Will it work? New Brunswick doubles down on team-based primary care

In New Brunswick, there’s a model in place that aims to better support primary care. But Family Medicine New Brunswick (FMNB), a voluntary program centred on team-based care, has been around since 2017, and uptake has been dismal.Just 5% of the province’s doctors have signed on. With only 55 family physicians participating, it’s not doing a whole lot to ease the load on doctors and increase access to care.Now, the province’s Department of Health has released the New Brunswick Primary Health Care Action Plan. This document has been around for eight months, but was just made publicly available.It outlines a somewhat dismal situation in NB, with everyone doing different things under different compensation models. “Currently, primary care in New Brunswick is delivered through a collection of moving parts rather than a cohesive system,” the report admits.As well, the system lacks oversight and accountability. The document also lists the myriad challenges patients face in the province.But it also offers a way out: doubling down on the 2017 model with better infrastructure and, most importantly, new financial incentives. These initiatives are aimed at giving doctors, nurse practitioners, nurses, pharmacists and other healthcare providers a reason to work on teams together—and to stick around in the province.The state of careIn New Brunswick, 55% of family physicians work in solo practices (with 35% of such doctors within 10 years of retirement age). A small group, just 5%, work on salary while another 10% of doctors and 75% of nurse practitioners work under a group salary model. Meanwhile, many operate under a blend of the above.This scramble of models means, according to the report, that few clinics offer straightforward access to care. Just 51% of healthcare providers can offer an appointment within five days, a benchmark set by the province. After-hours care is poor too: N.B. has the second-worst rating in the country on this front, with just 28% of primary healthcare providers offering this service. It’s last nationally for offering weekend care with just 16% of providers doing so.All of this is happening against a backdrop of a population in need of support. Seniors make up 22.5% of the population and New Brunswickers have an obesity rate of 37.5% (the national average is 28%) while smoking and diabetes rates are also above the national average.Teams to offer moreThe Department of Health insists, via this report, that the best way forward is through FMNB. Its team-based approach better supports patients and helps physicians and other healthcare providers work more efficiently. Electronic health records are woven into this model, and they help caregivers and patients, too.It also argues that the FMND compensation model—which pays physicians for the number and type of patients on their roster, allows for extra billing for things such as virtual visits, pays for overhead support and offers free access to electronic medical records (EMR)—works out better for practitioners.However, it concedes that change is in order, and physicians and other healthcare providers need a reason to switch up their practices to pair up with others, offer services after hours and include digital care. Making change appealingNew Brunswick has clearly realized that to get doctors to change, you have to make it worth their while. Money might be the key.To that end, it’s offering a 15% increase in the capitation rate, $15,000 annual stipends for full-time registered nurses and $10,000 annual stipends for licensed practical nurses. Overhead relief will go up to $40,000 a year.The province is also getting rid of its minimum guaranteed remuneration, replacing it with a transitional payment model that takes into account whether a doctor is new to practice or just moving to the FMNB model.As well, there’s a new extended hours premium, so practices can bill more for care early and late in the day, and on weekends.Allied healthcare professionals will be better included in the system, as will community health centres.Meanwhile, the province is bolstering the system overall with better governance, accountability and data collection. That includes the creation of a Health Professionals and Patient Advisors Table, to meet quarterly. It will also bolster the use of electronic health records and move towards a single system for the province.Team-based primary care and its numerous benefits has become the way forward for many provinces. Now, New Brunswick just has to see if its plan for change management and the infrastructure around its take on interdisciplinary care teams will actually, finally, see some uptake.

Will it work? New Brunswick doubles down on team-based primary care

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