Interviewer: Ontario had until April 1st to set up public funding for medically necessary care from nurse practitioners, but a province is set to miss it. So what exactly happened? Michelle Acorn is CEO of the Nurse Practitioners Association of Ontario, and she joins me in studio. How are you doing?

Michelle Acorn: I'm great. Thanks for the opportunity to be here today.

Interviewer: Great. Great to have you. Now let's talk about the family physician shortage Ontario. How can nurse practitioners help alleviate the problem?

Michelle Acorn: Language matters. So calling this a primary care provider shortage recognizes that care can be delivered by nurse practitioners and physicians and interprofessional team members, such as registered nurses, registered practical nurses, pharmacists as well. Nurse practitioners have the ability to expand substantially access to care in urban and rural remote areas as well, and across all sectors as well. And more importantly, we also know nurse practitioners are well evidenced, trusted and safe, and provide cost efficient care.

Interviewer: Well, let's talk about it because people hear the title a lot. Nurse practitioner. It's not always clear just how wide their scope of work is. What can a nurse practitioner do?

Michelle Acorn: A nurse practitioner title is protected by the way they marry nursing and medicine, and they can function as independent autonomous providers. So that means they can assess and diagnose, they can treat and prescribe from preventive chronic diseases, pain control, for example. Medical marijuana would be another one. They can actually admit, treat and discharge from hospitals and long term care. They can be your most responsible provider. They can do medical assistance in dying. They can do procedures, for example, as well. And they can also be leveraged as not just clinicians but leaders across the health care system.

Interviewer: All right. One thing that they can't do, and we're learning a little bit more of this when we talk about some nurse practitioners in the province, they can't bill OHIP at the moment. So help me understand here, do Ontarians pay out of pocket to see a nurse practitioner?

Michelle Acorn: The reality is some patients right now and residents are paying out of pocket because of a lack of fully modernized funding that's integrated across Ontario right now. There are some nurse practitioner roles and positions that are funded publicly, while there are others that are not fully integrated right now. So patients do have to pay out of pocket.

Interviewer: So right now in the province, I believe it's 27 nurse practitioner led clinics. But then are we seeing a uptick in sort of private clinics?

Michelle Acorn: Absolutely. So the 27 nurse practitioner led clinics are funded by the government. That's clear. What is not clear are the private clinics that they're calling. They're solo independent clinics where nurse practitioners are delivering care because they are not publicly funded roles right now at this point in time. So that is really important. However, they are delivering medically necessary services that should be deemed physician equivalent and should be reimbursable for not just primary care, specialty care as well. And across all the health care system.

Interviewer: When we talk about healthcare in this province and when we hear the word private, sometimes it can sound like a very scary word, a dirty word. Do these does a rise in private clinics undermine the public Medicare that we have in Ontario?

Michelle Acorn: These clinics are established because of need, not greed. They are not actually undermining. They're actually being responsive to improving access to care for Ontarians in your local community as well. What is undermining is the lack of public clarity and modernized funding that should be expedited right now to ensure that patients have access to universal health care.

Interviewer: All right. Well, you mentioned clarity. Let's talk about that. Ontario had up until April 1st to set up a plan for a public funding model for nurse practitioners. We asked the Ontario Ministry of Health about missing the deadline, and they wrote back to us saying that provinces have until March 31st, 2027 to implement new changes required by the Canada Health Act. Is that correct?

Michelle Acorn: Technically, the implementation was to begin for April 1st for publicly funded, medically necessary services. I think what the government is referring to is financial penalties or levers or enforcements that are in place for potential clawbacks on the Canada Health Act, transfer funding agreements for the ministry, what the big divide and disconnect is. Patients need care now. Nurse practitioners are ready, willing and able to provide that care right now. And patients shouldn't have to pay out of pocket right now because there's no available system in place.

Interviewer: So fair to say the province has missed the deadline.

Michelle Acorn: The province has missed the deadline.

Interviewer: Okay. Well, I want to talk a little bit about the province. Last last week, they had released their budget, and I wanted to know if there was something that you had seen in there that you thought was a win.

Michelle Acorn: Well, the government made important investments. I had the opportunity to be at the budget in obviously primary care, home and community care, hospital and long term care. What they did is they missed a critical opportunity and overlooked nurse practitioners by not explicitly mentioning them. They didn't actually embed nurse practitioner education seats that could be helping with recruitment and retention and distribution of nurse practitioners for access to care. They didn't embed any Canada Health Act funding and implementation of flexible funding and what that would look like, whether it be a schedule of benefits, a fee for service, a capitation or blended model. And another big thing is they didn't embed any equitable, respectful or competitive compensation for nurse practitioners to keep them practicing to ensure that it's publicly funded and more importantly, to keep them also in Ontario.

Interviewer: All right, Michelle, so on the issue of funding, the Ontario Ministry of Health also had this to say about the lack of support from the federal government. The federal government must be an equal partner in this effort, including coming to the table with adequate health care funding to support the provinces. Currently, the federal government provides Ontario with less than 1% of our total health care budget through transfers. Is it fair to say that the federal government also needs to step up here?

Michelle Acorn: I think both federal and provincial investments are important way to go. But as you know, health care is provincially or territorially run. So that is dependent on Ontario right now. I think, with some of the policy levers that are put in place to ensure compliance with the Canada Health Act, that actually has been clearly done right now. And I think we need to move forward in these investments. There are 6000 nurse practitioners in Ontario right now. More than 50% across Canada are embedded in Ontario right now. So everybody is looking at us to see how we can fully improve access to care, as well as ensure that our workforce is being utilized.

Interviewer: Is it fair to say that, according to that statement, that Ontario's sort of passing the buck to the feds.

Michelle Acorn: Resources are limited? I think it should be a shared mutual responsibility. But the federal government already shared that the Canada Health Act implementation policy and what that looks like right now, and it's up to the provincial and territorial, such as Ontario, to actually implement that right now. Obviously, making sure there's good return on value and investments of nurse practitioners is important right now, and it is a value add profession that can meet Ontario needs.

Interviewer: When we look across this country, how does Ontario compare when it comes to nurse practitioners?

Michelle Acorn: Ontario has been a leader. Actually, Ontario has invested in open nurse practitioner led clinics. We've expanded from 250 to 6000. For example, right now, they're embedded in not just nurse practitioner led clinics, community health centres, family health teams, indigenous centres. They can be attending in long term care and in corrections for health equity as well. But what that actually comes down to from the funding question is there's pockets of funding, but it's very laborious and it's not easily accessible and equitable right now. Right now, we have nurse practitioners that are underemployed, that are available to serve right now and delivering care, and they are not able to get remunerated respectfully in a timely way and open up clinics and practices where Ontarians need them.

Interviewer: If Ontario's Health Minister Sylvia Jones was sitting across this table right now, what would you tell her to prioritise?

Michelle Acorn: We need to modernise and expedite funding for nurse practitioners right now. Enter into a nurse practitioner main agreement, a service delivery agreement, and actually ensure that patients don't have to pay out of pocket right now and that we can provide care immediately across all our communities right now. I would also say that teams can be within four models for walls in a model of care. They can be across communities. We still can be connected with team based care that can be either nurse practitioner or physician led, and leveraging everybody's expertise. And nurse practitioners need to be leveraged as leaders and as clinicians as well, and be part of the solution. We could really expedite OHIP billing codes right now, or some type of transitional envelopes to address this date within two days.

Interviewer: It can be done that quickly.

Michelle Acorn: Why not? It's important. Why not? We don't have to just wait another year to ensure we're in compliance. We want to ensure patients don't pay out of pocket.

Interviewer: All right, Michelle, we are going to leave it there. Really appreciate your time. Thank you so much for your passion.

Michelle Acorn: Thanks for the opportunity to be here. And thank you to Ontarians for your trust.

Interviewer: All right. That's Michelle Acorn, CEO of the Nurse Practitioners Association of Ontario. Thank you.

Michelle Acorn: Thank you, thank you.