May 21, 2024

“A national solution is necessary to ensure Ontarians, and Canadians, can connect to publicly funded health care services, including primary care, no matter where they live.”

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Ontario’s health minister is calling on the federal government to take action to stop the “disturbing rise of clinics charging patients for access to primary care” in her province and others.

In a letter to federal Health Minister Mark Holland, Ontario Health Minister Sylvia Jones said continuing to allow nurse practitioners and other “non-physician providers” to operate fee-charging primary clinics would undermine the expansion of publicly funded primary care across the province.

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That request by the province is being dismissed by a leading Ontario nursing organization as a stalling tactic.

Nurse practitioner clinics that charge fees for access to primary care have been popping up around the province in recent months, including in Ottawa. Nursing officials say they are a response to the demand for primary care at a time when 2.3 million Ontarians are without family doctors and there is a shortage of publicly funded jobs for nurse practitioners.

Nurse practitioners can perform the same standard primary-care tasks as family doctors. But, unlike doctors, they cannot bill under OHIP for their services. There are around 25 nurse practitioner-led clinics in Ontario funded under the public health system.

Jones acknowledged that Ontario and other provinces had tools at their disposal that could “put this practice to an end,” but she argued that might lead to nurse practitioners leaving Ontario to work in other provinces.

“A national solution is necessary to ensure Ontarians, and Canadians, can connect to publicly funded health care services, including primary care, no matter where they live,” Jones said.

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The provincial health minister’s appeal to the federal government to fix the growing issue is being characterized by the head of the professional organization that represents registered nurses and nurse practitioners in Ontario as an attempt to buy time rather than taking direct action.

“They don’t need a national solution. They don’t need the feds to tell them what to do. The key issue is there is inadequate funding for nurse practitioners,” said Doris Grinspun, CEO of the Registered Nurses Association of Ontario, the professional organization representing nurses and nurse practitioners in the province.

Grinspun said the RNAO wants the province to provide $15 million in a separate fund to support nurse practitioner clinics in Ontario, similar to the way midwives are funded. It would allow nurse practitioners to work independently and to set up clinics without charging fees, she said. A spokesperson for Jones said they were not aware of the proposal.

“We have many nurse practitioners who are ready and eager to serve.”

Doris Grinspun Registered Nurses Association of Ontario
Doris Grinspun, CEO of the Registered Nurses Association of Ontario. Photo by Sabrina Bedford /Postmedia

Grinspun said that $15 million would save the province money by ensuring more people had access to comprehensive primary care, which includes preventative care that could reduce emergency department visits and more serious health issues in patients.

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She said most of the clinics with user fees that had opened recently in Ontario were responding to the “utter desperation” of people without family doctors.

“If we want to serve the public, the time is now to put the money on the table. They should be given money under the umbrella of the public health system,” Grinspun said.

In response to Jones letter earlier this week, a spokesperson for Holland said the federal minister would soon address the issue in the form of a Canada Health Act interpretation letter.

“This letter will clarify the application of the Canada Health Act on the modernization and improvements in health care, including virtual care, telemedicine and the expansion of the scopes of practice of health workers, such as nurse practitioners,” spokesperson Christopher Aoun said.

“This will help make sure that, no matter where in the country they live or how they receive medically necessary care, Canadians must be able to access these services without having to pay out of pocket. We have been working closely with the provinces and territories throughout the process of drafting this letter.”

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It remains unclear how or whether that would allow nurse practitioners to be funded under the health system, but Perry Brodkin, a former lawyer with the Ontario Health Insurance Plan, said nurse practitioners would not be able to bill OHIP unless Ontario laws were amended.

“The interpretation letter serves no purpose,” Brodkin said.

Jones’ office has said in the past it would crack down on bad actors charging fees for primary care, but it remains unclear whether investigations, or actions, have been taken.

Jones, meanwhile, said the province recognized and valued the role that nurse practitioners played in many places in the health-care system, including hospitals, primary-care clinics and long-term care homes. She said Ontario recently made the largest investment in expanding inter-professional primary care teams in the province’s history.

“Continuing to allow non-physician providers to operate in fee-charging primary-care clinics will undermine our public investment in these new teams and our expansion of publicly funded primary care across the province,” Jones wrote.

“Canadians expect all levels of government to work together and should have faith that they can access publicly funded primary-care services when and where they need them, for years to come, no matter where they live.”

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