The Future of a Strong Health Care System in Ontario Relies on Nurse Practitioners

Ontario is suffering an acute shortage of primary care providers that significantly limits access to health care for millions of Ontarians. Emergency rooms and intensive care units (ICUs) across Ontario are limiting hours because of these shortages. This brings a terrifying reality for Ontarians who could be turned away from a hospital or cannot access a health care provider in a time of need.

In Ontario alone, there are approximately one million patients without regular access to a primary care provider and are considered ‘unattached’ ¹. As the province’s population continues to grow both in size and age, stress is added to an already struggling system, limiting the abilities of family physicians to provide access and timely care.

Unattached patients place an additional burden on already over-stretched emergency rooms and hospital departments, because they have nowhere else to access health care services. Almost 30 per cent of Ontarians are turning to the ER for care that could typically be provided by a family physician. ERs have hit their breaking point, forcing department closures and patients to be turned away. Emergency care should be reserved for emergencies.

Primary care needs to be the foundation for a strong and effective health care system. Primary care is an individual’s first contact with the health care system, and can take many forms whether that be a family physician clinic, community health centre, walk-in clinic, home care or a nurse practitioner-led clinic.

The likelihood of you or your loved ones receiving prompt attention for a health scare or concern is now worryingly low. The gaps in our health care system are growing: utilizing Nurse Practitioners is the logical choice to solve this challenge.

Nurse Practitioners (NPs) have the knowledge and skills to deliver the health care services most Ontarians require on a day-to-day basis, and represent an opportunity to relieve strain on the health care system and provide quality care to patients across the province.

As Registered Nurses with additional university education, Nurse Practitioners are uniquely qualified to provide a full and comprehensive range of health care services to individuals, families, and communities. They work within all corners of health care across Ontario, including hospitals, community health centres, and primary care practices such as Nurse Practitioner-Led Clinics (NPLCs) and family health teams.

Nurse Practitioners collaborate with physicians, nurses, social workers, mental health professionals, and pharmacists to provide timely, well-rounded team-based care. As a member of a health care team, Nurse Practitioners can:

• Perform comprehensive assessments
• Diagnose conditions
• Prescribe medications
• Order tests
• Provide specialist referrals
• Develop personalized treatment plans

Team-based, interdisciplinary care is the most effective and efficient care model where a team of clinicians from different disciplines, together with the patient, undertakes assessment, diagnosis, intervention, goal-setting and the creation of a care plan.

This is the care model employed in Nurse Practitioner Led-Clinics (NPLCs) in Ontario. They offer
clinical leadership and deliver a full scope of care for patients. The high caliber of their services
speaks for itself: NPLCs have historically scored above the Ontario average on all standard
quality indicators.²

Cross-clinic analysis performed in December 2018

NPLCs represent the intersection of innovation in health care and practical services that exceed patient needs and wishes and relieve the burden on the health care system. Increasing the number of these clinics will bring thousands of unattached patients from across the province back into the fold. NPLCs improve patient access to primary care and enable greater health system efficiency, quality, and function, with the added benefit of reducing overall healthcare costs.

But if Nurse Practitioners and NPLCs are so effective, why aren’t we using them more?

Currently, the number of NPLCs in Ontario is capped at 25. There are at least six communities asking for the establishment of an NPLC in their region to address physician shortages and long lists of unattached patients with no access to a primary care provider. Often, these are Regions that have traditionally struggled to recruit physicians. Increasing the number of these clinics will ensure prompt and equitable access to high-quality healthcare services where they are needed most.

Establishing more NPLCs, however, relies on provincial funding. Nurse Practitioners are salaried employees and do not bill OHIP for health care services. It is up to the Government of Ontario and the Ministry of Health to make this happen.

To understand the clear benefits associated with the implementation of additional NPLCs, one needs look no further than communities like Thunder Bay, where Nurse Practitioners have been instrumental in filling the gaps in primary care for the last decade. NPLCs have had proven successes, particularly in northern and rural Ontario, collaborating with other health care providers to deliver quality, timely care.

Nurse Practitioners are valuable additions to health care teams, providing comprehensive treatment plans within the holistic, compassionate nursing care model. Improving the integration of Nurse Practitioners across the healthcare continuum can only have positive results for the province.

The people of Ontario deserve access to healthcare without compounding the already potentially life-threatening wait times. Time and time again, the Ontario government has expressed its intent to work with system partners and invest in rebuilding the healthcare system. It’s time to put their money where their mouth is. Nurse Practitioners are in the prime position to cut down waitlists, reduce overuse of emergency departments and provide unparalleled patient care and treatment.

Our healthcare system is suffering: the prescription is Nurse Practitioners.

Dana Cooper is the Executive Director of the Nurse Practitioner Association of Ontario (NPAO), the only organization exclusively dedicated to advancing the Nurse Practitioner profession.

¹ Ontario Ministry of Health, Health Care Experience Survey, 2019; Ontario Physician Human Resources Data Centre, Ministry of Finance Population Projections, Reference Scenario.

² Canadian Institute for Health Information, Health Indicators 2012 (Ottawa, Ont.: CIHI, 2012).