or choose not to take on patients, “in response to rapidly rising costs due to inflation and the impact of current government policies.”

“We need a joint plan, agreed upon by stakeholders, with defined targets and associated resources to ensure accountability to patients across this province,” said Keating.

Nurses union disappointed

The head of the New Brunswick Nurses Union is disappointed by the plan.

“Everything that I see on first blush really doesn’t speak to registered nurses or licensed practical nurses or nurse practitioners,” said Paula Doucet.

It also “misses the mark” on the crucial issue of retention, she said.

“They’re not retaining the experienced staff in this province and that needs to be addressed immediately if we’re going to move forward with safe patient care for New Brunswickers.”

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