N.S. need a doctor registry doesn’t prioritize sickest people: auditor general

The Nova Scotia Health Authority needs to find a way to ensure people with serious health concerns who’ve registered on a provincial website are actually connected with a doctor, the province’s auditor general says.

HALIFAX—The Nova Scotia Health Authority needs to find a way to ensure people with serious health concerns who’ve registered on a provincial website are actually connected with a doctor, the province’s auditor general says.

In a report Wednesday, Michael Pickup says the provincial web site where people can register to indicate they need a family doctor is of limited usefulness because there is no priority based on health history or the person’s condition.

As of Sept. 1, there were almost 36,000 people registered online with the health authority’s “Need a Family Practice” registry, about four per cent of the province’s population.

The health authority encourages doctors to use the list to obtain new patients, but as Pickup noted during a news conference, they aren’t required to choose new patients from the list.

“So you could have people that are on the list that are quite sick who may not get a doctor before others that do,” said Pickup. “That’s just one example of the potential impacts upon people.”

The audit, on the performance of the health authority and the Health Department, also says the government has generally done a poor job telling the public about its plans for primary care, despite growing concern over a lack of access to doctors.

Pickup said the department and health authority often get bogged down in discussions that can hinder efforts on such things as doctor recruitment.

“If you look it from the public perspective and from those of us looking for service, you just want the plan you don’t want this back-and-forth,” he said.

Pickup recommends the province bring in a communications plan that will inform people on what the goals are for doctor recruitment and when people should expect services to be available.

He says the existing website is inadequate and confusing in explaining the shift away from individual physicians to collaborative clinics. The report notes 50 of more than 70 planned collaborative care teams are already in place.

Health Minister Randy Delorey said Pickup’s report highlights the system’s “challenges,” but maintained several times that “work is ongoing” to improve areas such as doctor recruitment.

He also reverted again to what’s become a standard response around efforts to transform the system, saying it is taking time because much of the initial work involved merging nine health authorities into one in order to “work provincially.”

“That was a necessary step to move forward in the work being done,” said Delorey.

But the minister remained vague when it came to questions about what constitutes an acceptable wait time to get a family doctor, how long it will take to get enough doctors, and how many will be hired each year.

Progressive Conservative Leader Jamie Baillie said the government’s “we are working on it” response is no longer good enough. He said concrete work needs to be done to get doctors into communities that need them.

“There are no standards around wait times — not even a common definition of what a wait time is after all these years. That’s unacceptable.”

The auditor was also critical of health officials for failing to provide clear benchmarks for plans to find hundreds of new doctors over the next decade.

The audit says the latest forecasts estimate Nova Scotia will need 512 additional doctors over the next decade. But it noted the health authority had only come up with a doctor recruitment plan earlier this year.

It also says the province still doesn’t have a clear, province-wide plan on how to deliver mental health services, even though work on such a plan started in late 2015.

Pickup said the approach to mental health care across the province is not consistent and has led to significant variations in wait time standards, eligibility criteria, and in how clients are assessed.

As an example he pointed to the Dartmouth General Hospital, where there is no psychiatric support for emergency services and patients must be transferred for assessment. Pickup said the hospital has Nova Scotia’s fourth busiest emergency department, and saw over 1,400 mental health patients in 2016.

“That is the only regional hospital in that situation and that is by design, he said. “The government should re-evaluate if that is actually the way they want to deliver service.”

The audit also says health officials have not completed decade-old recommendations to do a better job monitoring home care services to ensure they met contract terms.

Pickup said the ongoing lack of controls following a fraud risk assessment in 2016 means “there is a high fraud risk around this program.”