By Ruth Lavergne and Tara Kiran
We all have family, friends, colleagues and neighbours who have been waiting to find a family doctor or nurse practitioner and struggling to access the health care they need when they need it.
Primary care — services to meet our day-to-day health needs, from family doctors, nurse practitioners and other team members — is under enormous pressure in Nova Scotia and across the country.
Strengthening primary care, and health systems more broadly, is a complex challenge. While clinicians and policymakers are always working to make improvements, the experiences and ideas of people who use the system are often missing from the conversation.
So we turned to members of the public to ask them for their input as part of our on-going research project, OurCare.ca, on primary care in Canada. We brought together a volunteer panel made up of 34 Nova Scotians from all walks of life to ask them their views and ideas on how primary care can be improved to serve Nova Scotians better.
Their ideas form the backbone of a practical plan to improve health care access in the province.
The 34 panelists came from communities, big and small, and from all across the province. Some have had the same family doctor for years, others have struggled to access needed care. Some have come to Nova Scotia recently, and others have lived here their whole lives. Some have never had to worry about money, while others worry about making ends meet every month. Some are healthy with limited needs for care, while others have dealt with serious and ongoing health concerns.
Over several days, these members of the public shared their experiences, learned from people working in the system and agreed on 25 practical recommendations for change. Even with all that was different about them, through discussion and dialogue they came together to agree on both the challenges that need to be solved, and recommendations for the future.
That OurCare volunteers could all agree on recommendations should send a clear message about
directions for change.
OurCare volunteers emphasized that the health system needs to be centred around people, and deliver empathetic, accessible and affordable care. They underscored the continued need to expand community-based collaborative care teams, delivering comprehensive care for all Nova Scotians. To make this happen, they identified the need for modern systems of health data and new approaches to training and supporting clinicians.
They also called for the information needed to play an active role in their health care, and also in health systems. They want access to both their own personal health data as well as transparent information on primary care initiatives and their outcomes.
You can read the completed recommendations from the panel in their own words.
As national and Nova Scotia leads of the project, we helped plan the process but weren’t part of the discussions. We are both health systems researchers, and Tara is a practicing family physician and clinical leader. While we had no role in writing the recommendations, every one of them is consistent with what research evidence says is needed for change and resonates with the experiences of people working within the health system.
Nova Scotians know what needs doing. Certainly, the recommended changes are not simple to implement, and they are not quick fixes but comprehensive and systemic. That doesn’t mean it can’t be done.
Many of the recommendations have long been recognized as needed but require parts of the health system to work in harmony and/or require the dismantling of silos. Importantly, key players in health care system were around the table as part of an advisory board from the start of the OurCare project.
The panel recommendations call on leaders and decision-makers to collaborate, champion transparency and align efforts in the pursuit of a more responsive and equitable health care system.
We all agree there is a problem. OurCare dialogues across the country and in Nova Scotia have demonstrated that we can also agree on solutions. What is left to do is act.
Ruth Lavergne is an Associate Professor in the Department of Family Medicine at Dalhousie
University and a Tier II Canada Research Chair in Primary Care.
Tara Kiran is a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto
and the Fidani Chair of Improvement and Innovation at the University of Toronto.
