More nurse practitioners needed to work in primary care

A new health policy brief from the C.D. Howe Institute is suggesting that an aggressive increase in the number of nurse practitioners (NPs) working in primary care is needed to improve access to primary care for Canadians. That said, the report’s author adds that a major cause for the dysfunction in healthcare is the reluctance of provincial governments to undertake institutional reforms, for fear of provoking physician’s special interest groups and organizations.

Entitled Addressing the Crisis in Access to Primary Care: A Targeted Approach, the brief further points out that a majority of Canadians in studies have reported that they face difficulty accessing health care. “60 per cent responded that they face chronic difficulty or some challenges,” they state.

“No single explanation of dysfunction - the COVID pandemic, aging of the population, inadequate public financing or the decline in physician hours – is satisfactory,” they add. “Collectively, they are a partial explanation.” 

Looking at Organization for Economic Cooperation and Development figures, they say Canadian’s satisfaction with the availability of quality health care declined dramatically – between 2019 and 2021. Scores imparted by Canadian respondents to the organizations’ Health at a Glance survey dropped by 22 points. 

“Since the reforms of the 1990s which were spurred by the need to address fiscal deficits, most provinces have been reluctant to provoke opposition from powerful interest groups – in particular physician’s organizations,” they write. The report also looks at the implications of generational change in the medical profession, at physician working hours (declining) and at reform options.

Equivalent or better patient outcomes 

“Nurse practitioners (NPs) in alternative provider ambulatory primary care roles have equivalent or better patient outcomes than comparators are potentially cost-saving,” they write. “Rigorous comparisons, conducted to compare the quality of services by NPs relative to services by physicians have consistently concluded that NPs provide services as good as those provided by physicians.”

The report also calls for the promotion of multi-disciplinary primary care clinics to be established. “There are many institutional reforms to consider but two, I argue, are imperative. The first is an aggressive provincial expansion of NPs,” they write. “The second suggested reform is, as in Ontario, the active promotion of primary care delivery via multi-disciplinary clinics, which incorporate NPs among other professionals.”