Thank you, Mr. Speaker. Mr. Speaker,
What We Heard
The committee held a public engagement period from December 22, 2021 to April 31, 2022 and a public hearing on May 16, 2022. Near the end of the committee's review period, the Government of the Northwest Territories Department of Health and Social Services identified issues with Bill 40 that could require substantial amendments. These issues addressed some of the points of contention identified by stakeholders.
At the suggestion of the Minister, the committee sought and received an extension of the review period on March 28, 2022. The committee indicated its willingness to work collaboratively with the Minister of Health and Social Services to improve Bill 40.
When a bill is before a standing committee, it is unusual for the Government of the Northwest Territories to be involved in consultation with stakeholders. However, in this instance, committee took the unusual step of requesting that the Minister of Health and Social Services again consult with key stakeholders on the bill during this extension.
The committee received written submissions from the College of Family Physicians of Canada, the Northwest Territories Medical Association, the Royal College of Physicians and Surgeons of Canada, and the Registered Nurses Association of the NWT and Nunavut, and also heard from the Northwest Territories Medical Association in a public presentation on May 16, 2022.
Submitters expressed two key concerns: The lack of integration of care providers into the NWT medical system if virtual care is permitted without a referral and the role of the government in establishing professional standards of practice.
The committee received additional recommendations on future virtual care access and standards of practice considerations beyond Bill 40.
Virtual Care and Exemption to be Licensed
All submissions welcomed Bill 40 for continuing access to virtual care beyond the COVID-19 pandemic emergency measures. As part of clause 9, this change would add subsection 31.6 and create an exemption to the NWT registration and permit requirements for medical practitioners registered in another jurisdiction and referred to by an NWT medical practitioner or nurse practitioner. The proposed addition of subsection 31.6 was not contentious.
The exemption from licensing based on a referral from NWT practitioners has enabled physicians to practice virtual care during the COVID-19 pandemic. All submitters made it clear that this was a welcomed practice that should continue.
The Canadian Medical Association and the NWT Medical Association supported the proposed exemption to allow physicians licensed elsewhere to provide virtual consultation to NWT residents beyond the current public health emergency given the care originates in a request from an NWT care provider with a referral. The NWT Medical Association pointed out that the referral allows for integrated and coordinated service delivery.
Medical practitioners providing virtual care based on a referral are integrated because they can work within an NWT-wide electronic medical record system. The fact that NWT-wide territorial staff are all employees of the NTHSSA allows coordination of virtual care within and outside of NWT.
The NWT Medical Association considered those aspects of the act that would enable referrals to physicians outside of the NWT an essential element of NWT healthcare and wants to continue this.
The Registered Nurses Association of the NWT and Nunavut, and the Royal College of Physicians and Surgeons of Canada, welcomed the exemption. Both submitters explain that the exemption would remove barriers to accessing safe and quality care for the NWT residents and leveraging virtual care as a complement to accessing in-person healthcare and services.
Virtual Care Register
Most respondents expressed strong concerns about the proposed creation of a virtual care register. Bill 40 proposed creating a new 12-month registration and licensing requirement for physicians practicing in other jurisdictions and in good standing with the Canadian Medical Protective Association to provide virtual care in the NWT (section 31, 81).
The registry would allow out of territory health practitioners to practice virtual care to NWT residents without a referral from an NWT health practitioner. This scenario raised several concerns in the medical profession.
Submitters were concerned that allowing practitioners to see patients without a referral may create a parallel system and leave doctors unable to integrate into the NWT medical system by not having access to NWT pharmacies. The NWT Medical Association expressed that the register would not be necessary and potentially harmful to patient care quality and cultural safety in the NWT.
The Canadian Medical Association saw concerns with continuity of care due to the fragmentation between in-person and virtual patient and physician relationships. Challenges with tests and diagnostics would potentially increase demand in hospital emergency departments. Equity concerns would arise, considering potential private pay options in virtual care services.
To address the lack of integration with NWT systems, the College of Family Physicians of Canada asked to include in the virtual register requirements for physicians. Physicians would need to have the ability to ensure informational continuity so that medical records are available and complete, have established connections with an in-person point of care in the NWT, not be affiliated with for-profit paid-access solutions, and have experience and appreciation for the uniqueness of the NWT's regions.
Concerned with continuity of care, the Registered Nurses Association for the NWT and Nunavut advocated for physicians practicing virtual care to understand the role nurses have in communities and healthcare in the North. This would recognize that the proposed amendments would affect the practice of registered nurses and nurse practitioners who work closely with the residents in the NWT.
Mr. Speaker, I'd like to now pass this over to the Member for the Deh Cho. Thank you.