Community Health Centres | Opinion | Halifax, Nova Scotia | THE COAST

Community Health Centres

The missing ingredient for effective primary care in Nova Scotia

Improving support for physicians in Nova Scotia is an important component of solving the province's current healthcare woes. However, the "crisis" is not about physicians. It's about inadequate health system policies, poor planning and lost opportunities, especially in primary care.

Data from the Canadian Institute for Health Information shows that Nova Scotia has the fourth-highest number of family physicians, per capita, among all 10 provinces. Yet over 50,000 Nova Scotians don't have access to primary care, commonly framed as not having access to a family physician. And that's the problem: It's not just about access to physicians. It's about access to primary care, effective and appropriate primary care. Considered from that perspective—what services and supports people actually need—the number is actually higher than 50,000.

Throughout Nova Scotia, primary care is still dominated by individual fee-for-service physician practices. The province's implementation of collaborative family practice teams has enabled some progress toward team-based care. But something is still missing. Even the most skillful collaborative care team is not going to be able to provide adequate care and support for many Nova Scotians, particularly those with complex medical and social needs.

What's missing, to round out primary care for Nova Scotians, is provincial support for Community Health Centres. In addition to supporting FFS practices and collaborative family practices, the provincial government needs to a establish a clear provincial policy and a mechanism to provide CHCs with core funding. A policy framework and core funding model would enable CHCs to provide collaborative care teams as well as other services and programs that address the real day-to-day causes of illness; issues like social isolation, poverty, food insecurity, precarious housing and other factors that can't be addressed in the exam room. These are the major causes of illness and even though we don't traditionally think of them as the problems of the healthcare system, they are the biggest drivers of healthcare and other public costs.

Governments across Canada talk a lot about these social determinants of health, about preventing illness, about reducing avoidable ER and other health care costs, and about responding to the needs of local communities. Nova Scotia's government is missing the opportunity for real action. As not-for-profit, community-based organizations, CHCs provide a high impact solution that needs to be part of the province's primary health care strategy. More than 20 CHCs already exist in NS and are doing incredible work, but with little to no support from provincial government. For years, they have been calling for core support and funding. It's time for the provincial government to listen.

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