As communities across the province struggle with inadequate access to primary health care, nurses and pharmacists want to expand the services they’re able to offer, while health officials say help is on the way.
The province is plagued with long wait times, misuse of emergency rooms, and inadequate access to a primary health-care provider, says nurse practitioner Kari Brown, one of many medical professionals pushing for an increase to their scope of practice.
The biggest hurdle in that process is MCP, Brown said: Currently, only physicians can bill the government agency for services rendered.
“This funding model is not working for people or [the] economy,” Brown said. “We have messages, emails and calls regularly from community members asking how they can access an NP for care.”
Brown said NPs with the necessary education and skills are standing by ready to help, but, unable to bill for services, they’re “only able to watch and listen in frustration,” Brown said.
Nurse practitioners are trained to perform a host of functions independently, Brown said, including cancer screenings, prescription renewals, and pre- and post-natal care, referrals, blood work and more.
Having NPs and other health-care professionals provide these services in primary-care settings, Brown said, would help ease up emergency room use and improve health outcomes.
Take out the middleman
A media release issued by the Newfoundland and Labrador Nurse Practitioner Association in late August cautioned the province was running out of time in addressing the health-care “bottleneck” seen in some communities, where doctors are overworked and skilled health-care professionals underutilized.
“Every month that goes by risks a domino effect,” the release read. “The health-care system cannot run on only one type of provider and that is becoming evident. Our health-care system cannot sustain the high costs with poor outcomes.”
Brown said concerns over the long-term implications for residents who can’t access the services they need have fallen on deaf ears.
Kara O’Keefe is a pharmacist at the Family Drug Mart on Bell Island. Two of the three general practitioners working on the island have just announced their retirement.
Residents are “very nervous” knowing there’ll soon be only one GP serving a population of some 2,700 people, she added.
“They’re scrambling to try to get their prescriptions. They don’t know who’s going to be following up on their tests, who’s sending them for testing. So there’s a lot of stress going around the pharmacy, and in the community right now,” she said.
O’Keefe says she’d happily step in to fill the health-care gap — that is, if the province would allow it.
“It’s frustrating because there are definitely more things that we could be doing to help as pharmacists,” she said, “but we’re simply not allowed to with legislation in this province.”
O’Keefe said a model like Alberta’s, where pharmacists can independently prescribe for high blood pressure, cholesterol and diabetes, could work well in rural communities where those conditions are rampant.
The role of pharmacist has shifted in the past decade, O’Keefe said: In addition to drugs, pharmacists are also dispensing treatment advice to patients. They’re also helping NPs decide on effective medications.
“But now we need to be able to take away that middleman and allow pharmacists to use their scope independently,” O’Keefe said. “Because in a lot of situations, we don’t have a physician or nurse practitioner to work with, and we’re more than capable in more ways than one in our skill set to to make these decisions independently.”
The Pharmacists’ Association of Newfoundland and Labrador has presented data to the provincial government underscoring the need for pharmacists’ roles to be expanded.
“It’s actually irresponsible for them not to act on it when we have so many patients who are going without care and who do not have a primary care provider,” O’Keefe said.
‘Where the future lies’
Acknowledging the “significant challenge” that exists for those trying access to primary-care physicians, Health Minister John Haggie said certain roles have already been expanded: Pharmacists can administer travel vaccines independently; optometrists can perform retina checks to screen for glaucoma; and advanced care paramedics can deliver dementia care to patients at home, he said.
Haggie noted the “concerted effort” that has been made to expand the responsibilities of NPs, the vast majority of whom, Haggie said, are currently providing “excellent primary care.”
“They now are completely autonomous because of changes we made to the Registered Nurses Act,” Haggie said. “They can set their own scope of practice through the College of Registered Nurses. They can set their own formulae for drugs to prescribe without having to refer to other disciplines. And they can practice on their own. So this is a work in progress.”
Those roughly 200 NPs are salaried employees of the regional health districts, Haggie said, meaning they wouldn’t use MCP’s fee-for-service system — one Haggie says “does not work” for primary care, and which the Newfoundland and Labrador Medical Association wants reviewed.
Rather than introduce what he considers “a flawed system,” Haggie prefers a collaborative care approach, “where primary care is available to people when they need it from the right person at the right time in a place that suits the individual, patient or their family,” he said.
“You would have physicians, you’d have nurse practitioners, maybe optometrists, pharmacists … and social workers all available in an easy way, with minimal barriers to access.”
The team-based care model had already begun to be implemented in the province before the pandemic hit, Haggie said, and plans to extend it have been met with approval from Premier Furey, as well as Dr. Patrick Parfrey and Sister Elizabeth Davis, co-chairs of Health Accord NL, the province’s health-care task force.
With meetings currently being scheduled with the nurse practitioners’ and pharamcists’ associations, Haggie said, “we are moving now.”
“As COVID becomes well-controlled, as the vaccine levels go up in the province, we now have the ability and the manpower to start on this,” he said.
Team-based care, he said, is “where the future lies.”
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