Improving access to primary health care priority for NSHA

Total number of doctors in the province has grown by 100 since 2012

While most Nova Scotians have access to a primary health care provider, such as a family doctor or nurse practitioner, there are some individuals who do not. We are working to change that. There are also some people who have a family doctor but wait too long to be seen. We are trying to change that too. This work is complex.

Let’s start with what we know. Doctors are a valued resource in our health system. In Nova Scotia, we have more doctors per person than many other jurisdictions in Canada. In fact, the total number of doctors in the province has grown by 100 since 2012 and we are committed to replacing every outgoing physician as they leave. Since April 1, 2015, more than 170 doctors have started working in Nova Scotia. This includes more than 70 family doctors.

So, if we have more doctors here than ever before, why is it so hard for some people to get one?

That’s the reason primary health care planning is so challenging. It’s not just about numbers. It’s about having the right type of care providers in the right places, delivering the right type of care based on the needs of the population.

The Nova Scotia Health Authority (NSHA) and the Department of Health and Wellness have been working together to help more Nova Scotians get the care they need. The best evidence available says that this is achieved with teams of health care providers working in a collaborative environment. This model not only gives people better access, but also improves health, which is our ultimate goal for Nova Scotians.

In this team-based approach to care, people have access to a family doctor, but may also see another health care professional such as a nurse practitioner, dietitian or mental health worker. Care is coordinated and all health providers have access to the patient’s information.

There are more than 40 of these teams in various stages of development in Nova Scotia, with plans for more. We are in the process of hiring more than 20 nurse practitioners and family practice nurses that will enhance access for up to 14,000 Nova Scotians. Many physicians are interested in this team approach; in fact 45 practices from across the province expressed an interest to work with the new practitioners who are being hired.

Recruitment: A Delicate Balance Recruitment is a shared responsibility between physicians, the health authority, government and communities. It is an ongoing priority to fill all vacant positions across the province. We compete internationally for these resources. Our four recruitment co-ordinators work with Dalhousie Medical School residents and the Family Medicine Residency Program. They attend recruitment fairs across Canada and connect doctors with provincial incentives like return-for-service agreements in rural areas.

With changes to the way we recognize international medical expertise, Nova Scotia is more attractive than ever before to doctors from the United Kingdom, and we have stepped up our promotion there as part of a targeted provincial recruitment strategy. We are seeing an increase in traffic to our recruitment website.

We know that a key element of success for recruitment and retention is the practice model. New graduating doctors want collaborative practices, mentorship and team environments. The days of the large solo practices are behind us. As doctors retire from these practices, it has become more and more difficult to fill these gaps.

Nova Scotia Health Authority leverages provincial incentives to recruit doctors to the areas where they are needed — these incentives work. We also work closely with the Dalhousie Family Residency Program where, in rural areas, 90 per cent of residents who train in a community stay there and practice. We know from them that community support is crucial.

We have the most success in places where we partner with communities to create a welcoming environment, where new doctors and their families can build a life. These doctors are attracted to the team-based practice, the mentorship opportunities, and the support and engagement of the local community.

The importance of data to guide decision making Through our new provincial registry, we have better information than ever before about Nova Scotians who need a family practice. We encourage anyone who does not have a primary care provider to call 811 or visit needafamilypractice.nshealth.ca to add their name to this list. This will allow us to better match doctors and other care providers to areas where they are needed the most.

While there are challenges, Nova Scotia Health Authority is making changes that will improve health care for Nova Scotians. This means making strategic decisions when recruiting and replacing doctors to serve the greatest number of people. It means choosing models that we know will work based on evidence. We are building practices with the support and partnership of local communities, such as the one in Digby, that will enhance access promote better outcomes for patients there and in surrounding areas, like Weymouth.

Nova Scotians should have access to a primary health care provider. We’re working hard to close the gap. We are focused on recruiting and retaining the health professionals in the areas of greatest need today, and creating a model that will improve access to care for all Nova Scotians into the future.

Janet Knox is the president and CEO of the Nova Scotia Health Authority, which operates hospitals, health centres and community-based programs across the province, providing health services to Nova Scotians and a wide array of specialized services to Maritimers and Atlantic Canadians.