With Population Ageing is it Time for Nurse-Practitioner Led Clinics (NPLC’s)?

…by Terrance Hunsley

As the baby boom retires, their doctors are also retiring. People who are used to having a general practitioner who gets to know them and their health issues, are having problems. And it is happening at a time of their life that they need more health care, more wholistic care, more continuity. 

But new doctors are tending to set up in the suburbs, or in walk-in clinics where they maximize their income on a fee-for-service basis. Some clinics will only address one ailment per visit, making wholistic health care a myth. These clinics do not always have your health records and there is no continuity of care provider, all of which makes for expensive and ineffective care.

In Ontario, there are a few community health centres (CHC’s), which provide a wide range of services. Their doctors are on salary and there are a number of other health professionals co-located for ease of referring.  They are often in areas where clientele are marginalized and low income people but they are open to the public in their catchment area. The Ottawa Centretown Community Health Centre is typical in its website notice that its primary care service is at capacity. Also indicative is its advice to disappointed residents, to try the provincial website intended to help people find a new family doctor. It suggests to keep checking it every month or so because it is clearly not meeting the need. 

The province has not established new CHC’s for the past ten years, partly because some doctors don’t want to be on salary. Also, CHC’s provide their clients and communities a wider range of services so they tend to have higher administrative overhead and thus are not considered a cheaper alternative. That remains to be studied in relation to the costs compared to health outcomes. 

But, tentatively, over the past ten years and mainly in areas where it is hard to get doctors to live, Ontario has been experimenting with Nurse Practitioner-Led Clinics. There appear to be about twenty-five in the province. These clinics provide a wide range of primary care, with the nurse practitioners consulting with physicians or other specialists when they need to. They also provide and coordinate a range of other health services.

The provinces have also been trying for many years to shift the bulk of continuing care for seniors from hospitals and long term care homes, to serve as many as possible in their own homes and communities. They have not been very successful at this and are behind most of the other OECD countries in this regard. The main reason for being behind is a great reluctance to spend money. Canada spends about 1.3% of GDP on long term care, compared to an OECD average of about 1.75 (and over 3% in some countries). 

So there are problems with finding a new doctor for many citizens. Plus, seniors need more access to service than they did when younger.  They also need a wider range of support services. Perhaps it would be wise for provinces to invest more heavily in NPLC’s, locating them in urban communities rather than just remote ones. Many of the services provided by doctors can be effectively provided by nurse practitioners, and they can also ensure continuity of care across a variety of service needs, including home and community care. Moreover, if seniors are to live independently for a longer time, they need an age-friendly community around them. The NPLC’s would fit nicely into that role.  

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