Government of New Brunswick

Primary Health Care Integration

What are we doing?

As of January  1st, 2018, the Extra-Mural Program and Ambulance New Brunswick services will be delivered by a Part III Entity EM/ANB, managed by Medavie Health Services New Brunswick.

The Extra-Mural Program will remain a publicly funded, government service.

 

Why are we doing this?

The delivery of health care is challenging across Canada and the rest of the world. Issues that are similar across jurisdictions are, amongst others, an aging population with increasing health care needs, as well as increasing pressure on acute care settings.

In New Brunswick, the focus of the health care system has historically been mainly on the acute care setting. Many individuals with chronic conditions who could be cared for in a primary health care setting, home-care or long-term care setting, are hospitalized.

New Brunswickers rely heavily on Emergency Departments (ED) and after-hour walk-in clinics in their community, where the services provided may not be appropriate to their care needs and lack continuity. The focus on care should be in the community first, while care in the hospital or a long term care facility is offered as a last resort and for complex care needs.

In order to have a sustainable health care system in New Brunswick, with better health outcomes, we must shift the focus of health care provision from hospital-based acute inpatient care to the community.  The model is focused on increasing access to care in the community and reducing/diverting hospital based care.  These are necessary changes as New Brunswick prepares for the health care needs of an aging population.  

Vision
The challenges outlined above present a unique opportunity to introduce and collaborate on innovative approaches to provide community services. This will ensure New Brunswickers can:

  • stay in their own home as long as possible;
  • receive help with navigating the health care system;
  • experience increased continuity of care and
  • receive the care and services they need at the right time and the right place. 

Improving health care can start with reorganizing existing services to increase collaboration of providers in the community, hence maximizing current resources. 

 

What are the benefits of the proposed model?

This new model  is an opportunity for New Brunswick to become a leader in the country with regards to community and home-based health care,  and will allow for more focus and emphasis on the services of the Extra-Mural Program; best practices and standardization; and technology solutions to maintain and increase excellence of care and patient experience.

Proposed service delivery model                
There are three province-wide programs in New Brunswick that can be leveraged to drive innovative change within primary health care as well as increase capacity.  These include:

  • The Extra-Mural Program: available on a province-wide basis. 
  • Ambulance New Brunswick: while the core mandate of ambulance services is the provision of emergency care and transport, there are numerous examples across Canada and internationally that demonstrate the ability of paramedics to play a role in primary health care.
  • Tele-Care 811:  provides a range of health triage, advice and information through Registered Nurses.  
     

What are the timelines?

The implementation of the model will take a phased approach, starting with a transition period, when Extra-Mural Services remain the responsibility of the Regional Health Authorities, but where preparations are made to move the service from the Regional Health Authorities to the Part III Entity.

It is anticipated that on January  1st, 2018 EM/ANB will start delivering the Extra-Mural Program. 

 

What does the transition phase entail?

The transition phase will commence on September 1, 2017. The transition phase will prepare the Extra-Mural Program, Regional Health Authorities, Medavie Health Services New Brunswick and the Department of Health for the start-up of EM/ANB, effective January 1st, 2018.

During the transition period, there will be no changes in the responsibilities of the Regional Health Authorities regarding the Extra-Mural Program and reporting structure of the Extra-Mural Program.

The Department of Health has established a Transition/ Implementation Steering Committee, which includes representation from the Regional Health Authorities, Medavie Health Services New Brunswick and the Department of Health, and several working groups to prepare for the operations of the Part III Entity. 

 

What will happen as of the start date of the EM/ANB?

Extra-Mural Program services will continue to be offered 7 days a week and 24 hours a day as a public service. There will be a continued focus on providing excellent care according to the current Extra-Mural Program mandate and vision policies and standards of care.

Over time, Medavie Health Services New Brunswick will focus on process improvement and leverage expertise and resources to increase capacity in the New Brunswick health care system by integrating resources from the Extra-Mural Program, Ambulance New Brunswick and Tele-Care 811.

 

What will the organizational structure look like?

The Part III Entity will be accountable to the Minister of Health through a Board with an accountability framework that includes performance metrics. 

 

What will be the role of the Department of Health?

The Department of Health will continue to plan, fund and monitor the Extra-Mural Program. The Department of Health will remain responsible for the development of program policy and standards; monitoring of performance of the program and ensuring the mandate and philosophy of the Extra-Mural Program remain in place. 

 

What will be the role of Ambulance New Brunswick?

There will be no change in services provided by Ambulance New Brunswick, in the short term. 

 

What will be the role of Tele-Care 811?

There will be no change to the current Tele-Care 811 services, in the short term. 

 

Will the quality of care change?

The current quality of care will remain in place, as well as care plans. There will be no change in the services you currently receive from the Extra-Mural Program.

Extra-Mural Program staff will continue to be available 24/7. There will continue to be a quality assurance and quality improvement framework in place to monitor processes and outcomes. 

 

Will the Extra-Mural Program be privatized?

Extra-Mural Program services will continue to be a public service. EM/ANB is a government entity, with government employees. Medavie Health Services New Brunswick is a private, not-for-profit primary health care solutions organization that is contracted for the management and clinical oversight of the Extra-Mural Program. 

 

Will my physician remain involved?

Physicians will remain essential members of the team providing your home healthcare services and the Extra-Mural Program staff will continue to work closely with your physician and other professionals involved with your care. 

 

Will the process of receiving equipment, supplies, medications and personal care services covered by EMP change?

These processes will not change.

 

What will the collaboration between Extra-Mural Program, Ambulance New Brunswick and Tele-Care 811 look like?

In the first phase of the contract, the focus of the Part III Entity will be on continuing to provide excellent Extra-Mural Program services to clients across the province.

Integration with Ambulance New Brunswick and Tele-Care 811 will be explored as part of a later phase of the contract. 

 

Will there be an impact on the language of service?

The Part III entity will comply with the Official Languages Act. Services will continue to be offered in the language of choice of the client. 

 

What will be the language of work?

The contractual agreement will require that, similar to what now exist for Part I departments, the language of work will be in both official languages.

 

How will client confidentiality be guaranteed?

There will be no change to current policies related to client confidentiality and privacy requirements.

 

How will New Brunswickers be informed of the implementation of this change?

Regular updates on the progress of implementation will be provided through the Department of Health website and a telephone inquiry line 1- 888-672-4611 (effective September 5th, 2017).