Nfld. & Labrador

Nobody has a monopoly on patient care, Haggie says in response to NLMA letter

Health Minister John Haggie said he would no sooner ask the province's physicians association about a nurse practitioner app than he would a social work program.

Haggie says family doctors can do their own virtual care, but patients now have choices

Health Minister John Haggie says nurse practitioners are autonomous from doctors, and therefore there was no need to consult the Newfoundland and Labrador Medical Association before launching the 811 app. (Gary Locke/CBC)

The beef between the province's doctors association and the health minister reached a new level on Friday, as John Haggie said he would no sooner consult them on the new 811 nurse practitioner program than he would on a social work program.

The Newfoundland and Labrador Medical Association sent Haggie a stern letter Thursday in response to government launching a new app that connects people with urgent needs to a nurse practitioner employed by 811.

The group said it wasn't consulted and had major concerns about it being disconnected from family practices.

"No one group of health-care providers has a monopoly on providing health care to the people of Newfoundland and Labrador," Haggie said during Friday's COVID-19 briefing.

Haggie said doctors have their own methods for virtual care, and it comes down to what a patient wants.

"Virtual care was instituted for the NLMA's members at the beginning of the pandemic. We forwent negotiations and simply said, 'Fill your boots, pick your platform and we'll pay for phone or video.' So they have their own mechanism. Nurse practitioners are autonomous practitioners. They have the ability to work fully within their scope of practice. I would no more ask the NLMA about a social work console."

Integrated, but fragmented

One concern the NLMA raised is patients of family doctors could turn to 811 and speak to a nurse practitioner who is unfamiliar with their charts and be prescribed medication that runs counter to their doctor's advice.

A virtual-care task force formed by three of the largest medical associations in Canada decided in 2019 that any virtual walk-in service should be done in a way that builds off an established relationship between a patient and a physician or primary care team, and promotes continuity of care.

Haggie said the new 811 app is fully integrated with the province's electronic health record — or EHR — but acknowledged there are major gaps in that record-keeping service.

"Unfortunately doctors from different practices do not necessarily have any commonality of record," Haggie said. "There are still doctors who are using paper. There are some who have transitioned to siloed versions of the EHR and there's some that are using the regional iteration through Meditech. So that's all fragmented." 

A new app brings 811 to your smartphone, giving people across Newfoundland and Labrador access to a nurse practitioner seven days a week. (Ryan Cooke/CBC)

He said the 811 app will be more connected with electronic records than the existing walk-in clinics in the province.

"From this point of view, it's all totally encrypted, safe and secure," Haggie said. "And it is totally compatible with the electronic health record."

Some doctors expressed concern about the direction of the integration. Whatever the nurse practitioner decides to prescribe will be part of the electronic record, but the person's previous medical history might not be available to the nurse practitioner before deciding what to prescribe.

As for why the province decided to enlist 811 to run this type of service, Haggie said it was based on feedback from people already using virtual care.

"There is science behind it," he said. "There is evidence to show that for a significant proportion of consults, virtual care is as effective and probably better received by the participants than face to face."

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