With long wait times in emergency rooms across the province, opposition parties are calling on the government to urgently create additional primary care clinics to take pressure off the creaking health-care system.
That style of clinic has a few different names, referred to interchangeably as primary care clinics, multi-disciplinary clinics or non-urgent care clinics. The idea is based on the community health centre model, where several health practitioners, often with various areas of expertise, work together to provide patient care rather than the traditional single primary care provider model.
Both the Liberal and Green parties want to see clinic options in the province expanded, allowing more people to access primary care outside of the emergency room.
“To have that type of clinic, it could be a nurse practitioner, different health professionals, pharmacists, that are able to take walk-ins, that are able to take appointments and get people out of the ERs that don’t belong there,” said Liberal health critic Rob McKee.
There are already 14 of these types of clinics across the province, the first of which were introduced by the Bernard Lord government about two decades ago. The Downtown Community Health Centre in Fredericton is one of the more successful of those clinics. Health Minister Bruce Fitch says they’ve started taking some low acuity patients from the emergency room at the Dr. Edward Chalmers Hospital to help ease wait times.
But very few of the existing community health centres currently take walk-ins, something Green Leader David Coon says should change immediately.
“Community health centres need to be given the resources, all 14, who are not providing walk-in services right now, need to be able to take in patients,” Coon said.
He points out that the Queen’s North Community Health Centre in Minto is one of the few that does so already, but says it needs to be expanded.
“We’ve got them in place, with the appropriate budget, they can provide walk-in services. That needs to be done quickly to reduce the pressure on the ERs.”
The province’s five-year health plan also identifies the need to move towards a team-based collaborative care model and has begun taking steps toward doing so. Fitch says similar types of projects are underway as well, including an upcoming family clinic in Lameque, where a team of doctors will work together to provide patient care.
“We encourage more family doctors to work in those collaborative practices where they share the patient records, where they’re available. Maybe not the same doctor every time you go in, but a doctor who has access to your records so that you can manage the client better,” Fitch said.
The province’s primary care waiting list is slowly being eliminated by taking patients and giving them access to Health Link NB, a network of various practitioners who will take in-person and virtual appointments on an as-needed basis.
The program began rolling out in the Moncton region earlier this year and has been expanded to the Capital and Restigouche regions. Fitch says it could be province-wide by the spring.
In Dalhousie, the program includes a physical clinic where people will go to get primary care. That could be expanded to other communities as well.
“Where we have Health Link, you can go in, you can see a doctor, a nurse, possibly a nurse practitioner, and your records will be there and be kept. So it’s not a walk-in clinic where you don’t have that follow-up, that continuation,” Fitch said.
Coon sees that as proof that the ability to expand the clinic model to more areas of the province is there. He says the former CEO of Horizon, Karen McGrath, told him she had put together a plan to open six more community health centres across the province, but that proposal was ultimately shelved.
“The health authorities were presenting proposals in 2018 or 2019 for, in Horizon’s case, six additional community health centres with multi-disciplinary teams that year,” he said.
“(McGrath) explained to me they have all kinds of real estate at Horizon … so that wasn’t the issue. The issue was the budget to staff up and equip them, and they didn’t get it. So that’s clearly a lack of political will to move forward.”
The events having predated his time as health minister, Fitch says he wasn’t aware of McGrath’s plan.
The biggest obstacle to setting up additional community health centres is the same one the rest of the health-care system faces, Fitch says. With a chronic lack of staff and inability to fill current vacancies, Fitch says that creating new clinic positions likely wouldn’t do much good.
But McKee says that’s no reason not to try. In fact, he says, creating clinic positions could be a recruiting tool in itself.
“My understanding is that there is a willingness from professionals, young professionals that are looking for more work-life balance, are looking to collaborative practices,” he said.
“If I would see an indication from government that they are moving in that direction, I think you’d get buy-in from those professionals.”
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