Province unveils primary health care plan

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The province plans to boost pay rates for doctors and other health professionals who agree to work in collaborative clinics, acknowledging that its previous efforts to lure solo practitioners to that model haven’t worked.

After months of talk about its new primary health plan, the province unveiled it on Tuesday afternoon.

It focuses on the need for more collaboration, and a model called Family Medicine New Brunswick (FMNB), which was created by the government and the New Brunswick Medical Society (NBMS) in 2017. FMNB was, according its website, “built to improve and enhance access to primary care for New Brunswickers while improving the work-life balance of physicians through collaborative practice.”

That model sees doctors, nurses, and other health professionals work together. Patients’ records are shared with everyone at the practice, allowing them to be seen by a sometimes-rotating cast of workers.

But the new primary care plan – which fits within the Tories’ overall five-year plan to fix the health system – admits that so far, the FMNB model hasn’t been attractive enough to lure doctors away from solo practices.

About half of New Brunswick’s doctors still work in solo operations, the highest rate in the country. Some have previously said they don’t want to move to a team-based model because they’ve already invested lots of money in their existing operations.

“Despite the benefits, this (collaborative) model has not grown as expected. After five years in operation, it has enrolled 55 physicians (five per cent of total workforce). This model has had especially low adoption rates in francophone areas,” the plan reads.

The province can’t force solo-practice doctors to move to the FMNB model.

And while Premier Blaine Higgs has repeatedly said that “simply throwing more money” at the health system won’t fix it, the new plan includes a series of moves centred around cash for anyone willing to work within the FMNB model.

They are:

• A 15 per cent rise in physicians’ pay rate, calculated on the number of patients seen;
• A $15,000 annual stipend for FMNB clinics to hire a full-time registered nurse, and/or a $10,000 stipend for a full-time licensed practical nurse;
• A change to “full-time” pay rates, which will be “pro-rated and defined based on service levels”;
• An overhead relief payment of up to $40,000 a year, depending on the size of the practice and the number of patients;
• “The minimum guaranteed remuneration will be replaced with a transitional payment model, which will consider whether a physician is new to practice or an existing physician transitioning to FMNB,” and;
• A new “extended hours premium” and a higher fee-for-service payment for FMNB physicians working outside the hours of 7 a.m.-6 p.m., and on weekends.

In January, NBMS urged the province to make some of those moves, including the after-hours premium.

The changes are expected to come into effect this fiscal year, Health Minister Bruce Fitch told reporters at the legislature.

Other moves outlined in the plan include the creation of “a functional unit at the Department of Health to drive change focused on accountability,” the establishment of a “leadership and accountability table” comprised of the health department and the Regional Health Authorities, and improved data collection and sharing.

Fitch said the plan offers some “good incentives for family practices to move forward,” and also addresses some “other issues” the system is grappling with. There are 18 initiatives in the plan, Fitch said, and “some are underway, some are ongoing,” and some are new.

“Everybody across Canada is struggling with primary care … I think these types of initiatives are going to help,” Fitch said, later adding that it may “force some people to look” at the FMNB model “a second time.”

He also stressed that other efforts to fix the system, including recruitment and adding more nursing seats in New Brunswick universities, are ongoing.

Liberal Leader Susan Holt said while she’d only had time to “skim” the plan, her initial impression was that “it’s pretty light, and there’s no commitments to deliver, so it seems like they’re making it look like they care about primary care” while not actually listening to front line workers’ concerns.