A new primary care clinic operated by Horizon will grow to operate as a ‘patient medical home’ serving the region, and eventually providing some after hours care, according to updates by Horizon Health Network managers at a public meeting on October 12 in Sackville.

About 60 community members gathered to hear updates from the leadership of the Horizon Health Network, about half as many as gathered in July for a similar meeting. Both meetings were organized by MLA Megan Mitton.

Richard Lemay is Horizon’s director of primary health care for the Moncton area and one of the people spearheading the creation of a new community clinic located in the Tantramar Community Health Centre, a privately owned building across the parking lot from the Sackville Memorial Hospital. Lemay said the clinic opened on September 11, and as of October 6 has seen 154 people, with 163 appointments in total.

The clinic alternates between opening three days and four days a week, depending on availability of staff. There’s a registered nurse, two administrators, and three physicians working part time in the clinic so far, including Dr. Catherine Johnston, and Dr. Sarah Thomas working virtually.

Lemay says Horizon has funding for a licensed practical nurse (LPN) and nurse practitioner (NP), plus “a bit of casual support”. He told the meeting Horizon is “trying to fill those positions at this time,” and said there is also an outstanding posting for a nurse practitioner at the Port Elgin Health Clinic.

The Horizon website shows a number of generic postings for LPNs and NPs that mention the Sackville area along with a number of other communities, but does not show any Sackville postings for RNs. Lemay told CHMA by email that the jobs are currently going through an internal posting process before they get opened up to candidates outside of collective agreements.

‘What other choices do you have right now?’

A number of people in the crowd asked about the relationship between the new Sackville clinic, NB Health Link, and Patient Connect NB.

Patient Connect NB is the longstanding list of people waiting for a primary care provider, which at one point in 2022 topped 74,000. In an effort to reduce that list, the department of health hired Medavie Health Services to create NB Health Link, a primary care service for people waiting on the Patient Connect list. NB Health Link doles out primary care appointments, but does not assign doctors or nurse practitioners, so people using NB Health Link are still waiting for a permanent primary care home. The two NB Health Link clinics in the Moncton area have over 32,000 people receiving services, with another 7,000 registered and waiting.

The new Sackville clinic is another initiative, this time by Horizon, intended to become a permanent primary care provider for patients in the area. That means patients have to choose, said Lemay, between staying registered with NB Health Link, or choosing the new Sackville clinic as their primary provider.

Dr. Ravneet Comstock, chief of family medicine for the Moncton area, responded to one man who was concerned at being asked to choose between the two options. “I think what’s happening here is that you’re just starting to get care [at the Sackville clinic],” said Comstock. “You’re worried you’re gonna lose it… But the goal here isn’t short term. Your medical home is now the Tantramar Health Clinic. If you’ve been called, then you call them your doctors going forward.”

Comstock was matter-of-fact with her advice. “What other choices do you have right now?” she asked. “There isn’t that easy access to care elsewhere. This is your best bet.”

But the Sackville clinic is only an option for a limited number of people in Sackville. Currently the clinic is taking patients that have been referred from the now closed practices of Dr. Catherine Johnston and Dr. Andrea Wall, who submitted lists of the patients they felt had the most need. The same process is underway for patients of nurse practitioner Angela Tower, who up until recently was seeing a roster of patients in Sackville as a Horizon employee. Tower recently took a different position in Horizon, and so her patients will be asked to move into the new Sackville clinic on the same priority basis as those of doctors Wall and Johnston.

Patients who were orphaned before the Horizon clinic initiative started are not yet eligible for care at the Sackville clinic, and services like eVisit, after-hours clinics, and NB Health link are their only options. But Lemay and Comstock say the long term vision is for a permanent primary care clinic serving anyone in the Sackville area.

“This is a work in progress,” Comstock told the crowd. “If we have this meeting again in six months or so, I hope that we can say we have 1.5 [full time equivalent providers] on a daily basis… The bigger dream is a medical home where you have all sorts of people working --physicians and RNs and LPNs and a diabetic nurse and a physiotherapist and a mental health nurse… This seems like a dream but it is something we’re holding on to.”

Lemay said Horizon staff were “working on trying to build a case” for the patient medical home concept which would be ready for Horizon leadership scrutiny in the fall. If approved, the proposal would then go on to government for funding approval.

Emergency services still a priority, says Melanson

The October 12 meeting also touched on the status of services at the Sackville Memorial Hospital. Sackville and Moncton hospital director Christa Wheeler Thorne told the crowd the Emergency Department in Sackville was now 85% staffed, with a few part-time nursing positions left to fill. Wheeler-Thorne said in contrast to the situation for the past few years, “we are getting a number of applicants on these positions. So that means they want to stay and work here and live here. So that’s very positive.”

Horizon interim CEO Margaret Melanson reaffirmed the health network’s goal of bringing back overnight service in the Emergency Department (ED), which currently is open just 8am to 4pm each day. “It may seem as though that has gone to the side, however it has not,” said Melanson. “We’re very fortunate that over the past several months, we have been able to recruit sufficient nursing staff for your emergency department. So now, we are at the point of needing to have sustainable physician coverage.”

Melanson said the focus now was to staff the Sackville ED with physicians from the Moncton hospital, a model currently in place between Saint John and Sussex. Dr. Ross Thomas, retired Sackville physician and member of the Rural Health Action Group, said new primary care doctors coming into the system no longer wanted to work ED shifts, and emergency specialists wanted to be located at major trauma centres. That makes smaller hospital EDs like Sackville’s hard to staff. Thomas said, “we’re trying to convince the Moncton hospital,” to follow the Saint John-Sussex model, where physicians that work in the bigger city ED would also have to cover shifts in the smaller ED.

“It’s hard because you can’t tell doctors what to do,” said Thomas. “They have to be brought along as they come into the system.”

Thomas also noted that the goal of the new Tantramar Health Clinic would be to eventually offer after hours care for non-acute patients.

A community role in health care?

Melanson promised the crowd that she and her colleagues would be back again to update and engage the community about how things are going, and MLA Megan Mitton committed to hosting another meeting, this time with an additional invite extended to Medavie, who now run both Ambulance NB and NB Health Link.

Both Mitton and Thomas expressed a need for some sort of formalized community role in the future. Mitton pointed to the trend towards centralized decision making in New Brunswick health care. “And that has created problems,” said the MLA. “We need local decision making. And I think we need some of that decision making to be from elected officials.”

“We have a community engagement model,” said Melanson in response to a question from CHMA about the possibility for future local control over both primary and hospital care. “We’re probably most established here in Sackville, but we’re introducing this as well in other communities,” said Melanson. “I can commit to you that this engagement is not something that’s temporary or to be curtailed. This is something that’s here to stay, it may evolve as time progresses, however, I can commit to you that we will always be open to hear your voice, to have that dialogue and to have the conversations about what you believe is working well, what you believe we should be expanding and doing differently.”