Ontario misses federal funding deadline for nurse practitioners

Ontario’s health minister shut down one avenue of publicly funding all nurse practitioners Wednesday as the province missed a federal deadline for ensuring their medically necessary services are covered.

The federal government gave provinces and territories until April 1 to ensure they are funding nurse practitioner services equivalent to what doctors provide, though penalties for noncompliance won’t kick in until April 2027.

Ontario does not yet have a plan in place, despite Health Minister Sylvia Jones pushing the federal government years ago to close what she called 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 be in compliance with the federal directive before April 2027, but she did not say when.

“I want (nurse practitioners) embedded in our multidisciplinary teams,” she said Wednesday after question period. “I want them working in our hospitals. And the truth is, the vast majority are doing that now, and that work will continue.”

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 set up nurse practitioner-led clinics beyond the approximately two dozen that are already publicly funded or establish independent practices in the public system.

Nurse practitioners have said they are looking for 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.

That is not under consideration, Jones said.

“Any changes to billing codes would have to be worked out and agreed upon in partnership with the Ontario Medical Association,” she said. “So we have no plans at this point to make changes there.”

The OMA echoed Jones’s emphasis on team-based care in a statement.

“The OMA has long supported nurse practitioners as valued members of collaborative, physician-led health care teams,” the association wrote.

“Working together in teams can help optimize resources, easing pressure on physicians and the health-care system, while responding 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 financial autonomy like some other health professionals.

“Why is it only for nurse practitioners that these flexible options are not an option?” she said.

“Why are we not moving that forward when we are most responsible providers? We can help in their health-care journey, across the entire health-care system, but we’re handcuffed to how we get paid right now.”

Some nurse practitioners outside the public system have tried to set up publicly funded clinics but their proposals were turned down, Acorn said.

“It still doesn’t answer the question for those that are not getting paid out of the public purse, how they continue to actually deliver care,” she said.

Province should reimburse patients: Liberal MPP

Liberal primary care critic Adil Shamji called on the government to reimburse anyone who has to pay out of pocket for nurse practitioner primary care between now and when Ontario extends public funding.

“As we face an affordability crisis, people shouldn’t have to be asking themselves whether they’re going to put food on the table or pay for a primary care visit that should be covered,” he said.

NDP Leader Marit Stiles said she herself goes to a nurse practitioner and sees them as essential to connecting more people with primary care.

“I’m very concerned about (Jones’s) competence in this role,” she said.

“They’ve now missed the deadline for the nurse practitioners agreement. And again, did she not 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, paying out of pocket right now, which is unacceptable in Canada — I think they’re wondering when this minister of health is going to be replaced.”

Jones has set a goal of attaching 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.