OPINION: Flexible funding models for nurse practitioners required to fill health care gaps

DRAYTON – Flexible funding models for nurse practitioners (NPs) are required to fill the gaps in health care.

With Nurse Practitioner Week upon us (Nov 12 to 18), there remains an ongoing perplexity as to why NPs are not being better utilized to meet the needs of patients in the Ontario Health Care system.

On Oct. 25, the Ontario College of Family Physicians “called on the Ontario government to take urgent action to support family doctors and improve patients’ access to care. 

The College’s latest forecast shows a troubling trend: approximately one in four Ontarians – that’s 4.4 million – will be without a family doctor by 2026.” 

At the same time, the Canadian Medical Association (CMA) advised “Physicians themselves are experiencing exhaustion, burnout and job dissatisfaction.” 

In a document entitled A Profession in Crisis: The survival of family medicine in Ontario, “65 per cent of respondents cited plans to leave office-based family practice or reduce their hours in the next five years.”

Furthermore the CMA states, “there aren’t enough family doctors to go around and that 90% of respondents said they’d be willing to see a nurse practitioner for most of their needs.”

NPs can independently assess, order tests, diagnose, prescribe and make referrals. This should prioritize them to provide support to our physician colleagues in addressing the overwhelming demand of Ontarians who do not have access to care.

According to the Canadian Nurses Association (CNA), there are “7,400 NPs in Canada. This is a growth of 10.7% from 2020, the largest increase of all the nursing designations. In fact, NPs became one of the fastest-growing professions in health care.” 

Despite being legislated in all 10 provinces, almost two thirds (5,000) of NPs are licensed to the province of Ontario as per the College of Nurses of Ontario. 

The ultimate question: Is Ontario utilizing them to their full capacity?

The reality for Nurse Practitioners in Ontario continues to be accumulating barriers to their autonomous integration into the health care system. 

Over the past several decades, despite evidence that they provide safe and effective care, Ontario NPs have had to tirelessly advocate for slow advancements in their scope of practice. 

This entails prescribing all medications, point of care testing, expansion of diagnostic imaging to now include MRI and CT scans and so on. 

Ongoing systemic barriers include:

– stakeholder/public confusion about their roll as independent practitioners;

– under-utilization of their full scope of practice;

– failure to increase funding models to allow hiring where there is demand; and

– role emphasis on physician replacement as the only answer to improving access to care.

This is not the case however, across all provinces. 

Despite having significantly less NPs, other provinces are maximizing their scope and practice. 

A 2023 published study in the BMJ open analyzed “the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience.” The evidence showed “access to an NP-led alternative dramatically improved their care experience with gains in overall physical health.” It states “significant increase” in domains of accessibility, continuity, comprehensiveness, responsiveness and outcomes of care and concluded that their findings were “well aligned with the large body of evidence showing that NP-led primary care is equivalent” to other forms of care. 

Alberta, on the other hand, simply advises NPs “are authorized to order and/or perform screening and diagnostic investigations using best available evidence to support or rule out differential diagnosis. Lists of treatments and diagnostic/laboratory tests are not specifically outlined; rather nurse practitioners have a broad scope of practice, autonomy and independence to determine the appropriate diagnostic tests for their clients, within the individual nurse practitioner’s level of competence.” 

The CBC recently reported that Alberta plans to minimize barriers and “will be introducing a new payment model to encourage nurse practitioners to open their own clinics, take on patients and “offer services based on their scope of practice, training, and expertise. These immediate actions will help to address urgent pressures and strengthen primary health care, as well as improving access to family medicine,” according to the Health Minister.

Meanwhile, despite the intensive advocacy from organizations like the Nurse Practitioner Association of Ontario, the Ontario government has not answered the repeated requests for further expansion of Nurse Practitioner funding. 

With staggering statistics listed above about the projected number of patients who will not have access to care, there is no question that there needs to be prioritized funding for more NPs to practice in Ontario. 

Ontarians deserve better and therefore need to demand better.

To notify your elected official that you support Nurse Practitioners, visit supportnursepractitioners.ca and complete a letter to your MPP.

Written by Jodi Colwill, nurse practitioner at the Minto-Mapleton Family Health Team.