Fewer than 500 Quebecers have been cared for by specialized nurse practitioners (IPS) since they obtained the right to register patients in their name in mid-April. A number that appears very low considering that 640,000 people are at the counter for access to a family doctor.
As of June 11, 13 IPSs had registered a total of 482 patients, according to the Régie de l’assurance santé du Québec.
Figures that do not surprise the Association of Specialized Nurse Practitioners of Quebec (AIPSQ). For the moment, this new type of registration is only possible in the 12 IPS clinics and service points in the network. Around thirty IPS work there full time, according to the Ministry of Health and Social Services (MSSS).
“We are impatiently awaiting phase 2 [of the project] so that IPS can register directly in GMF,” says AIPSQ president Maude Raymond. In Quebec, 1060 IPS offer front-line services, according to the MSSS. “More than 80% are in GMF,” she estimates.
Family doctors can receive a list of patients from the access desk and have a maximum period of one year to offer a first consultation to a person deemed vulnerable and three years in the case of a patient not vulnerable.
“For IPS, there is no such mechanism,” laments Maude Raymond. Does the patient really need to be seen on June 14 [for example] for registration? We are less relevant at that time. »
Another “big rock in the shoes” of front-line IPS: they do not have the power to assess and diagnose mental health disorders, recalls Maude Raymond. If a patient is depressed, these professionals must turn to a doctor or a mental health NP. “Once the treatment plan is made, the IPS can adjust the molecule, follow up and renew work stoppages,” she explains.
The MSSS indicates that the number of registrations by IPS will increase as clinics open – a thirteenth will be launched in the fall in the National Capital – and as positions are filled. According to the MSSS, an “experienced NP who practices full time in a clinic” can take care of up to 1,000 patients.
And registration by IPS in GMFs? This will become possible “during the next deployment phases” of the project, responds the Ministry. “The necessary negotiations on this matter are continuing. »
Asked to react, particularly with regard to the registration of patients by IPS in GMF, the Federation of General Practitioners of Quebec (FMOQ) did not wish to comment “while negotiations will soon begin with the government of Quebec on the renewal of the framework agreement”. The union emphasizes, however, that collective registration remains an “essential avenue” since “there is a shortage of 1,500 family doctors in Quebec.”
The Interprofessional Health Federation of Quebec (FIQ) considers that the registration of patients by IPS is a “good recognition” of their autonomy. But this raises questions of “accountability and responsibility”, according to its vice-president, Jérôme Rousseau. IPS are employees and not self-employed workers like doctors, he recalls.
“If an NP, for example, has to be absent due to illness, maternity leave or simply a change of position, how do we monitor the patients who were in their name? he asks. Is it the professional who must ensure follow-up herself or is it the establishment in which she works? »
