Citizen engagement vital if we are to solve our primary-care crisis: OurCare Nova Scotia panelists

Nova Scotia’s primary health care is in crisis. A sobering indicator is the number of residents in need of a family doctor or nurse practitioner – as of July 2023, some 152,000 Nova Scotians, or 15 per cent of the population, were registered on the Province’s Need a Family Practice Registry, a threefold increase since 2019.

Equally troubling is the added pressure brought about by a growing provincial population, which has increased by 10 per cent since 2017, with most of this growth – about 60 per cent – taking place over the past two years. Some 1,047,000 people now call Nova Scotia home. During roughly the same period, the number of full-time, resident family care physicians has not kept pace. Using the Province’s College of Physicians and Surgeons statistics for active licenses for the above doctors – now totaling 1,160 – we calculate that the net growth of new doctors is less than five per cent (2018 to 2023). The situation may soon get worse as a quarter of these doctors are more than 60 years of age and may be considering or nearing retirement.

To add to the dilemma, there are record vacancies among nurses, paramedics and other allied professionals, worsening access to timely emergency care and forcing closures of emergency departments at rural hospitals. For patients, navigating services is difficult without the guidance of a primary care provider for referrals, direction and preventative medicine and advice. We’ve failed to address critical social and structural determinants of health such that our proactive health-care system has become a reactive “sick-care” system.

Government approaches to date have fallen short regardless of political affiliation. The political debate appears to be so divisive and agenda-laden that policy and action proposals are short-sighted and fail to balance the need to get more primary care doctors to the front line. For instance, the list of residents without a family doctor and the pending doctor shortage has been developing over several years and only recently has reached the limit of critical capacity. So, while encouraging family physicians in Nova Scotia to take on more patients with financial enticements is laudable, it is unclear to what degree this short-term measure can address the large number of residents without a dedicated primary care provider or whether this simply adds administrative burden to practices already heavily subscribed with patients.

Health care is admittedly a political issue but people are tired of a four-year political cycle in health-care programming.

Health care is admittedly a political issue but people are tired of a four-year political cycle in health-care programming. Investments require a much longer time horizon than solutions tied to the next provincial election. Health care, particularly the fundamental primary care element, must be a profoundly non-partisan issue with long-term dependability and predictability in its solutions.

There is hope that it can be.

Despite an increasingly polarized political and societal environment, 34 Nova Scotians representing different backgrounds and circumstances came together to evaluate issues affecting primary health care and reach a consensus on a list of recommendations to be presented to health-care leaders and the provincial government. The highly diverse group found there was far less polarization and much more agreement on issues and could therefore work toward a common view of the way forward.

Among the recommendations are improving the way health records are managed, linked and accessible; developing sustainable delivery models for primary care, particularly in strategically located communities across the province; retaining health-care professionals; expanding primary care; better governance and system oversight; and enabling a better informed public about preventative care and access to the system of primary health care. The full report and list of recommendations can be found here.

It is noteworthy that the efforts of the group, committing numerous hours over a shared concern for health care, were entirely voluntary. The panel was guided by the Our Care project, which is enabling citizen engagement on health care across Canada.  Our group learned considerable detail from health-care leaders and practitioners from both within and beyond Nova Scotia and had access to various resource materials on primary care and its challenges.

Two themes emerged from group discussions:

1) Individual differences were outweighed by the common belief that everyone has the right to primary health care and that this must transcend the shorter-term political process: This is a quintessential Canadian value.

2) By focusing on social cohesion rather than division, a group of ordinary citizens constructed intelligent and actionable recommendations to improve health care in ways that transcend polarizing political debate.

The OurCare Panel in Nova Scotia hopes to continue its engagement and is optimistic that the provincial government will enable this going forward. The notion of a province-wide, non-partisan, citizen primary health-care board was raised as one route to ensuring citizen engagement on setting priorities and determining the way forward.

Citizen engagement is vital and necessary to place individual concerns, visions and actions at the forefront of primary health-care planning and delivery for now and into the future. We believe that Nova Scotians want to live their healthiest lives and that this is a right of all residents, regardless of circumstance.