Heading to the Pharmacy Association of Nova Scotia (PANS) annual conference in Dartmouth last weekend (Oct. 13-15), I was curious to learn more about the Community Pharmacy Primary Care Clinics.
In this innovative province-wide demonstration project, launched in February 2023, pharmacists in 25 pharmacies provide a host of extended services to Nova Scotians by appointment as part of their provincial health coverage. While I knew that the clinics were exceeding expectations—with more than 50,000 services administered so far and the project evaluation moved up by six months to facilitate faster expansion—I didn’t understand exactly how they worked.
I now realize I also had no comprehension of just how advanced and integrative this project really is.
Similar clinics have been implemented in Alberta and Ontario; however, the Nova Scotia model is almost the platonic ideal of a pharmacy-centred care clinic. Every step of service has been thoughtfully planned to provide maximum benefit to patients, communities and the healthcare system, while also allowing participating pharmacists to derive a high level of personal satisfaction and giving pharmacies a sound business model for setting up appropriately to allow pharmacists to provide consultative services.
To be clear, it is not scope of practice that makes this initiative unique; it’s the over-arching framework and support system that enables the pharmacy care.
As Nova Scotia College of Pharmacists registrar Bev Zwicker (fresh from presenting at the International Federation of Pharmacist’s conference in Australia) noted, “where the province is really leading the world is in terms of what pharmacists can do when leaning into their full scope—all pharmacists, not just a subset of pharmacists. And that it is being integrated into the provincial health system so that patients see that we are integral to that system.”
Certainly being a smaller province, where the advocacy and regulatory groups can work closely and communicate openly with the government is a huge advantage in testing such dramatic systemic changes.
Planning for success
Imagine coming in to work each day knowing that you will have a fairly predictable number of 15-minute appointments booked with patients; and that your time will be blocked out to allow you to focus on those common ailment, preventative care, chronic disease or medication-related consults. Or being a pharmacy owner who receives a fee each month (for now, for the purposes of this pilot, a $7,000 monthly stipend) to cover the expenses of staffing and administration required to provide these services, which for patients are covered under the provincial health plan.
As pharmacist Kari Ellen Graham told CBC News, the system has led to "10 times better job satisfaction" among pharmacists working in the clinic, who are now able to work to their full scope of practice.
And what about a single provincially-managed appointment system which allows patients to book pharmacist consults online or by phone? And an ongoing, province-wide marketing and information campaign with TV and newspaper ads and mailers designed to educate the public and other healthcare providers about what pharmacists can and can’t do—and equally important—that such care is better provided with just a little bit of planning and lead time.
Supports for business and practitioners
Planning and support for pharmacies and pharmacists who wish to maximize their scope and services have been a key focus for PANS leading up to and even outside of the CPPCC project.
A program called Prescription to Thrive, launched in 2020 has helped to set up more than 45 pharmacies with the tools, education and workflow processes they need to successfully transition to a services-focused business and practice model. For pharmacists embracing their new role as providers of crucial primary healthcare, the Clinical Consultant Pharmacist Service, led by the College, is a call away. This service provides a free one-on-one consultation with an experienced clinical pharmacist who can recommend how to handle challenging clinical issues, particularly related to prescribing, therapeutic substitution and adapting prescriptions for patients.
And while the CPPCC’s are having admirable success, both PANS and the College are working well ahead on the countless issues that need to be resolved in order to take this demonstration project to the next level; that is, to where it is a simple fact of living in the province that a patient can make an appointment at their local pharmacy when they feel they might have strep throat or need a vitamin B12 shot or to start birth control.
Ensuring that enough properly-trained staff are available in pharmacies where the time, technology and working environment allows such consultations (while also of course still operating as a dispensing pharmacy, if that’s the business plan) is a priority. To that end, watch for initiatives designed to speed up licensing for pharmacy assistants moving towards regulation; smooth the path for international and inter-provincial pharmacy professionals, and set enforceable workplace and staffing standards for employers who wish to become a clinic-style pharmacy services provider.
Now, things are not perfect in Nova Scotia. As they are elsewhere in Canada, many pharmacists are stressed, exhausted and working at their limit. Wages have not kept up with inflation—nor with wage increases implemented for other healthcare practitioners in the province. But looking at the big picture, one can see that steps are being taken to try and improve the situation sooner rather than later.
It’s one thing to implement forward-looking initiatives that advance the profession. It’s another thing (arguably the most important thing) to set up everyone involved so they can succeed and thrive as they step out into new territory. It appears that those leading pharmacy in Nova Scotia are doing their best to build a solid framework for this new kind of pharmacy practice.
It’s a huge goal, but if anyone can do it, this little province can. I for one will be watching.