On May 7, 2024 the Minister of Health released a plan entitled New Brunswick Primary Health Care Action Plan. He said that it re-iterates the government’s commitment to improving access to health care services. Since its release, it has been faced with criticism from the Medical Society in which its President, Dr. Paula Keating, said that she had not seen the plan prior to its release. Other groups that should have perspective have not exactly been too vocal thus far. The plan consists of 26 pages of description of issues in the current primary care system with ideas for implementation to create a primary care system in a province in which, as the plan states, has primary care provided by a group of “moving parts” that are not organized in any “cohesive system.” That lack of organization has been more than a little apparent in the past two decades as family physicians have retired requiring sometimes three physicians to take over their practice. Worse still is the something over 60,000 New Brunswick residents that have no access to essential primary care services. The document is heavy on statistics and description of the shortcomings in the current array of services. It falls a bit short of a true action plan since it does not describe the where, what, how and when of planning. In its defense, it is strong on team-based practices which has been promoted in New Brunswick for nearly two decades by health service advocates.
The predominant model of primary care has been, as the plan points out, the solo practitioner family physician model, a model that served the province very well “back in the day”. That model began to show signs of creaking many years ago as Emergency Departments and an uncoordinated array of after-hours clinics sprung up as an alternate to family doctor care evenings, weekends, and holidays. Emergency Departments have become stressed beyond reason and patients have become justifiably angry, frustrated, and disillusioned with the difficulty faced in obtaining and maintaining quality primary care. Alternate arrangements for physician compensation and for primary care organization have been springing up across the country. New Brunswick has been stuck in conventional fee for service or salary as a method of remuneration while other methods have been described in Canada and elsewhere for decades. The New Brunswick “Primary Care Plan” is short on description of just how will be rolled out. Successful implementation requires engagement with physician and nursing leaders and how that is to be achieved is not yet clear. It is not possible to develop a modernized, team-based primary care model with all potential participants feeling thrilled about it. But in this important initiative, it is important to gather a “coalition of the willing” to move the agenda forward. Whether in rural or urban New Brunswick, interdisciplinary primary care services are the way forward and those who want to continue to practice in other, conventional arrangements should be allowed to do so. Eventually they will either convert or retire. But clear priority needs to be declared for the new model and every step possible needs to be taken, including compensation models, to ensure success. The reality of primary care simply is that every ailment or belly pain does not necessarily need to be seen urgently by a physician. Nor does every stable diabetic or post-acute survivor of heart attack need to see a physician for routine follow up. In well organized group practice/clinic arrangements, care can be, and usually is, delivered based on Clinical Protocols in which the leaders of the clinic establish in writing the methods for diagnosing, providing care, monitoring the progress of care for persons with clinical problems. Properly done, such an approach to care can improve quality, volume, wait times, delays, and contribute to the reduced anxiety of persons seeking care. In my own experience in other provinces, I have seen the enormous potential of protocols and enabling other professional groups to function at full scope of practice. The synergy that comes from physicians, nurses, dietitians, and other professionals collaborating is absolutely astounding. Right here in New Brunswick, in addition to the innovations of Nurse Practitioners, the wise support of Extramural Nurses has helped Special Care Homes reduce the percentages of residents referred by ambulance to emergency departments by 60%! The health authorities now have renewed boards of directors and qualified persons confirmed as CEOs. The Vitalite Health Authority is moving the reform agenda forward with purpose and focus. Horizon reportedly has some great initiatives underway in primary care. Both health authorities should be given the vision and responsibility to execute Team-based primary care in each of the communities for which they are responsible. That may require serious amendment to their governance model and policies but it is essential. By-Laws, for instance, are intended to govern the methods by which physicians are recruited, selected, and organized within the health authority structure. A really bright spot in the plan is the intended overhaul of community health centres. Like so much else in health and long-term care, these centres have evolved in the absence of a serious plan, so re-focus is long overdue. The idea of the New Professional Training Incubator for new-to-practice physicians is refreshing, assuming it will be supported by the Medical Society and the College of Physicians and Surgeons. Coming from Residency Training directly into practice is a challenge for physicians. Getting to understand the structure in this province, figuring out where the resources are, the different medical cultures, good business practices, what to do about patients who really need long term care and ever so much more. These are very bright, highly-motivated professionals and any steps that can be taken to help them acclimatize to the unique characteristics of practicing in NB would be helpful. The plan is a decade or more overdue so government now will have the challenge of how to pick up the pace. Governmental structures are not known for lightning speed but the stakes here are so high that moving with intentionality is essential. They might look to the 12 Neighbors and the leadership of Marcel LeBrun and his colleagues as a model of how to get innovation and difficult change moving. The Homeless issue in Fredericton, and other cities, has been a constant in the news for years. But until Marcel got tired of all the continual and repetitious headlines the stories seemed, to the public, more of the same. With a heart for people, he started asking good questions: Why? Does anyone know of programs that really help people beyond simply keeping them off the streets? So, he invested his own money and visited several programs in large, North American cities that actually have shown success at helping people discover self-worth, self-respect, learn job skills, discover the satisfaction of life-change. As he thought and consulted, he developed the concept of 12 Neighbors. Today, two years later, they have over 90 people off the street, learning skills, discovering life. Not easy; not anything that government could do alone; lots of partners sharing the vision, passion and direction. Passion, sacrifice, heart for change, vision for people and potential, dissatisfaction with the status quo……those are the qualities that drive change in major health and social policy. Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at [email protected] or www.kenmcgeorge.com
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AuthorKen McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada. Archives
May 2023
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