Ontario misses federal funding deadline for nurse practitioners
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Ontario’s health minister closed a path to publicly funding all nurse practitioners on Wednesday as the province missed a federal deadline to ensure they provide medically essential services.
The federal government has given provinces and territories until April 1 to ensure they are funding nurse practitioner services on par with services provided by doctors, although penalties for non-compliance will not come into effect until April 2027.
Ontario does not yet have a plan, despite Health Minister Sylvia Jones pressing the federal government several years ago to close a “loophole” in the Canada Health Act that allowed nurse practitioners to set up subscription-fee-based clinics outside the public system.
Jones has said the province will comply with the federal directive no later than April 2027, but has not said when.
“I want (nurse practitioners) to join our multidisciplinary teams,” she said after question period on Wednesday. “I want them to work in our hospitals. And the truth is that most people are still doing that, and that’s where they will continue to work.”
Nurse practitioners want flexible funding models
In Ontario, nurse practitioners – registered nurses who receive additional university education – work in a variety of settings, including hospitals and primary care, but they are unable to widely establish more of the approximately two dozen nurse practitioner-led clinics that are already publicly funded or to establish independent practice in the public system.
Nurse practitioners have said they are exploring flexible funding models, such as those for family doctors, who can bill OHIP on a fee-for-service basis or who are paid per patient enrolled.
It’s not under consideration, Jones said.
“Any changes to the billing code will have to be worked out and agreed upon in partnership with the Ontario Medical Association,” he said. “So we don’t have any plans to make changes there at this time.”
OMA reiterated Jones’ emphasis on team-based care in a statement.
“OMA has long supported nurse practitioners as valuable members of collaborative, physician-led health care teams,” the association wrote.
“Working together in teams can help optimize resources, reduce pressure on physicians and the health care system, and respond to patient needs.”
Michelle Acorn, CEO of the Nurse Practitioners Association of Ontario, said nurse practitioners have professional autonomy when it comes to their scope of practice, but not the financial autonomy that some other health professionals do.
“Why isn’t this flexible option just for nurse practitioners?” He said.
“Why aren’t we pursuing this when we are the most responsible providers? We can help them in their health-care journey throughout the entire health-care system, but we are tied to how we get paid right now.”
Acorn said some nurse practitioners outside the public system have tried to set up publicly funded clinics but their proposals have been rejected.
“It still doesn’t answer the question for those who are not getting paid from the public purse, how they actually continue to receive care,” he said.
Province should reimburse patients: Liberal MPP
Liberal primary care critic Adil Shamji called on the government to reimburse anyone who pays out-of-pocket for nurse practitioner primary care between now and when Ontario expands public funding.
“As we face an affordability crisis, people should not be asking themselves whether they will put food on the table or pay for primary care that must be covered,” he said.
NDP Leader Marit Stiles said she herself sees a nurse practitioner and sees them as essential to getting more people connected to primary care.
“I am very concerned about (Jones’) ability to perform in this role,” he said.
“They’ve now missed the Nurse Practitioners Agreement deadline. And then again, didn’t they have time to figure this out?
“I have to say, I’m very disappointed and I think many Ontarians who are looking for that connection to primary care – and, frankly, are paying out of pocket right now, which is unacceptable in Canada – I think they’re wondering when this health minister will be replaced.”
Jones has set a goal of connecting everyone to a primary care provider by 2029 and last month announced 124 successful proposals for new or expanded primary care teams, but has not yet indicated how many of those are nurse practitioner-led clinics.
