HANSARD

 

NOVA SCOTIA HOUSE OF ASSEMBLY

 

 

STANDING COMMITTEE

ON

HEALTH

 

 

Tuesday, August 12, 2025

 

 

LEGISLATIVE CHAMBER

 

 

 

Primary Heath Care Attachment

 

 

 

 

Printed and Published by Nova Scotia Hansard Reporting Services

 

 

HEALTH COMMITTEE

 

John A. MacDonald (Chair)

Adegoke Fadare (Vice-Chair)

Hon. Susan Corkum-Greek

Ryan Robicheau

Nick Hilton

Lisa Lachance

Rod Wilson

Hon. Iain Rankin

Hon. Derek Mombourquette

 

 

In Attendance:

 

Robin Dann

Legislative Committee Clerk

 

Gordon Hebb

Chief Legislative Counsel

 

 

WITNESSES

 

Nova Scotia College of Family Physicians

Dr. Colin Newman, President

Dr. Leisha Hawker, President-Elect

 

Department of Health and Wellness

Colin Stevenson, Chief, System Performance and Integration

Barbarie Palmer, Project Executive, Physician Services

 

Doctors Nova Scotia

Dr. Shelly McNeil, President

Dr. Amanda MacDonald Green, President-Elect

 

Nova Scotia Health Authority

Karen Oldfield, Interim President and CEO

Katie Heckman, Director, Primary Health Care and Chronic Disease Management Network

Dr. Nicole Boutilier, Executive Vice-President, Medicine and Clinical Operations

 

 

 

 

HALIFAX, TUESDAY, AUGUST 12, 2025

 

STANDING COMMITTEE ON HEALTH

 

1:00 P.M.

 

CHAIR

John A. MacDonald

 

VICE-CHAIR

Adegoke Fadare

 

 

THE CHAIR: Order. I call this meeting to order. This is the Standing Committee on Health. I'm John A. MacDonald, the MLA for Hants East and the Chair of the committee. Before I start, jackets are optional at this meeting today.

 

Today, we'll hear from the Department of Health and Wellness, Doctors Nova Scotia, the Nova Scotia College of Family Physicians, and the Nova Scotia Health Authority regarding Primary Health Care Attachment.

 

Please remember to set your phones on silent. Also, please don't touch your microphones. I'll ask all the committee members to introduce themselves for the record by stating their name and constituency, starting with MLA Fadare.

 

[The committee members and staff introduced themselves.]

 

THE CHAIR: I'd like to welcome all the witnesses. What we'll start with is just your name and the group you're representing, then we'll get to opening statements later. We will start with Dr. Hawker.

 

[The witnesses introduced themselves.]

 

THE CHAIR: We're going to start with opening statements. I have first Ms. Oldfield.

 

KAREN OLDFIELD: Last year, the Nova Scotia Health Authority, together with the Department of Health and Wellness, added approximately 70,000 new primary care appointments each month to the care system. The numbers don't lie. Primary health care has evolved, and we've all evolved with it. Gone is the singular focus on a physician for every one person. Today's primary health care is delivered by teams that include family physicians, nurse practitioners, nurses, social workers, dietitians, pharmacists, physiotherapists, and so many others. The progress we've made is unprecedented. I would like to say thank you to each and every one of you for your contributions. Still, no question, we have a long way to go until the job is done.

 

Behind the Need a Family Practice Registry is a team, a group of people across the Nova Scotia Health Authority that I am immensely proud of. I see some of them in the gallery, and I just want to acknowledge the work that you've done.

 

I defer the remainder of our time to Ms. Katie Heckman, who is a member of that team and who will speak more about our determination to get this job done.

 

THE CHAIR: Ms. Heckman.

 

KATIE HECKMAN: I am one of the directors with the primary health care network at the Nova Scotia Health Authority. My team's job is to help connect Nova Scotians to primary health care. We are directly reaching out to Nova Scotians on the Need a Family Practice Registry and working with health care providers and their clinics to connect more patients with primary health care within their communities as quickly as we can.

 

Before we started our transformation journey in spring 2024, the Need a Family Practice Registry was just a list. But people aren't lists. People have stories, needs, and health journeys that deserve attention and coordination. Our team is working with many teams across our health care system to transform the registry from just a list into something that patients can actively engage with and be supported by. This means smarter tracking, proactive outreach to support validation, and the ability to match Nova Scotians with care teams faster and more effectively.

 

We decided to move to a proactive approach that allowed for two-way communication with patients. We are taking the time to fully understand each and every individual on the registry to help inform our entire approach. We have meaningful conversations with Nova Scotians and take the time to hear about their experiences and what they need from us. These calls take time and care. We're not just trying to cross people off the list to say that we've done it. We're not just validating Nova Scotian phone numbers and cleaning up data. We are validating that they have the care that they need and that they know where to go to get it - and if they don't, we're helping them figure it out.

 

It's a single parent waiting too long for a child's diagnosis. It's a senior citizen with multiple medications without continuity of care. It's your neighbour who is a newcomer struggling to navigate a new system alone.

 

This was our call to action and our opportunity to make a difference. We haven't backed down from that challenge. In fact, we're leaning in - with purpose, with innovation, and with the belief that we can lead the country in patient attachment to comprehensive collaborative care. We are doing it as a team, from one Nova Scotian for another.

 

From our administrative staff on the front lines connecting with Nova Scotians, hearing their stories and navigating them to care, to the analysts tracking data, to the leaders driving decisions, and to the clinical teams working passionately to provide exceptional patient care, this work has been a continuous wave of effort. Each person plays a vital role, and together their dedication and perseverance have kept this work moving forward without pause and without giving up.

 

Currently, we are leading the country in this work. We have successfully reduced the registry by almost half.

 

As of August 1^st, 87,879 Nova Scotians are on the registry, which is down to 8.3 percent. We know there is still a lot of work to be done. It takes time and effort to build a system that sees people not as numbers on a wait-list but as partners in their care, deserving access, dignity, and continuity.

 

I want to share a real quote with you that we received from a woman in Cape Breton on the registry that speaks to the work we are doing and the impact that it's having:

 

I just wanted to show my appreciation for the help the other day. I'm now booked at a primary care clinic next week. I've also contacted the college to request my previous medical records. I wouldn't have been able to make this progress without you listening and caring. That means so much to someone who's felt so alone and without help for a very long time. I wanted you to know how much your little bit of kindness has positively affected me.

 

We know the road ahead requires commitment from staff, providers, and communities, but together we are moving away from a system that asks people to wait and toward one that welcomes them in.

 

Nova Scotia is not just responding to this challenge; we're redefining what's possible in primary care for today and for generations to come. Our message is simple: Every person deserves access to care they can count on. We won't stop until that's the reality for every person in this province.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: Good afternoon. Thank you for the opportunity to join you here again today. I was here in July to discuss the expansion of multi-disciplinary care teams. That was an important conversation and a piece of work that directly supports primary health care attachment.

 

In many ways, today is an opportunity for us to continue to build upon our conversation from July. We have a clear and simple vision for primary health care in Nova Scotia where everyone is attached to comprehensive and connected care. The journey to get there is complex and not without its challenges, but we are making progress. We owe our success to strategic investments in health care infrastructure like new health homes, and in people like new and strengthened multi-disciplinary care teams. We also owe it to our health system partners who are innovating and adapting to changes in the health care landscape.

 

As we continue to implement our vision, we have also been working to redefine what “primary health care attachment” means. It's more than pairing a patient to a provider; it's about attaching patients directly to health care. Health homes are a prime example, and so far, we have 118 across the province. That number will continue to grow and so will the multi-disciplinary care teams to staff them. In a health home, the patient is attached to the clinic and not just the provider. It's an important distinction because should a provider retire, leave, or become unavailable, our goal is that the patient's care needs can continue to be met by their health home.

 

Primary health care attachment is also about creating opportunities and incentives for providers to want to take on more patients. A new compensation model for physicians called longitudinal family medicine, or LFM, was introduced in 2023. It has been a remarkable success, designed to increase physician accountability, transparency, and competitive compensation that also supports attachment. Almost all new physicians are choosing the LFM funding model, and as a result, are attaching more patients than their colleagues who are building under other compensation plans. LFM is directly contributing to increased access to primary care for Nova Scotians. Since its introduction, we have seen a 53 percent increase in LFM physicians providing evening and weekend services. In our view, this is the ideal compensation model to support primary health care attachment in our province, and it's because LFM only pays for the services delivered. If a physician wants to earn more, they can work more hours, attach more patients, or provide more services.

 

We know our efforts to create more health homes, expand teams, and incentivize physicians are working. We've seen a direct and positive impact on reducing the Need a Family Practice Registry. I'm sure we will be discussing the registry in more detail shortly, so I will leave you with this. As Ms. Heckman has stated, the registry is more than just a list because the people on it are more than just a number. It's a tool that has evolved beyond its original function of simply tracking who isn't attached to health care. People move in, out, and around our province all the time. Health care professionals retire or pursue other opportunities for personal and professional reasons. The registry is becoming a tool that helps the system support, guide, and connect people to the care they need.

 

Our health care system is always in a state of flux, but there is one constant and that is our efforts to adjust, adapt, and innovate to meet and overcome those challenges. We are working hard to create primary health care attachment for Nova Scotians. We have made improvements, seen results, and continue to move forward to fulfill our vision of a health care system that provides comprehensive and connected care.

 

THE CHAIR: Dr. McNeil.

 

DR. SHELLY MCNEIL: Good afternoon and thank you for the opportunity to speak with you about primary health care attachment today. My day-to-day work is as an infectious diseases specialist based in Halifax. In my specialty, I'm also oftentimes providing essential primary care to patients with no family physician. I must follow these patients for their primary care needs, which limits access for patients who require infectious diseases treatment and delays access to my clinic to support my primary care colleagues in caring for the complex infectious disease needs of their patients. I know my colleagues in other disciplines are doing the same.

 

While we do our best in these cases, our patients would be better served by a family medicine specialist. We believe family physicians leading health homes is the model to deliver the best care to patients. Family medicine is the backbone of our health care system. We brought with us copies of our position paper, The Backbone of Primary Health Care: The Role and Value of Family Physicians in Nova Scotia. Our comments are based on this research.

 

[1:15 p.m.]

 

The depth of a family physician's medical knowledge and skill set places them in an ideal position to manage patients with complex medical needs. Family physicians are trained to approach the medical decision-making process differently than other providers. They can work with uncertainty and incomplete information, taking calculated risks jointly with their patients, integrating information from multiple sources.

 

They help to ensure health care resources are used effectively and efficiently. The comprehensive scope of practice of family physicians, coupled with the deep long-term relationship they build with their patients and their families, contributes to the high value of family physicians in the health system.

 

Family physicians play an important role in coordinating patient care, advocating for patients, providing leadership at the practice, hospital system, and community levels; training and mentoring learners; and supporting quality improvement and research. Many family physicians lead their own staff and/or collaborative teams.

 

That's why we believe that every Nova Scotian deserves access to a health home model led by family physicians with a core group of providers. The 2023 Physician Agreement focuses on both incentives to support our current complement of family physicians and initiatives to attract new physicians to our province. The new Longitudinal Family Medicine payment model is working. It's incentivizing attachment, access, transparency, and accountability, and it's better valuing the work of these family physicians. In the handouts, you'll find some of the data supporting our claim.

 

I'd like to hand off to Dr. Amanda MacDonald Green, the president-elect of Doctors Nova Scotia, to share how the LFM model is working for her practice and where there is still room for improvement.

 

THE CHAIR: Dr. MacDonald Green.

 

DR. AMANDA MACDONALD GREEN: Thank you, Dr. McNeil. I'm a physician specializing in family medicine. The Windsor Collaborative Practice, which I co-founded, has evolved into a clinic with four physicians, two family practice nurses, and a social worker, serving a population of nearly 5,000 patients. Our team provides same-day and next-day access and after-hours clinics for our patients.

 

Recently, we welcomed a family medicine resident into our clinic for her two-year specialization. Residents must demonstrate competency in 105 key priority topics prior to receiving their designation following medical school. This gives family physicians unique expertise to diagnose and manage complex issues over a patient's lifetime. In teaching her, I'm reminded of the value of attachment and how the relationships that I've developed with my patients impact the quality of their care.

 

Between collaboration with our team, reduction in some administrative burden, and the development of the LFM payment model that recognizes not just efficiency but quality of care, I recognize that I am practising in a realized vision of team-based care that will give me longevity in a specialty that has the highest rates of physician burnout.

 

As Dr. McNeil said, the LFM model prioritizes attachment. I want to emphasize the difference between attachment to a family physician versus access to care delivered in silos. We can look to countries such as Finland and Norway for quantitative data on decreased emergency department visits, unnecessary referrals, increased preventive care, and improved health outcomes for decreased costs for systems that are built on primary care physicians with attached patients. I'm happy to offer some qualitative commentary on the value that is being realized in Nova Scotia for some patients today.

 

The part of the job I love most is also the part that is the most valuable to the system, and that's the relationships that I've developed with my patients. I have at least five families where I provide care to four generations within the family. We do not see patients episodically; we know their stories. It gives me the ability to treat a person in their entirety. When discussing diet during a visit for diabetes, I know what food security issues they're facing. If assessing readiness to quit smoking, I can gauge their motivation after a recent COPD flareup, or conversely, choose to say nothing at all, because I know that their acute priority is caring for a loved one with dementia. Behavioural modification science shows that wellness comes from small, brief interventions and discussions over time.

 

Our province has done a great job of standing up interim measures to help patients access care. However, unintended consequences can be fragmentation of the system and a shift towards transactional care. These services might address a short-term access problem, but they continue to operate in a disease-based model of care.

 

The disease model of care is where there is identification and treatment of a problem, which is also harder to do if you don't know the patient. We need to shift to a wellness model of care, where prevention and ongoing lifestyle improvements are paramount. This requires longitudinal attachment. That is what makes family medicine effective and economical for the system.

 

We know other providers are incredibly valuable and enjoy working with them. For example, the primary care pharmacy clinic in Windsor where I work is a great example of how my patients can access care for minor ailments, and with collaborative communication, I remain part of the care circle. We support innovation and all care providers working together to their full scope of practice, but it needs to be thoughtful and preserve the relationship that binds together the patient journey. To build a system that works, we need a structure that values long-term relationships, team-based care grounded in family physician leadership, and policies that support retention. The risk of siloed care and prioritizing access over attachment is a system that costs more and delivers less, but if we get this right, the return is enormous for our patients, for our system, and for the future of health care in Nova Scotia.

 

To guide the critical work ahead in primary care, we recommend the establishment of a primary care action team dedicated to shaping the vision, supporting implementation, addressing challenges, and evaluating the impact of the health home model.

 

THE CHAIR: Dr. Newman.

 

DR. COLIN NEWMAN: Thank you for the opportunity to speak with you today. I'm Dr. Colin Newman. I'm the president of the Nova Scotia College of Family Physicians, which represents over 1,300 family medicine specialists in this province. More importantly, I've worked in full-scope rural family practice since 2012, and for the past 10 years have had the privilege of working in a high-functioning collaborative practice in Annapolis Royal.

 

The College of Family Physicians of Canada is primarily responsible for establishing standards for family medicine training. However, as the crisis in primary care deepens, we are increasingly acting as a voice for family physicians on both a provincial and national level. The members of our college are acutely aware of the importance of longitudinal patient attachment to a family physician. We build relationships with our patients and their families over a lifetime, and this deep-seated relationship allows us to provide high-quality, cost-effective, and patient-centred care in our communities.

 

As we discuss this important issue today, I want to emphasize that attachment goes far beyond patients simply being rostered on paper to a provider. It's about an ongoing relationship with a robust care team, led by a family physician trained to provide comprehensive and holistic care to their patients. The CFPC has created the Patient's Medical Home model, which outlines how these types of collaborative practices can be developed to provide the best experience to both patients and providers working within them. We strongly support the development of these types of practices across Nova Scotia.

 

As my colleagues from Doctors Nova Scotia have mentioned, the new Longitudinal Family Medicine payment model has demonstrated real benefits in recognizing the value of community-based family medicine. As we move forward with the new model, we need to ensure that there is room to include and expand the critical areas of collaboration and education that family physicians undertake in their offices daily. We want to ensure that this model reflects the true breadth of work that family doctors do and supports a work environment that attracts new physicians to the province, and retains the dedicated family doctors currently in practice.

 

While there are many ongoing initiatives to solve the primary care crisis, education is the most long-lasting and sustainable. Increasing medical school enrolment, creating positive learning environments in family medicine, and providing high-quality community-based family medicine training to our graduates is the pathway to putting more well-trained family doctors in our communities and ensuring that all Nova Scotians have access to the care that they need.

 

We are seeing real progress and there is momentum building. With targeted support for attachment, collaboration, and teaching, we can build a stronger, more sustainable primary care system in Nova Scotia.

 

I'll hand it over to Dr. Hawker, who is the president-elect of our college.

 

THE CHAIR: To say your name properly: Dr. Hawker. I apologize for saying it wrong the first time.

 

DR. LEISHA HAWKER: No worries, I get it all the time. I'm Dr. Leisha Hawker, pronouns she/her. I'm a family medicine and addiction medicine specialist here in Halifax. While Dr. Newman's a rural medicine expert, my area of expertise is more inner-city health. I provide comprehensive primary care at the Newcomer Health Clinic, which I co-founded just over 10 years ago, and I provide addiction medicine care at the North End Community Health Centre and the Recovery Support Centre in Dartmouth.

 

What I love and value the most about my clinical practice is the long-term relationships that I build with my patients. The North End Community Health, which Dr. Wilson's very familiar with as we worked as physician colleagues when he was executive director there, is a really unique health centre. It's more than 50 years old. It was started by the community. It has a robust allied health professional team including mental health support, dental care, housing first, and, I would say most importantly, the Mobile Outreach Street Health team as well.

 

In that community, I see patients who are on the margins and often have a hard time accessing what I would call traditional primary care. The North End Community Health Centre is an excellent example of a medical home, and at the addiction clinics where I practise, unfortunately about half of my patients don't have this access to a medical home. Those who do have access to a family physician or other primary care provider, some of their wait times are anywhere from two weeks to up to three months.

 

At the Newcomer Health Clinic, we're struggling with health human resource shortages right now. We can't really turn off the tap. The refugees are coming in and, unfortunately, they're not being seen for their post-arrival health assessment in a timely manner. My follow-up visits are currently booking into November, and that causes me loss of sleep at night. That drives home the important point about access and attachment because attachment does not necessarily mean that the patient has access to care.

 

Family medicine is the foundation of our health care system, and family physicians are poised to be the leaders of the medical home teams. We need to continue our efforts to improve both access and attachment as every Nova Scotian deserves timely access to medical homes and family physicians.

 

THE CHAIR: I'm going to allow Dr. Boutilier to introduce herself.

 

DR. NICOLE BOUTILIER: Good afternoon. I apologize for my late arrival. I'm Nicole Boutilier. I'm a family medicine physician by training and I am currently the executive vice-president of Medicine and Clinical Operations at the Nova Scotia Health Authority.

 

THE CHAIR: MLA Mombourquette, if you want to introduce yourself, sir.

 

HON. DEREK MOMBOURQUETTE: I apologize for being a few minutes late. I'm Derek Mombourquette, the MLA for Sydney-Membertou. Thank you all for being here.

 

THE CHAIR: There's a lot of construction on the highway, so it's understandable. What we do is 20 minutes for each caucus. The first will be the NDP caucus, and it will be MLA Wilson.

 

ROD WILSON: Just for the record, Dr. Hawker, you are right. The North End Community Health Centre was collaborative health care founded on November 11, 1971, way before the models became thought of, and there's been evidence in supporting that.

 

Before I speak to the numbers, I have questions about - we heard there has been improvement. We've also heard that there are a lot of challenges, and I want to speak to some of those challenges. A few months ago, Cathy Croskery told the CBC about her experience of nearly missing test results confirming that she had breast cancer because without a family doctor, she had to navigate, get the appointments, get the follow-ups, understand them, and interpret them. That takes a high degree of ambition, a literacy to access that care and navigate a very complex system that even I find difficult as a patient.

 

Most recently, as an emergency doctor working in Yarmouth, my good friend and colleagues (inaudible), I unfortunately - regrettably - had to tell a person based on their presentation and their exam that they most likely had prostate cancer. That person had been without a family doctor for at least five years and did not have attachment or access to screening and early detection.

 

We can speak to the numbers, but I think we need to keep it real for people's experience across Nova Scotia. My question is for Ms. Oldfield or your team: What do you say to people who are struggling to get the care they need and also struggle to navigate the system, especially with an inequitable and unequal distribution of physicians and specialists across the province?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: Let me start. The first thing is every story I hear, whether it is word of mouth, somebody meets with me, or I read it in the newspaper, my heart goes out to anybody who's in the position of being anxious about their health care, about test results, about navigating. For me, personally, it strengthens the desire to find the solutions. Solutions are not always easy, and they're not always the same solution for each person.

 

[1:30 p.m.]

 

Somebody in the introduction talked about the importance of education. While that's not a panacea, and I'm not suggesting for a minute that it is, I think that a large part of what we need to do, and where this committee is particularly helpful, is to educate Nova Scotians as to the various paths that are available and can be pursued to get information about their own health.

 

I'll start with that. I fully recognize some of the challenges around early screening and around test results, particularly in cases where people do not have a provider, whether it be a family physician or a nurse practitioner. I think part of what we need to do is specifically set out what the paths are that somebody can take if they need to find out information and they find themselves in that situation. Either Dr. Boutilier or Katie can talk about those specific points.

 

THE CHAIR: Dr. Boutilier.

 

NICOLE BOUTILIER: I think it's really important that we - we've heard a lot about attachment and also connecting people to care and longitudinal care. I think we have a combination of both going on in the province. The attachment's improved to 92 percent, and then we have the questions about timely access. Then we have the over 800,000 appointments that have been created for access, which can also connect people who are unattached into regular longitudinal care through the primary health care clinics.

 

When we send out the letters to folks who are waiting on the list, we actually spell out all the navigation that they can take. We also have a 1-800 number where patients can call, and we can help them with the navigation. We also have their ability to connect with us by email and connect with the care. We have a request-for-care form that can come from anyone. We also have this ability to - if we look back to the prostate cancer example in particular, in the emergency room, ensuring that that person is on the list and can be connected to care, especially when they have a change in health status.

 

One of the big things about all of this work we've been doing on the NFPR has been really to transform it from a list, where we didn't know anything about conditions or what kind of health problems people were having, to actually taking the time with those thoughtful questions and having people do the health questionnaire. We can really make sure that we're connecting people to care when they need it.

 

ROD WILSON: Thank you for acknowledging there's more work to be done and a desire to challenge that. I have to be regrettably skeptical when we heard the numbers went from 106,000 to 87,000. Why am I skeptical? Because as of August 26, 2024, the government stopped releasing where the unattached patients were. We have no idea. Any of the 55 MLAs who sit in this Legislature - unless you have access to other information that we don't - do not know how many unattached people are in their constituency.

 

Also, my skepticism is further enhanced - we did a FOIPOP for March of 2025. We were informed that 4,000 Nova Scotians added their names to the Need a Family Practice Registry, when I think the release was there had been a 2,000 reduction. We have to get information by FOIPOP. I'm just a bit concerned. Pardon me for being skeptical and cynical, but why not release the full data - when, where - so Nova Scotians know where improvements are being made and when they might expect to be attached, followed by access to a family physician?

 

KAREN OLDFIELD: I'll start. Number one, I hope that you leave here today with less skepticism and less cynicism. I'll tell you straight up that at the outset, when we initially suspended the former report in order to start a validation process, I was very clear then that we'll not go back to that specific report until we had completed at least the first round of the validation. There were so many different errors and kinds of errors in the original list that required the validation in the first place. We are not quite finished what I would call the first round of validation.

 

There are approximately 27,000 more people to be validated. I would expect that work to conclude at some point in the fall. I also want to be clear that I don't see the validation ever finishing. I think, as you say, people come on the list, they go off the list, people move from Nova Scotia, they move within the province, physicians retire, they go to a different level of work. This is ongoing, and it's continuous evergreen work. I would see some form of this validation work continuing.

 

When the first round is completed, we will issue a report. We will likely send that to the Department of Health and Wellness. If asked for recommendations, we would certainly send recommendations in terms of what an ongoing report might look like, because we have so much more information at our fingertips now, partially as a result of the validation process, but also because of many other forms of data that we are now able to collect.

 

I would just conclude by saying that the number that is released every month is a net number. It is not a gross number; it is a net number. The example that you refer to: You indicated that you had submitted a Freedom of Information request with some 4,000 - I think that case was 4,200 people had added their names to the list. The next month, a number of those people, if not all of them, would have been removed from the list, and the number that was issued publicly would have been a net number. People coming off the list, in addition to people putting their names on the list, who also came off the list.

 

I hope I've answered that completely. If not . . .

 

THE CHAIR: MLA Wilson, do you need more, or are you good? I just wanted to know if you needed any more answers. MLA Wilson.

 

ROD WILSON: I couldn't hear because of the echo, and I'm also getting old. I don't want to misquote. Did you say there's further data of 27,000 people who need to be validated, and you hope to have that done by the fall? I didn't understand how much.

 

KAREN OLDFIELD: Yes, I indicated that there were remaining to be validated approximately 27,000 Nova Scotians. That would be on the list as of today, not those who may add their name to the list and not those whom we continue to validate every day. That's an approximate number. Based on the rate upon which we're validating, I would look for that to be complete at some point in the fall of 2025.

 

ROD WILSON: Would you be able to provide the data for the first six months of 2025, the number of people who were added and removed for each month, from January to June of 2025?

 

KAREN OLDFIELD: Yes, we would have that. Just let me find it and we will give you the exact dates and the numbers.

 

THE CHAIR: Did you want the data now? That's what they're going for. They're not going to get the report; they have it with them. Ms. Oldfield.

 

KAREN OLDFIELD: Chair, the numbers are as follows: These were individuals added to the Need a Family Practice Registry in the year 2025. For the month of January 2025, 3,053. For the month of February 2025, 1,174. For the month of March 2025, 4,502 Nova Scotians. In the month of April 2025, 2,853. In the month of May 2025, 4,811. For the month of June 2025, 3,596. For the month of July 2025, 5,001.

 

ROD WILSON: Those were added at the - that number's correct. If I've understood, it's number added per month, correct?

 

KAREN OLDFIELD: Yes, individuals added to the Need a Family Practice Registry in 2025.

 

ROD WILSON: Are you able to share that breakdown by zone?

 

KAREN OLDFIELD: I'm sure I could get that. I do not have that with me at this moment.

 

THE CHAIR: The clerk has made note of that. MLA Wilson.

 

ROD WILSON: Thank you for that. That's really helpful. For family medicine colleagues, you have spoken a little bit to this, Dr. MacDonald Green. You spoke quite eloquently about transactional care, and I really liked the highlight that both Dr. Newman and Dr. Hawker spoke about: the difference between attachment and access. There are different points of access. There's virtual, there's pharmacy, there's mobile clinics, yet they all have, in my understanding, different records, and it's episodic when off care.

 

As family physicians, what impact, if any, are you seeing when those people come from the list to your practice who've had episodic care with different medical records?

 

THE CHAIR: MLA Wilson, who would you like? Or who wants to put their hand up? Dr. MacDonald Green, correct? Okay, thank you.

 

AMANDA MACDONALD GREEN: I've had a pretty full list in the last couple of years, but my practice colleague is onboarding now, and she finds it very difficult to sort out what's been done, when they might need a colonoscopy in the future, et cetera. In terms of the siloed care, it can be quite challenging. I do have pretty good access in my clinic because of the model that I'm working in, but there are a number of patients who may seek a private Maple appointment for convenience or other access points.

 

It can be frustrating, a little bit, when I see the patient and I don't know that they've already been treated for X, Y, or Z, or what antibiotic, how many COPD exacerbations they've had, et cetera, because I'm not part of that care. The pharmacy clinic in town is great. They notify me right away: what they've done, what they saw the patient for; but if it's access points elsewhere, it's hard to navigate, and we see gaps with that.

 

I have a patient who was treated for UTIs through a private, paid - Maple - platform a couple of times. I had no knowledge of this. She was treated one or two times in a pharmacy clinic and then was having continuing symptoms. Ultimately, when I saw her, examined her, and got a full history, her symptoms were secondary to a cancer, which had kind of fallen through. I still don't have any records from Maple - what antibiotics she was given. We do see those gaps in care where you can't collate all the information.

 

In our area - in the West Hants area - it's unique in that our EMR is a shared EMR throughout the network. Most clinics and providers have access to that, and it does make a huge difference. If I'm seeing a patient in an after-hours, urgent clinic environment, I have their entire record and when they saw their family physician last for this, what medications, et cetera. It makes the quality of care that I can deliver in that much different than when I'm in the emergency department and you're seeing someone in a one-off. I think the more access we have to that, the better care we can deliver, and the fewer things fall through the cracks.

 

ROD WILSON: Dr. Hawker, do you think every Nova Scotian who doesn't have a family doctor is on the registry?

 

THE CHAIR: Dr. Hawker.

 

LEISHA HAWKER: Negative. Working in addiction medicine, many of my patients aren't on the list. Navigating the health care system is really challenging when your biggest priority is that you're sick from withdrawal or where you're going to sleep that night. The biggest thing I do, probably, at Outpatient Withdrawal Management is actually health system navigation. I'm explaining how you download the YourHealthNS app because if you don't have a family doctor, it's really convenient to have all your records in one spot. That way, if you are in emerg or a walk-in clinic, you can show them your last blood test or what meds you were last prescribed.

 

[1:45 p.m.]

 

I recently had a patient who had a breast abnormality. This person was coming in for alcohol withdrawal, but I can't take my family doctor hat off when they have other symptoms and other complaints. Helping them get a mammogram and a timely ultrasound - driving up to Antigonish, I think it was, to get it in a timely manner. If she was going to a walk-in clinic, I don't know how well that would have gotten coordinated and had that follow-up to make sure that was getting done and that the next steps were being taken.

 

At the addictions clinic, a lot of times people haven't had their lung cancer screening or their colorectal cancer screening or their pap test or their mammograms or things like that. I'm constantly making sure that they're aware of all the avenues - all the pathways that Karen speaks of. There are a lot more pathways now, but a lot of my patients - kind of average Nova Scotians - aren't aware of them or don't know how to navigate them.

 

ROD WILSON: Dr. Newman, do you have any thoughts?

 

THE CHAIR: Dr. Newman.

 

COLIN NEWMAN: No, I would just echo what Dr. Hawker said. I work in an urgent treatment centre where we see unattached patients frequently, and many are unaware of the Need a Family Practice Registry. We educate them to the best of our ability - people who have moved to Nova Scotia, people who live rurally with minimal internet access and fairly isolated. Certainly not all are captured, although we do our best to make sure that they're aware.

 

I would echo Dr. MacDonald Green's comments as well about the episodic care. Certainly many of my patients, because of geography - when my patients move to Halifax, they keep me as a family doctor even though I'm two hours away, because they can't get another. But those patients, geographically, may need to be seen in other mobile clinics and things like that. Generally speaking, they're seen for kind of acute short walk-in-type issues like urinary tract infections or tick bite or things like that. When they get into more detailed or more complex issues, generally it's deferred or very minimal past medical history is assessed or any kind of investigation is done, and we get very minimal information back, for the most part.

 

I am certainly very much in favour of any access point for Nova Scotians in a situation where they have difficulty accessing health care, but the goal in the future should be that those are temporary access points that would be wrapped into a collaborative health home so that we would provide that 360-degree care so that these things wouldn't be falling through the cracks.

 

THE CHAIR: MLA Wilson, 21 seconds.

 

ROD WILSON: Quick question - it sounds like you're doing your best, but people are going uphill and facing many challenges. That must be discouraging at times?

 

COLIN NEWMAN: It can be. As you know, the health system can be a challenge to work in, although I would say that we have seen progress. For example, the primary care clinics now are taking over some of those complex patients who have moved to the province without a family doctor . . .

 

THE CHAIR: Order. I apologize. For the new ones, after 20 minutes I have to call order. I apologize.

 

MLA Rankin.

 

HON. IAIN RANKIN: Thank you all for being here on an important discussion around access to primary care. I will note that there have been some marked improvements in terms of opening up pathways. That was recognized, I think, broadly in terms of access to pharmacy clinics and such but accessing consistent primary care has been a challenge for this government over the last few years. Despite heralding the success of decreasing the list recently, that was only after ballooning the list up to more than double what it was back in 2021. That's just the Nova Scotians we know who don't have access to a consistent primary care team.

 

I'm not sure that all Nova Scotians would agree with the statement from Ms. Oldfield that gone is the goal for a physician for every Nova Scotian. I still think that Nova Scotians want to have access to a physician on a consistent basis - maybe an entry point as a team, but ultimately, because of the scope - the comprehensive scope that was mentioned today, there is value in that.

 

I want to talk about this so-called new initiative of health homes. Mr. Stevenson, you mentioned that there are now 118 health homes. You mentioned that this is a new initiative. I wonder if you could explain to me - are those all 118 new collaborative care centres? I think they basically are. Maybe you can describe what the difference really is from a collaborative care team, which has been supported by previous governments that go back quite a way, and the new model of a health home.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: I'll certainly start and ask my colleagues from the Nova Scotia Health Authority if there's anything else they want to add around some of the criteria with respect to the maturity of a health home. They've been doing a lot of work around the health home model - how that's developed, characteristics associated with it, and the demographics that they look at to try to ensure that they have the right support from a practice environment within geography to function as that particular model.

 

The 118 number includes collaborative practices that would have formerly existed within the province - so there have been growth and developments. I believe as of August 2021 up to approximately March, there'd be 68 existing practices that would have been strengthened and matured more into a health home. Fifteen more are currently being strengthened, and 23 total new health homes were implemented within the province over that period of time.

 

IAIN RANKIN: Could 23 new health homes be simply adding a specific FTE? What constitutes a new health home?

 

COLIN STEVENSON: A new health home would be new location, new providers working within that particular environment as opposed to strengthening something that was in existence. Some of the strengthening - and again, Dr. Boutilier and team would be able to give specific examples and expand more - but there would be some individual practices or small group practices that - through augmentation of providers and supporting them in the sense of their approach to onboarding. We've heard examples around shared electronic medical records, ensuring comprehensive care, and expanding types of providers to expand the types of services and supports that are available within that environment. Those could qualify - associated with strengthening an existing environment. New is generally looking at new location, new team of individuals coming together in order to take on a new population of patients.

 

IAIN RANKIN: Maybe I'll ask it another way because I don't know any collaborative care centres that aren't recognized as health homes, at least within our area. Virtually all the clinics around the Timberlea-Tantallon-Prospect area, they've been collaborative care centres for decades now, and I think they are all listed as health homes. I'm just trying to figure out what's different for patients who go into these collaborative care centres or is this more of a branding strategy for government to call something a health home when it is, in fact, a team-based approach system that's been operating for a long time.

 

COLIN STEVENSON: You can have a team-based approach, but it wouldn't necessarily meet all the qualifications or requirements to be truly functioning as a health home. Maybe I'll ask Dr. Boutilier or Karen Oldfield from the Nova Scotia Health Authority if they want to highlight some of the differences or characteristics associated with the health home and the maturity model that's being looked at.

 

THE CHAIR: Dr. Boutilier.

 

NICOLE BOUTILIER: Collaborative family practice teams and the evolution to health homes is - you're right, there are a lot that were established and worked, then there have been increases and there's been strengthening. Some of the ones that would currently now be collaborative family practice teams, they may have smaller teams that don't fit into the definition of what we've said is going to be our definition for health homes.

 

Someone had referenced earlier the College of Family Physicians of Canada model. We have based how we are approaching the health home on that model, as well as data that we received from the OurCare report, which was that people and practitioners in our own area provided lots of things that they would want to see in a health home.

 

Part of the health home structure is also creating health neighbourhoods so that - we've heard a lot of talk about the siloed care in different pharmacies, mobile clinics, and other ways to work. Really, the health home would be taking this and existing in a health neighbourhood.

 

As we evolve the health home strategy, some of the things that when you talk about the strength - I'll just go back a little bit to what was said. Since 2021, we've added about 275 practitioners to the multi-disciplinary team within primary care. We currently have about 918 people working in collaborative care. Given what people were looking for in their clinics - there's also a new program with the last master agreement that allows a professional to be hired by a family physician and be supported. That also is what the physician was looking for to support their practice best.

 

Some of the other things that we put into place to try to really get that team working as cohesively as possible - and as we've heard also today a lot, the family medicine specialist is a core member, the person who is the highest-trained in that environment who would navigate care amongst their teammates.

 

The health home is really about everybody working to full scope - we've heard that today - and really making sure that the patient is seeing the right person they need to see that day. It's really about the team strengthening, the way we evaluate the health home and their outcomes. We look at things like practice support where we've gone in and done multiple interventions. I think there were 500 and some last year, with either family physician offices that were in trouble or needed help, whether it's with improving access or flow in their actual clinic, or if it was strengthening their electronic health record.

 

There are many projects going on. This is really getting to the place where we have health homes everywhere. They're well-established. Everybody knows where they are in the community. The patients flow in and out regardless of where they come from and when they're moving into a community. That's the vision for the future - to have them all connected in health neighbourhoods, health homes for everyone.

 

IAIN RANKIN: Thank you for the answer. Some of that is helpful in terms of the incremental FTEs and the 23 considered-new clinics. I'm still not seeing a full, new vision in terms of what was there before. I think Hatchet Lake was a pioneer with this - some of these doctors funded their own nurses with their own compensation model. There's a physio centre next door. There's always been a drug store there. Again, there's been some success with the expanded scope, but if we are to look at the 275 new practitioners that are in the system, it just begs the question: Is that enough with the population growth in our province, with the aging population and further complications with patients?

 

If we're looking at those numbers, and I look more specifically at the last announcement, we have three new clinics at some point taking on about 20,000 patients. These clinics - we're talking about 10 FTEs each. It doesn't take long to get to 270 new practitioners. I'm just wondering what the timeline is for these clinics. Do we have enough announced to get to a point where we're actually going to make traction beyond getting back to the baseline of where we were in 2021? We're still not down to that baseline level.

 

My understanding is that there are 250 patients at that clinic. How long would it take to get to that 8,600 level at the Hobsons Lake Health Home and have a full complement of staff - six physicians, two nurse practitioners, three family practice nurses, and then you have a couple of LPNs in there too?

 

THE CHAIR: Dr. Boutilier? I'm not sure who . . .

 

NICOLE BOUTILIER: Yes, I can take that, thank you. There was an announcement for the Halifax region. The Hobsons Lake Health Home will take 8,600 patients from the registry, the Citadel Health Home will take 6,000 patients from the registry, and the Needham Health Home will take 8,600 patients from the registry. Some providers have already arrived at Hobsons, as you're referring to, and they've begun seeing some patients. Over the next 12 to 18 months, as the providers arrive, the health homes are expected to welcome all of the 20,000 people from the registry.

 

When we're adding them like that, when it's all new providers and a new site, we add them in a gradual fashion so that people have the access that they need. They may find out that they've been attached and they'll be getting - we have nurse navigators who provide forms for people to start to do intake; we have a rapid onboarding team. We're doing everything we can to get patients into the practices as quickly as we possibly can, once the providers arrive, and actually supporting the physicians.

 

We have a lot of family physicians in the room, and some of them mentioned their residents earlier. The new providers who start, they need a lot of support. We are trying to make sure it's as great an experience for them to come and stay and retain the physicians here as well. That's one area where we're having people come in, but recruitment is going well. The LFM model is really helping us to attract people. Our access is coming from actually new providers in the system.

 

[2:00 p.m.]

 

IAIN RANKIN: Do we have a timeline on that so we can actually see how many of these new clinics we need to start? I think it's going to take years to get to the 20,000 and get your fully complemented staff. Just looking at the numbers - quick math - you're going to need another dozen of these across to keep up with growth, to keep up with everything else and the HR complications around trying to attract physicians to these new clinics.

 

NICOLE BOUTILIER: We have been very cognizant of that. There are some really smart people on our teams who develop forecasting models for population, for health of the population, for different data inputs that we have now, and they've developed forecasting models that can tell us what we might need into the future over the next 10 years, and also from all the inputs that we have because we do have a lot of inputs coming.

 

When you look at the Cape Breton Medical Campus, for example, there's going to be just an influx of physicians who we'll be able to keep retaining over time. The increases in the number of family medicine positions in residency across the province has increased in the last several years. We've also had medical school enrolment. We've had an improvement of people joining residency programs. We have improved international pathways for many physicians being recognized who weren't previously recognized or without exams. We have the PACE clinic, which is actually assessing international physicians faster, and we'll have an input to that as well.

 

When we look at the forecasting that we're doing with the population changes, depending on those variables that we've put in, we can look out and see a steady state coming. It could possibly be as early as 2028, and certainly by 2032 we see that really stabilizing.

 

IAIN RANKIN: Okay, so over the next three years - so 2028 - how many graduates from the medical school in Nova Scotia have applied to be a family practice physician in the province? Do you have those numbers?

 

THE CHAIR: Dr. Boutilier, would you have that or is it somebody else?

 

NICOLE BOUTILIER: All the family medicine positions every year?

 

THE CHAIR: Is that something you can get back to us? Dr. Boutilier.

 

NICOLE BOUTILIER: I don't want to say the wrong number. We've got a lot of physicians.

 

THE CHAIR: MLA Rankin, we'll add it to the list, if that's okay? MLA Rankin.

 

IAIN RANKIN: I think it's important. I just want to underscore . . .

 

THE CHAIR: Sorry, one second. I got warned - did somebody have it? Hold on, MLA Rankin. Dr. McNeil, I apologize. Thank you, MLA Lachance. Dr. McNeil.

 

SHELLY MCNEIL: In the past, conventionally, about 58 family doctors have been trained in Nova Scotia each year. In 2025, that number of seats has increased to 114, so almost double.

 

THE CHAIR: MLA Rankin, does that get you your answer?

 

IAIN RANKIN: Yes, sure. As an MLA, we hear about these issues anecdotally all the time, the access to care. My colleague brought up one case of someone not being able to access primary care so they can look to get diagnostic imaging, specialist referrals, procedures like biopsies, imaging, and that can result in, God forbid, a late diagnosis of Stage 4 - Stage 5 cancer. Given that the numbers were so high in the last few years, do we have any - are we tracking any data in terms of Stage 4 and Stage 5 cancer in patients in Nova Scotia? Do we know that if there are fewer people who have access to primary care and therefore aren't seen when they need to be before it's too late, are we tracking that?

 

NICOLE BOUTILIER: We wouldn't have those cancer statistics at our fingertips today to provide, but I can say we have created 860,000 more primary access appointments. In particular, when people are unattached, they have a direct path to seeing a provider. That's one thing that we would want. You said, as an MLA, getting those questions, we really would want people to direct them back to our 1-800 number or email because we can absolutely help navigate those folks to the right place; 811 is doing a lot of navigation now back to our primary care clinics. We have connections with virtual urgent care in emergency rooms directly to the primary care clinics. We're really trying to not narrow those silos, provide that temporary access, and get them into a system where they can get comprehensive care because that is the goal.

 

IAIN RANKIN: Just a question again on the access points. The mobile care clinics have been, I think, effective, sometimes in alleviating the lineups at the ER. I've seen it myself, bringing the kids there on a weekend to Cobequid. When you look at the map, there's not really good coverage across the province. Right now, there are a handful in Halifax and there are two down towards the South Shore. Has there been a step back in terms of investing in these mobile clinics? There's definitely not good coverage in the province - there's a disparity regionally - but also, just the fact that there are a lot of Nova Scotians who could benefit from that access and not go directly to the ER. We're seeing ER closures. We're seeing long lines in the ER that are not getting any better.

 

NICOLE BOUTILIER: I think what you see with the mobile clinics is, we look at where we need access the most and put access into the communities where there is the highest need. Sometimes it depends on what else we have in communities. If we have a UTC or we have other things that might support the mobile clinics, it would be better to have them doing something else in that particular community. We have a bit of a flexible workforce in that we would look at our need and really monitor the usage or what is going on in that particular community - like what you spoke to, like an ED closure or something else that's happening around that time or that particular geography.

 

THE CHAIR: MLA Rankin, one minute and a half.

 

IAIN RANKIN: My time is coming to an end, but I would suggest continuing to look at those clinics, even from a retention perspective of family physicians. I know some who do practise in these collaborative care centres that have been around for a long time. Some of them actually supplement some income from working in these centres on the weekends. You're in and out pretty quick, so it prevents people from clogging up the ERs. I just want to encourage you to look at the investments. I've noticed a pull-back, at least if you look at the map online, that there's not good coverage.

 

NICOLE BOUTILIER: Since the institution of the LFM, there's been a 58 percent increase, I think - 53 or 58, something like that - in the amount of after-hours and weekend care that's been provided. That's been another exceptional outcome from the LFM model. We are seeing physicians choosing to work longer hours and at different times.

 

THE CHAIR: We'll go to the PC caucus. I believe it's MLA Hilton - 20 minutes.

 

NICK HILTON: Thank you all for being here. I started the day today by receiving a message from my community navigator that the Yarmouth Regional Hospital had two ER physicians arrive this morning, along with another family doctor to follow in the next couple of weeks. I truly believe that the differences that are being made by all of you and the Nova Scotia government are being felt across the spectrum.

 

As an LPN who has worked in the community for the last few years, I personally felt that difference. It was the first time that I felt that difference in a number of decades. To hear CEO Oldfield talk about the motivation and drive to continue to find solutions and to even be able to share the numbers of people added to the Need a Family Registry wait-list - I think it's important that Nova Scotians realize that we are being upfront with them, that we care about their needs, and that we are working every day for their welfare.

 

At the last Health Committee meeting, we had Dr. Aaron Smith here. He's the provincial medical executive director for primary care clinics and the health home model. A quote from that committee meeting is: “Nova Scotians are receiving world-class care in primary care and across the acute care realms.” I truly believe that, and I think it's important that we convey that to Nova Scotians. It's important for them to believe in their health care system. I think for the first time in a long time, that's a possibility. Thank you again for all of the work that you're doing.

 

For the Nova Scotia Health Authority, a question would be: Can the Nova Scotia Health Authority talk about the system-wide impacts we are seeing due to expanding primary care and urgent care options?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: I can start. I appreciate the words. The education component - we've all talked about it, or it's been mentioned more than once. It's so important. The pathways that can connect people to the right care in the right place, whether they are attached or unattached - it's imperative that we get this word out. Notwithstanding we think we communicate, we know we don't communicate enough. That's as a collective. We have to get this out, because people just don't know.

 

With respect to the impacts, we do have a lot of data. We could do a data dive on impacts, but perhaps I'll just do some anecdotal. We do know for sure that all of the access that's been created over the past number of years has led to a general overall decrease in the number of visits to emergency departments across the province. That's a generalization, not a specific, and it's always different times of year, but we can track what access means, particularly for CTAS 4 and 5. We can draw some direct correlations to that.

 

We can also see from our evaluation and data relating to YourHealthNS how many people are using it. There have been, to date, close to 850,000 downloads of a province of 1,080,000. That's a massive number. What people want is access to their records. That helps a great deal. As Dr. Hawker said, it even helps when somebody pulls it up in her office, perhaps, or in another provider's office who doesn't have access to that record. That's an impact, because they have it right there in the palm of their hand. They can also take and have greater autonomy in their own health journey, which is very important to many Nova Scotians.

 

Impacts are numeric. They're qualitative. They're quantitative. I could go on. Where do I even take this conversation? I don't know - as a front-line person, I think maybe Katie could add how this list work that she's doing impacts Nova Scotians.

 

THE CHAIR: Ms. Heckman.

 

KATIE HECKMAN: I do believe that we're creating a lot more access points for these patients, and also allowing more opportunity for them to know what's going on with their care and how they can access care. That back-and-forth two-way communication is relatively new for us in this space, and truly able to respond to the individual needs of patients.

 

I also think there's been a lot of strengthening that's happened between service areas within our health care setting, which can further help to link those patients and connect them to the care they need, whether that be follow-up from specialty services or otherwise.

 

NICK HILTON: Thank you for the answers. The Longitudinal Family Medicine - LFM - payment model has changed the payment structure for family physicians. How does it help increase attachment and access? This is for the Department of Health and Wellness.

 

THE CHAIR: Ms. Palmer.

 

BARBARIE PALMER: The Longitudinal Family Medicine payment model was put in place to address attachment, access, and increased remuneration for physicians. One of the ways - or a couple of the ways that it does that - it's a contracted-based funding modality. What it means is we have physicians who are committing to the longitudinal care of a patient population. It has flexibility so that physicians get paid for the patients they attach - for each additional patient they attach.

 

Also within the contract, we can make sure that physicians commit to a minimum of 46 weeks of access to that patient population, which means that they're there, they're present, and there will be an increased relationship over the course of that patient's health journey with that health home and that physician.

 

Also, the ability to be able to incent evening and weekend access means that there's a lot more flexibility for a patient population, as well as the ability to - since COVID, obviously the uptake in virtual care doesn't just extend to things like VirtualCareNS. It also extends to your ability to be able to access your primary care provider in a virtual way. That flexibility is all inherent in the LFM, while also making sure that physicians receive the competitive compensation and the flexibility that they need to make sure they can adapt to the needs of their community and their own family, which really speaks to recruitment and retention and the reason LFM is such a significant tool in our arsenal to make sure that we can bring more family physicians into the province.

 

[2:15 p.m.]

 

THE CHAIR: MLA Fadare.

 

ADEGOKE FADARE: I want to say thank you to everyone for being here today. I want to just say to the Nova Scotia Health Authority: You guys do an incredible job. Just listening to what Heckman talked about regarding the registry list not just being a list - people have a story, people have experiences, and all that (inaudible). I think it's remarkable.

 

Some of these I've heard today is, I've seen we've had increased capacity and access. I can see the strengthening of the workforce and recruitment. I can see that primary care infrastructure is increasing. I can also see that technology is also improving within the health care sector. I want to basically just quickly ask the Nova Scotia Health Authority how technology has helped with what we're doing. I just want you to talk a bit more, because I know you spoke a bit about the YourHealthNS app. How does this support the entire journey? One of the things we heard today is based on individuals saying that people are not aware of some of these things. We also heard about 800,000-and-some people have downloaded the app. Can you just talk about how this supports the journey of the average Nova Scotian in accessing the app and the entire journey in accessing primary care in relation to health in Nova Scotia?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: I just made a couple of notes here to myself in terms of breaking down that question. I will come back to the app, which unifies all of it, but other aspects of technology which are relevant to the conversation, of course one being VirtualCareNS, which is separate but also flows into the app and being available in an unlimited fashion for those who are unattached to a family physician or a nurse practitioner, but also available in a more limited fashion to those who are attached, but for whatever reason can't get in to see their provider as quickly as may be required. They have access to two free visits a year.

 

Also, other elements: virtual urgent treatment. Just in preparing for today, I was given a notice that the emergency department in Windsor is closed today. That's bad news. The good news is there's a virtual urgent treatment option available. I'm not suggesting that solves every problem, but it solves an element of our problems, and it helps.

 

The Virtual Hallway is another aspect of what impacts. It's technology, it's a partner that we're using. It's a group of physicians who have found a way through technology to connect a family physician with specialists to determine whether or not that specialist is required or not required, as the case may be, to see a particular patient. It's almost like walking down the hall to speak to the specialist, although it's all done virtually. It saves time. It saves effort. It helps the patient.

 

Many of these pieces of technology wrap up into YourHealthNS. I think going forward, YourHealthNS is and will continue to be a fundamental part of how an individual Nova Scotian navigates their health. Records will continue to be placed on the app as quickly as we can, as they can be made available. That gives a great deal of autonomy but also comfort to people when they can see their lab results, or whatever it may be, as quickly as possible. It's in their hand. They don't have to go to someone's office to see it. They can see it on their phone or on their computer. We know that's important to people just because of the rate at which they are seeking the records every single day. There's huge usage for that.

 

The goal for YourHealthNS is that we create the patient record - the single source of truth, which is there in the patient's hand. We're close to that, and it's leading work in the country. I'm not blowing my horn here; I'm blowing the horn of the people who do this work. They're in the trenches coming up with this, finding ways to make it available to impact Nova Scotians and helping Nova Scotians. I can tell you conclusively, because I get calls from across the country: How are you doing this? Can you do a seminar with our folks? Can you teach us? Can we connect with your folks?

 

This is a good thing, except I don't like taking too much time away from our own work to share with everybody else, except that it's the right thing to do, of course. It is groundbreaking, but it's a team effort. There are so many people, so many teams, and a lot of back and forth required. I'm not saying for a minute that it's the only thing; it's just one element, but it's an important one.

 

ADEGOKE FADARE: Thank you for emphasizing the importance of technology. I know that some people always feel like we must do things the way it's always been done, but we're thankful for the opportunity of technology. I want to appreciate the emphasis on health homes, the way they ensure continuing care, even when a provider changes. I think it's a real shift in the system from the silo or one-on-one attachment that we've always seen before now. I know that some people might call it so-called health homes, but I want to ask: How are we ensuring that the health homes are well-resourced, staffed in a way that meets this promise for patients across the province?

 

THE CHAIR: Dr. Boutilier.

 

NICOLE BOUTILIER: Staffing and human resources are a challenge, as everyone knows. Some of the work that we're doing now - I talked earlier about the physician forecasting model. We're really moving into the team forecasting model, what we need for every team and what that core team is to essentially provide that care that folks need. Again, it is tailored. We have a core staff that we need, but we also try to tailor it to what's available in that community. There may be some communities that have great access to this but not access to that. Not everyone is exactly the same. You'll see every health home looks a little bit different, but it's really about providing the needs for that community.

 

Our model is flexible enough to include different providers based on the demographics of the population in that community, the needs of that population in the community, and really where we are. Are we in rural Nova Scotia? Are we in an urban downtown setting like Dr. Hawker was talking about earlier? Not every health home looks exactly the same, but it has the same core principles to it.

 

I think that we have been able to demonstrate that people are interested in working in health homes with the number of new recruits we've had over the last few years. People are really extending and stabilizing. Part of this work has not only been to create new attachment; it's been to stabilize people where they are. When their provider leaves, if their actual physician retires, we have many things that we do, but one of them is to try to keep the people in that practice, whereas before, they would automatically go on the list. We can't count those numbers. They don't show up on the list, but we've stabilized thousands of people at the same time.

 

Some of the enablers for that have been the TIP-TOP program, that was negotiated again as part of the master agreement. There have been a few examples in the media lately around when an actual physician is retiring - they have up to a two-year period to bring someone else in. It's great for the new provider; they have a nice ease into taking over somebody's practice; somebody else is slowing down. It really actually builds the skills of the family physician in that particular practice, and it also gives a physician a way to retire and leave their practice stabilized.

 

A lot of our focus - we talk a lot about the list in what we're doing. There is so much other work that is going on at the same time to make every aspect of the health home a stable environment for patients.

 

THE CHAIR: MLA Robicheau. Three minutes.

 

RYAN ROBICHEAU: I'd like to share a bit of what's going on in my constituency, where the Municipality of Clare and the Clare Health Centre - they've done great work on their health care approach. In collaboration with the Province, we are approaching a time where everyone in Clare will be attached to a doctor. That's a big feat.

 

I'm aware of some of the specific strategies that have been successful for attachment in Clare and more broadly overall Nova Scotia. This is directed to the Nova Scotia Health Authority and the Department of Health and Wellness. The number of people on the Need a Family Practice Registry has been dropping since last fall. Could you outline some of the main factors that have been contributing to this drop?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: Let me start. I think we have to go back before we can go forward from this perspective. It did take quite a while to build, rebuild, enhance - you could use whatever word you like there - the foundation. There is more than one piece that we really had to put together. I think part of it was recruitment. The proof is in the pudding there. There's never enough, but the collective efforts of all - and many here around the table - in the recruitment of not just family physicians but nurse practitioners and other practitioners who would be helpful to work in a health home or in community to assist in attachment. Recruitment efforts have definitely improved. Success does beget success. That's also very important. The medical school - Dalhousie Medical School - has been a very good partner in this effort, but as well, the soon-to-be new Cape Breton campus is going to be a huge help. All of that is a piece.

 

We have the technology that I just spoke to. It's an important piece. The understanding - the fundamental understanding of that list of individuals, and then knowing what to do with it and how to do it, and having the tools and the people, the HR and all of the things that you would need to actually do it.

 

That really came together, I would say, perhaps around this time last year or spring 2024. All the tools enable you to put the thousand-piece puzzle together, and the thousand-piece puzzle is coming together now.

 

THE CHAIR: Order. That was good timing.

 

The next round will be four minutes. MLA Lachance.

 

LISA LACHANCE: I'm not going to take a lot of time to go back over some of the important information that's been shared. I think there's still a need for more transparency for Nova Scotians from the information that is available in the system. I think for Nova Scotians to have faith and trust, there needs to be - we need to show, not just keep telling people that everything's going to be fine or everything's working well. We have to show them.

 

Unfortunately, one statistic that we do have access to is the number of babies who don't have primary care. That number has gone up again this past year. There are 1,585 families, or 22 percent of all infants born last year, who needed access to the Unattached Newborns Clinic versus 941 or 16 percent the previous year.

 

This is an example of a particular population that is not getting the primary health care that they likely should. Why does this situation continue to get worse?

 

THE CHAIR: Dr. Boutilier.

 

NICOLE BOUTILIER: I think it's important to note that the Unattached Newborns Clinic came out of a need as well. It is a response to a need. It's very important for us to be able to connect the right people to the right care. Part of that is making sure that newborns have care.

 

One of the things on our list - when we talk about transforming the registry to more than just a list - is knowing the health status of a person when they sign up. Are they pregnant? Are they expecting? That type of thing. When we know that information, we can place people.

 

[2:30 p.m.]

 

Also, they have a really good back and forth with the clinic around people who do need attachment. I think that as we continue to provide the care that people need in a variety of different settings, we will see the needs for things change over time as we have more and more people connected to a health home at the right time.

 

THE CHAIR: MLA Lachance, I believe Ms. Heckman had a comment. Would you like to hear it? (Interruption) Ms. Heckman.

 

KATIE HECKMAN: I can really just add that the Need a Family Practice Registry does specifically work with that group in terms of unattached newborns. There is constant work toward improving some of those processes that we know specifically relate to those infants who require that care, and every day, working on improvements on how we can do that, not just in Central Zone either but across the province. Using our ability as a provincial program to be able to then appropriately navigate those people and their babies to where they need to go. That work is under way.

 

LISA LACHANCE: I'm not sure if I understood clearly from the two answers, but my question was: Why are those numbers deteriorating in terms of access points? What I understood perhaps was suggested was because it's being counted better. I do wonder what other factors we could look at if we had the data by zone, by constituency, that sort of information.

 

THE CHAIR: I added 10 seconds to MLA Lachance's time because of the fiasco, so who was that for? Only about 10 seconds to get an answer. MLA Lachance.

 

LISA LACHANCE: To rephrase: I understand that you've committed to providing information about the registry via zone. You've provided information today about people who join the registry. We'd also like to know month-by-month numbers of who was removed from the registry and that type of information. Just to confirm that we'll have that follow-up?

 

THE CHAIR: Yes, that's on the clerk's list. Thank you, MLA Lachance.

 

MLA Mombourquette.

 

DEREK MOMBOURQUETTE: I appreciate everyone being here. Thank you for all you do to support Nova Scotians each and every day. I don't have much time but I do want to ask this question because it did come up. I heard the statistic of the attachment rate across the province of around 92 percent, but I also heard from Dr. Hawker in particular that there were doctors across the province who are supporting families who aren't on the Need a Family Practice Registry or weren't aware of being on the Need a Family Practice Registry. I guess my question through you to the doctors here: Based on your experience and based on the fact that you know that you're supporting a lot of families and a lot of folks who aren't on the registry, how accurate do you feel that attachment rate is that's being provided by the government?

 

THE CHAIR: Dr. Hawker.

 

LEISHA HAWKER: I think I might be unique compared to some family physicians in that I see a lot of patients on the margins - a lot of patients who are unhoused or might not have regular access to phones. Their ability to get on the list and stay on the list is more challenging. If they're trying to validate the list and they're calling a number that no longer exists because a lot of my patients have - their phone number changes on average four times a year - it can be challenging for them. Their only access to internet is wi-fi at the library or at a fast-food joint or something like that.

 

DEREK MOMBOURQUETTE: Thank you for that, doctor. I know that you wouldn't have the information. I have the same conversation with doctors at home who are supporting families as well. I know it's kind of a rough estimate to ask, but in your experience, could you give a rough estimate of how many families you feel are in that situation, or people who are in that situation who don't have that access to get on the list or who have some barriers to actually getting on the list?

 

LEISHA HAWKER: I wouldn't have a number for you, but I would say, as an estimate in my addiction practice, I would guess about half don't have family physicians, and for various reasons. Some have been on the list and sometimes get appointments and get attached, and then because their lives are so chaotic and they have conflicting priorities, they have a hard time even having that first meet-and-greet with their new provider sometimes.

 

DEREK MOMBOURQUETTE: I think that's an important piece of this. A quick question, yes or no, because I'm running out of time. Through you to Dr. Hawker, or any doctor, for that matter, who are supporting those families: Have you ever been approached by the provincial government to actually be part of that validation process to make sure that everybody has the opportunity to have access, to get on the list if they need to?

 

LEISHA HAWKER: I haven't been involved in validation, and I'm not aware of physicians being involved in that work.

 

THE CHAIR: MLA Mombourquette, I believe Ms. Heckford has a comment. Are you good with that? Heckman, sorry. Ms. Heckman.

 

KATIE HECKMAN: Everybody at any point in time absolutely has the opportunity to put themselves on the registry. Right now, you can call 811 to do that, especially if you don't have access to internet or are unable to use technology. An 811 TA will actually support you through that process. If you are able to do it on your own, anybody can put themselves on the registry at any point in time using the Need a Family Practice Registry public website.

 

DEREK MOMBOURQUETTE: It does raise a point about working with the doctors more closely to validate the list, because that's what we heard today - that many of the doctors may not be contacted to help validate that list. I only have 10 seconds left, so I'll ask my question. We won't have time, but it was to Dr. Newman. Thank you all for being here again. You did mention in your comments the crisis of primary care, and I was hoping to have an answer but I'm out of time.

 

THE CHAIR: Order. MLA Corkum-Greek.

 

HON. SUSAN CORKUM-GREEK: To our witnesses today, again, thank you for this session. I am a Nova Scotian. I am very fortunate. Neither myself nor anyone in my immediate family has been without attachment. However, about 10 years ago, I was asked, as one of the physicians in the Pelham Street practice in Lunenburg was looking to eventual retirement: Would I consider being attached to a nurse practitioner? It has been a completely satisfying experience. I have never had a complaint. I have only the best things to say about the care I receive, so shout-out to Axel Saile and nurse practitioners across Nova Scotia.

 

My question for the department, I guess, is: Realizing that we've talked a lot about family practices and these collaborative teams - recognizing on a personal level the value of nurse practitioners - what are we doing to recruit, retain, and train more NPs?

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: I know you said department, but I'm going to give them a minute to collect their thoughts. I have a letter that one of our folks gave to me today from the Nurse Practitioners' Association of Nova Scotia, and it's got some really interesting information, but first and foremost, they respectfully request that they be part of the conversation when we're talking about the Need a Family Practice Registry. We've tried to be careful today to respect that because they are a fundamental part of our health homes and our system going forward.

 

Just a couple of stats to reiterate that point: There are approximately 470 nurse practitioners practising in Nova Scotia with about 170 working in primary care settings. There are approximately 136,000 Nova Scotians who are not on the registry. They are attached, but they receive their primary health care from nurse practitioners. Those are the numbers, which are significant. Thus, your question is a good one in terms of recruitment and retention.

 

I know in my short time with the Nova Scotia Health Authority, coming on four years September 1^st - but there were 178 nurse practitioners. Over that period of time, there have been almost 300 nurse practitioners. The program is thriving. There are challenges in terms of recruiting and not as many in retention, but people want to do certain kinds of work. It's important to both satisfy desires but also put people in spots where it's the biggest impact for Nova Scotia patients as well.

 

They're high on the radar. They're very valuable - certainly performing fantastic services for Nova Scotians and for us. There are many in our health homes, but also in the mobile clinics and many of the other things that we are providing by way of access. I just want to recognize the importance and echo that, yes, the retention and recruitment of NPs is very high on the list.

 

THE CHAIR: MLA Corkum-Greek with one second.

 

SUSAN CORKUM-GREEK: I think I'm finished.

 

THE CHAIR: Order. That concludes the questioning portion. I'm going to allow anybody for closing comments.

 

I'm going to start with Dr. Hawker. Do you have any closing comments?

 

LEISHA HAWKER: Thank you for the opportunity to speak about this very important topic today. Family physicians have broad medical expertise, and they take care of the whole person - even the whole family - from birth until death. They advocate for their patients and for the health of their community.

 

We must continue to build on our progress and expand the patient medical home model across Nova Scotia. We need to integrate better our siloed care initiatives so that we have a robust primary care foundation that supports our health care system. Every Nova Scotian deserves a medical home with an exceptional team led by a family physician.

 

THE CHAIR: Dr. Newman.

 

COLIN NEWMAN: As usual, I couldn't put it any better than Dr. Hawker did. We appreciate the opportunity to speak to you today. What I hear from you and what I appreciate is - we appreciate the increased scrutiny on this. Family physicians have been kind of canaries in the coalmine for a long time - recognizing that things were getting difficult in the health care system. We welcome any and all discussion, debate, discourse around the topics of attachment, primary care, and longitudinal care. We appreciate the opportunity to be here.

 

THE CHAIR: Dr. MacDonald Green.

 

AMANDA MACDONALD GREEN: I'll defer to Dr. McNeil.

 

THE CHAIR: Dr. McNeil.

 

SHELLY MCNEIL: Thank you for the opportunity to be here and to share our perspectives on primary care attachment. We have seen tremendous improvements driven by a steadfast focus on transformation. As we look ahead, there are real opportunities to build on the momentum toward a sustainable integrated system for all.

 

Despite the challenges of recent years, from family physician shortages to difficulty with access, meaningful progress has been made. To sustain that advancement, we must continue to prioritize recruitment and retention efforts.

 

We believe that every Nova Scotian deserves a family doctor to quarterback their care. Ultimately, ensuring that patients are attached to health homes led by family physicians with a core team is the most effective and enduring model for primary care.

 

Doctors Nova Scotia calls for the establishment of a primary care action team made up of all primary care providers and partners to develop a broad plan and shared vision for primary care in Nova Scotia.

 

THE CHAIR: Mr. Stevenson.

 

COLIN STEVENSON: Thanks to the committee for the opportunity for us all to be here today and talk about this important topic. As I mentioned in opening remarks, it feels like a continuation around the advancement and development of interdisciplinary or multidisciplinary teams within Nova Scotia.

 

The focus really is getting everybody connected to the health care system in a different way. The health home is a foundation of that. We've heard positive comments with respect to the improvements within the system and I would say optimism associated with where the Nova Scotia health system is going with respect to primary care and primary health care.

 

As we continue to move forward with investments with health homes - it's more than just the name of a health home. It means that we're investing in technology, infrastructure, people, recruitment, development within province - all rooted with an individual's better understanding of their own health through an integrated electronic health record.

 

We have made progress. We're seeing changes. We recognize and appreciate that there are still steps to be taken, and there continues to be a commitment to do so.

 

THE CHAIR: Ms. Palmer.

 

BARBARIE PALMER: The attaching family medicine sphere, either with physicians, nurse practitioners, or the health homes that support them, is a complicated environment. Patients need a simple way of accessing that. The work that's been done to make sure that there are multiple means of doing that through collaborative stakeholder engagement - whether it's Doctors Nova Scotia, the College, the Nova Scotia Health Authority, or the Department of Health and Wellness, as well as the providers themselves - has really made for the success that we've seen. Collaboration is the key to innovation. If we're standing still, we're failing to evolve. Continuing to work amongst a team with all the skills and all the ideas that come to pass are what is going to allow attaching family medicine in the province to make sure that all Nova Scotians are attached to a health home.

 

[2:45 p.m.]

 

THE CHAIR: Dr. Boutilier.

 

NICOLE BOUTILIER: Thanks for the opportunity. I wanted to take a moment to thank all of our primary health care frontline providers in every setting that we have, as well as the primary health care team. We work in co-leadership, so physicians are connected to the work at every level. These leaders have had their work cut out for them, and they've been as passionate as Katie was in her opening remarks.

 

I also wanted to thank - we have some of our partners here today - Doctors Nova Scotia, the Department of Health and Wellness, the Nova Scotia College of Family Physicians. We also have the College of Physicians and Surgeons of Nova Scotia and others. Everybody has done their parts in building strong relationships between these partners and coming up with innovative ways to help solve our collective problems. I've been in leadership in Nova Scotia for 20 years, and I've never seen the level of understanding, collaboration, and actual progress on our goals, and with some of the relationships that people around this table have formed with each other make things move forward. I want to take that opportunity to thank all of our partners.

 

THE CHAIR: Ms. Heckman.

 

KATIE HECKMAN: Nothing further to add for me, but thank you for the interest in the work and the opportunity to speak about it.

 

THE CHAIR: Ms. Oldfield.

 

KAREN OLDFIELD: Three quick points: Just to re-emphasize, the number that we report on a monthly basis is a net number; secondly, the list will be an ongoing tool, and many of the reasons for that actually were brought up today in the conversation. I reiterate that the ways to get on the list are very important, and that we all are aware of them. Number one is 811. Secondly, there is a 1-800 number. Thirdly, a public website, and then fourthly, there is an email attached to the Need a Family Practice Registry, and there's a whole team that supports - that's in the background of these four pathways.

 

Finally, thank you. I just want to call out the team, because I see them up there. We have Ms. Noella Whalen, we have Dr. Maria Alexiadis, and Ms. Lindsay Cormier. They are three of the key members of this team. Katie, and Dr. B is never going to pat herself on the back, but I'll do it. Guys, they work tirelessly to get this list down and to do the right things for Nova Scotians. Far be it from me to take one ounce of any credit. I deserve none; they deserve it all. I really appreciate it, and I applaud them and thank you.

 

THE CHAIR: I'd like to thank you all for coming. Your part is done; however, we'll take a five-minute recess, and then we'll get back to the last part of it. We're in recess.

 

[2:48 p.m. The committee recessed.]

 

[2:54 p.m. The committee reconvened.]

 

THE CHAIR: Okay, order. We're back. We have some committee business. Everybody received the letter showing Maureen Brennan, clinical director of Mental Health and Addictions at the IWK Health Centre suggesting that we also add Trina Clarke, CEO of YMCA of Cumberland, the lead agency for Integrated Youth Services, to the meeting. Does anybody have any objection or comment on it? Are we good? I'd say we're good.

 

We received a response from Dr. Annette Elliott Rose and Dr. Aaron Smith in response to the request for information from the July 8^th meeting. It was attached. Any discussion? Seeing none.

 

November's meeting is scheduled November 11^th. Is everybody okay if instead of the 11^th, we do it on the 13^th at the same time, which would be Thursday from 1:00 p.m. to 3:00 p.m., assuming the House isn't sitting? If the House is sitting, it would be 10:00 a.m. to 12:00 p.m. Is that in agreement? All agreed, perfect.

 

I'll go to my last page. September 9^th is our next meeting from 1:00 p.m. to 3:00 p.m. on Integrated Youth Services. Witnesses are the IWK Health Centre; Integrated Youth Services New Glasgow, Big Brothers Big Sisters of Pictou County; Integrated Youth Services Halifax, YMCA; and from Amherst, YMCA of Cumberland.

 

Is there any other business?

 

We are adjourned.

 

[The committee adjourned at 2:56 p.m.]