N.B. hopes multidisciplinary clinics in future of primary care, but no timeline yet

In the next few years, New Brunswickers seeking primary care may be able to schedule an appointment at a clinic. It’s unlikely they’ll see a general practitioner, as many have in the past, and even more unlikely they’ll see the same person each time they visit. Depending on their needs it may be a physician, a physiotherapist, psychologist, nurse practitioner or social worker who greets them.

That sort of multidisciplinary clinic is at the centre of the province’s vision for the future of primary care.

“It should be the goal in the future for patient care having an M.D. with collaborating colleagues who are taking care of a patient holistically, so looking after their physical health, mental health, all those things put together,” says Dr. Mark MacMillan, the president of the New Brunswick Medical Society.

The province’s five-year health plan calls for that sort of model to be up and running by April of next year, with all New Brunswickers, including those without access to a sole primary health-care provider, able to access primary care.

MacMillan says once properly set up, the model would reduce the burden on emergency rooms, which are often flooded with non-urgent cases as they deal with staffing shortages and ambulance offload delays.

“But right now those less-than-urgent patients, that’s all they have,” he said.

“They need to access health care somewhere and if they can’t get health care through either an e-visit or e-consult or 811, right now the ER is all they have left.”

But it looks unlikely the system envisioned will be up and running by the April deadline set out in the health plan. First, the foundations need to be laid.

The province’s health plan called for the doctor wait-list to be eliminated by the end of last week, replaced by the New Brunswick Primary Care Network “where anyone without a doctor or nurse practitioner in the province will be able to access a family doctor or nurse practitioner in a timely manner while they wait for a longer-term placement with a local community clinic or a primary care provider.”

That deadline was missed. The province has been piloting a program called NB Health Link in the Moncton region, where people on the Patient Connect list are given a temporary primary care provider until a more permanent solution can be found. But rather than setting up new clinics and hiring additional staff, that care is being provided by a combination of practitioners who have agreed to take on more patients and virtual appointments through E-Visit NB.

“We’ve got nurse practitioners and doctors that have agreed to take on extra clients and that is where the additional resource is coming available in order to take these patients on,” said Health Minister Bruce Fitch.

“It’s going to take a lot of work as we roll it out across the province but that pilot project is to make sure there’s no glitches and to see if it can be enhanced or improved.”

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According to the department, more than 50 per cent of the 10,357 contacted through the pilot project have now signed up and 35 per cent had already found a primary care provider. The department says 844 people have scheduled appointments through the program. The total number of people on the Patient Connect list was 74,000 as of August.

NB Health Link will roll out in the capital region sometime this month and Fitch says he expects it will be provincewide within the first six months of next year. That would be around nine months behind schedule.

Lack of primary care and the accompanying clogging of emergency rooms have led some to call for the immediate creation of clinics that can see patients without a family doctor. The Green Party has taken to calling them “urgent care clinics,” while Liberal Leader Susan Holt has called for multidisciplinary clinics to be set up as soon as possible.

The terminology may differ, but the idea is similar to that set out in the health plan. Fitch says the government has something in the works, but wouldn’t provide details of what that will be.

“As we move forward, items such as that are underway. Depending on what someone’s vision for what exactly that is, there could be announcements that satisfy that in the coming future,” he said.

Green Party health critic Megan Mitton is frustrated by the lack of details.

“I’d like to hear the minister of health and the premier explain, what is the hold-up? Why can’t we have urgent care centres to take pressure off of our ERs and why can’t we ensure that they’re available across the province?” she said.

“I want to see what their plan is around how many staff do they need?”

Premier Blaine Higgs says the multidisciplinary or clinic-based model is where the province is moving, but says setting up the clinics requires human resources and throwing some of the projected $135-million surplus at the issue won’t change the lack of available staff.

“It’s not financial resources to put up a building — we could put up a building with all the amenities in it — it’s getting the people to actually run it, that’s the challenge,” he said.

But Holt says the government needs to be creative with the resources it already has, even seeing the creation of the clinics as a potential recruitment draw. She and the premier have a meeting set for Thursday to talk about opportunities and ideas to improve the system and Holt plans to bring up the clinic idea.

“I know one of the concerns is where do we find the staff to move into these clinics, but we have a lot of single-family practices that could be combined, we have nurse practitioner clinics that could be leveraged, we have pharmacists and physios that are ready to practise in these team environments,” she said.

“What steps can we take to re-organize our current resources into the kind of delivery model that is more attractive to the people we are trying to recruit?”

MacMillan agrees that the chronic lack of staff in the system will get in the way of setting up the sorts of clinics envisioned by health-care professionals and politicians alike, but he says now is the time to stay laying the groundwork for them. That means a properly resourced and professional-led plan to take the NB Health Link program, which at its best is a loosely connected system of various health-care providers, and turn that into a holistic, patient-centred primary care system.

“We don’t need someone to come in and tell us what to do,” MacMillan said.

“They need to come to us as the health-care providers and say, ‘How do we set this up? What do you need?’ so that when we find more physicians and more nurses, this plan is ready to roll out, it’s ready to go and there’s no red tape stopping us from getting up and running.”

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