Health Transformation Hub

Key Messages

  • The primary health care system is a person’s first contact with the health system. It is where they have the most frequent interactions in receiving care.
  • A strong primary health care system supports Nova Scotians and communities to be healthy, and enables them to build the capacity to live well. It also enables Nova Scotians to receive the right type of care when and where it is needed most. Over time, this reduces demand for hospital-based care.
  • We want to provide and support quality primary health care in the communities where people live and work, enabling Nova Scotians to receive the right care, from the right provider, at the right time.
  • We can reduce the burden on the health care system by keeping people healthy with wellness and chronic disease management services and support that provide important and timely access to care.
  • There have been many positive changes to the primary health care system across the province over the past few years. We will continue to build upon this work with a focus on team expansion, supporting health care providers and supporting Nova Scotians.

Overview

The Transformation Vision for Primary Care:

“Primary health care is the foundation of the health system and, through working with others, will enhance the health and well-being of Nova Scotians.” 

Our goals and objectives are to: 

  • Enhance access and patient attachment to comprehensive, team-based primary health care 
  • Support people and communities to live well and manage chronic conditions 
  • Ensure enablers are in place to support a modernized primary health care system, including a high-performing workforce 
  • Strengthen partnerships to achieve integration and coordination across the health system

Areas of Focus

Care Delivery

  • Access to primary care clinics 
  • Patient attachment to team-based care 
  • Access to urgent care 
  • Community-based care and wellness programming 
  • Chronic disease prevention and management 
  • Test and try (expansion of Dalhousie Family Medicine's Proof of Concept project, REDUCE-IT rehab program) 

System Experience Design

  • Modernized Health Neighbourhood and Health Home Experience 
  • Compensation model for team-based care 
  • Alternate Payment Plan (APP) accountability 
  • Practice Support Program (expansion of Access and Efficiency Practice Support Program)
  • Nurse Practitioner Panel Identification and Quality Improvement  

Virtual Care

  • Virtual Care Scale-up and Sustainability Planning 
  • 811 expansion and integration with Primary Health Care (includes rebuild of the Need a Family Practice Registry) 

Outcomes Management

  • Benefits and Outcomes Management System 
  • System Performance Framework

Change and Communications

  • Change Management 
  • Communications Management

Current Activities

Care Delivery

The 2023-24 provincial budget included $19 million in funding for new and strengthened primary care teams to increase access and strengthen attachment.

Highlights include: 

  • Eight new collaborative family practice teams and 26 strengthened teams. 
  • Four of the new or expanded collaborative family practice teams will adopt a new rapid onboarding process. Other teams will start using this process over time.
  • Six new primary care clinics will be added and 10 clinics will be enhanced.

This funding is part of a series of efforts to improve primary care for patients and providers. Other initiatives include: 

  • Piloting the Community Pharmacy Primary Care Clinics program in 26 locations across the province and the Pharmacist Walk-in Clinic+ pilot at five locations.
  • Expanding VirtualCareNS to everyone on the Need a Family Practice Registry.
  • Introducing urgent treatment centres.
  • Launching a mobile primary care clinic that travels the province providing care.

System Experience Design

  • Integrated Chronic Disease Management (CDM)
    • Beginning with diabetes, the project management team is conducting research and consultation to identify clinical pathways that improve access and efficiency for CDM patients and providers.
  • Modernized Health Neighbourhood and Health Home Experience
    • Project management team engaging patient and providers in a co-design process to identify how to operationalize the concepts of Health Homes and Health Neighbourhoods.
  • Practice Support Program
    • ​​​​​​​The goals of this project are to improve timely access for patients and work-life balance for providers through improved efficiency and patient flow.
    • Plans are in development for the Engage and Test phase of the project.
  • Primary Health Care in Long Term Care
    • ​​​​​​​Goal is to design and cost a program to ensure 24/7 primary care coverage in LTC facilities across Nova Scotia.
    • Project management team is conducting research and consultation to develop a proposed design.

Virtual Care

  • Need a Family Practice Registry
    • As of June 22, anyone on the registry can add health information to their profile that will be used to direct them to services, resources, and care options in their community.
  • VirtualCareNS
    • It has now been one year that VCNS has been available to anyone on the Need a Family Practice Registry. There have been over 90,000 visits in that time. 

Change Management and Communications

  • Team roles and responsibilities have been established.
  • Initial assessment of change risks is underway.
  • Development of key messages is underway.
  • Development of project-specific communications plans is underway.

Other Developments

  • Primary Health Care in Long-term Care
    • Our goal is to design and cost a program to ensure 24/7 primary care coverage in long-term care facilities across Nova Scotia.
    • Project team is in place and engagement plans are in development.
  • Mobile Primary Care Clinics
  • COPDNS (Chronic obstructive pulmonary disease Nova Scotia) 
    • A pilot project is underway in Eastern Shore to provide support to people with mild-to-moderate chronic obstructive pulmonary disease.

Sponsors and Leads

Leads

  • Dr. Maria Alexiadis, Senior Medical Director Corporate & Clinical Service Networks (Primary Care & Chronic Disease Management) and Head, Department Family Practice Central Zone, Nova Scotia Health
  • Noella Whelan BN, RN, MN, CFHI EXTRA Fellow, Senior Director, PHC-CDM Clinical Network, Nova Scotia Health

Executive Sponsors

  • Dr. Nicole Boutilier, Vice President, Medicine, Nova Scotia Health
  • Colin Stevenson, Chief, System Integration, Department of Health and Wellness
  • Craig Beaton, Associate Deputy Minister, Department of Health and Wellness
  • Bethany McCormick, Vice President, Operations, Northern Zone, Nova Scotia Health

Contact