Mr. Speaker, Your Standing Committee on Social Development is pleased to provide its Report on Bill 40, An Act to Amend the Medical Profession Act, and commend it to the House.
Bill 40, An Act to Amend the Medical Profession Act, was first introduced by the Department of Health and Social Services on November 25, 2021, and then referred to the Standing Committee on Social Development for review. A plain language summary for Bill 40 was tabled on November 26, 2021.
Bill 40 proposes changes to the Medical Profession Act to:
• Exempt physicians in other provinces and territories providing virtual care to NWT residents from needing an NWT licence when there is a referral from an NWT doctor or nurse practitioner;
• Clarifies a regulationmaking power to adapt and adopt standards of practice for the practice of medicine;
• Allows the Minister of Health and Social Services to enter into agreements with other governments or organizations about physician licensing;
• Creates a new category of registration and licensing for physicians practicing virtual care without a referral; and
• Allows registers of physicians to be posted online.
The main changes made in committee include:
1. Removal of the virtual care register; and
2. Requiring the Minister to consult with the Northwest Territories Medical Association before recommending regulations on standards for the practice of medicine.
The committee thanks everyone who took the time to participate in the review and provided us with comments and concerns on Bill 40.
This bill provides a permanent arrangement for virtual healthcare services based on NWT referrals. During the COVID19 public health emergency, the state of emergency, the Minister of Health and Social Services authorized virtual care through a ministerial directive. In accordance with section 3.3 of the Hospital Insurance and Health and Social Services Administration Act, the Department of Health and Social Services made a temporary agreement with the College of Physicians and Surgeons of Alberta to exempt its members from having to licence in the NWT and to continue to provide services needed in the NWT.
The agreement was renewed by one year and will expire by the end of 2022. This bill provides a more permanent arrangement.
Mr. Speaker, I would like to pass to my colleague for Great Slave further reading of this document. Thank you.
Thank you, Member for Kam Lake. Member for Great Slave.
Thank you, Mr. Speaker. Mr. Speaker,
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.
All submissions welcomed Bill 40 for continuing access to virtual care beyond the COVID19 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 COVID19 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 NWTwide electronic medical record system. The fact that NWTwide 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 inperson healthcare and services.
Most respondents expressed strong concerns about the proposed creation of a virtual care register. Bill 40 proposed creating a new 12month 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 inperson 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 inperson point of care in the NWT, not be affiliated with forprofit paidaccess 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.
Thank you, Member for Great Slave. Member for Deh Cho.
Mahsi, Mr. Speaker.
Bill 40 proposes adapting standards for the practice of medicine by adding a code of ethics and competency programming. The new paragraph would allow the Minister to recommend regulations on code of ethics, continuing competency programs and the nature of those programs, and scope of practice frameworks and guidelines. The medical community responded with concerns that in most provinces, licensing colleges set and enforce standards of practice within the framework of selfregulation of the medical profession physicians.
The NWT Medical Association pointed out that the profession's priorities may not always align with the priorities of the government. The College of Family Physicians of Canada recommended aligning the application of standards with comparable structures in neighbouring provinces and suggested Alberta is the best fit due to proximity and existing integration.
The College recommended considering an affiliation with an existing licensing College for ease of operation. The Royal College of Physicians and Surgeons of Canada encouraged the NWT government to collaborate with the Federation of Medical Regulatory Authorities of Canada and its regional authorities to ensure panCanadian alignment in professional standards of practice.
The Registered Nurses Association of NWT and Nunavut welcomed the new paragraph as it would lead to "increased patient safety and satisfaction by ensuring that virtual practice physicians clearly understand the context of virtual practice in the North."
The College of Family Physicians of Canada noted that the amendments proposed in Bill 40 do not address issues the Physician Executive sees with the current MPA. These include the reliance on outdated certification requirements, the differential and discriminatory treatment of family physicians compared to other specialists, the inability to administer conditional licenses, etc.
The College recommended consultation with the local physician leadership from the Territorial Physician Executive to understand these requirements.
1. Leverage virtual care models in an ecosystem that promotes continuity of care (ensure availability of information in the NWT Electronic Medical Record);
2. Provide virtual care within NWT's publicly insured system, which meets the principles of the Canada Health Act;
3. Provide all people living in NWT, including those in rural and remote communities, access to reliable highspeed internet to ensure they reap the full benefits of virtual care;.
4. Design virtual care services in genuine partnership with Indigenous communities of the NWT to ensure care is delivered in a culturally safe manner;
5. Collaborate with people with lived experience (including patients and care partners) to ensure that the virtual care model meets the needs of the people relying on it;
6. Pursue ongoing quality improvement to assure NWT's successful deployment of virtual care;.
7. Integrate virtual care services with inperson care. Consider physician workforce, medical facilities, specialized equipment, clinical teams and other necessary resources, to ensure a proper balance of inperson and virtual specialty care within the territory.
Mr. Speaker, I now turn it over to Member from Inuvik Twin Lakes. Mahsi.
Thank you, Member for Deh Cho. Member for Inuvik Twin Lakes.
Thank you, Mr. Speaker.
The committee considered several motions that would improve Bill 40, including removing the virtual care register, and adding a requirement to consult with the medical professional community before proposing regulations concerning standards of practice.
Committee members noted the strong endorsement of an exception to registration to continue virtual care with referral and to allow the Minister to enter into agreements that would exempt care practitioners from licensing in the NWT and permit them to provide virtual care services to NWT residents. To this effect, subsections 31.6 and 31.7 of clause 9 were maintained.
The committee took into consideration the risks and concerns expressed in the submission. It was noted that the proposed virtual care register would not apply to every situation to prevent unlicensed physicians from practicing in the NWT, not ensure continuity of care or connection in the NWT system, not entirely remove the administrative burden; and, may create a sense of oversight not truly reflective of the situation.
Committee put forward Motions 2, 3, 4, 9, 12 to 19, and 23 to remove the virtual care register from Bill 40.
Bill 40 proposed establishing or adopting standards of practice, codes of ethics, continuing competency programs, and the nature of those programs, and scope of practice frameworks and guidelines.
The committee observed that the Health and Social Services Professions Act uses the exact wording to give Cabinet the power to make regulations to establish standards of practice, codes of ethics, and competency programs and guidelines.
After hearing from various medical organizations about the potential for the Minister to infringe on the independence of the medical profession through this clause, the committee deliberated whether the concern was the regulationmaking power or the standards themselves.
The committee recognizes the position of the professions that creating regulations on standards of practice may infringe on the independence of the medical profession. In connection with those concerns, committee members heard that the concern is not at the level of the standards themselves but that should the Minister choose the standards, it could mean competing interests because the Minister's interest may not be in line with patients' interests.
In conversations with the committee, the Department of Health and Social Services expressed the commitment to consult the medical profession on standards of practice adapted from the College of Physicians and Surgeons of Alberta to bring standards into force in late 2022. The Department plans to include consultations on adopting the Canadian Medical Association's Code of Ethics and Professionalism.
The current legislation allows the Minister to develop regulations respecting standards for the practice of medicine. Therefore, Bill 40 does not contemplate removing or adding the power that the Minister already has. Therefore, removing this power would not be within the scope of Bill 40. The committee considered all comments on selfregulation out of scope but looked to other ways to ensure collaboration as noted in the next section.
The committee proposed that the Minister should consult with the NWT Medical Association before recommending making regulations regarding establishing or adopting standards of practice, codes of ethics, continuing competency programs and the nature of those programs, and scope of practice frameworks and guidelines under clause 24 para 94.
Committee pursued an amendment with Motion No. 10 allowing the Commissioner to make the stipulated regulations only after consultation with the Northwest Territories Medical Association.
Mr. Speaker, I will now ask to pass it on to my colleague, Member for Monfwi. Thank you.
Thank you, Member for Inuvik Twin Lakes. Member for Monfwi.
Thank you.
Several concerns from witnesses were about aspects of virtual care or professional regulations that the committee did not consider in scope with Bill 40. However, the committee found the recommendations relevant to creating a supportive environment for the legislative changes to be successful.
The NWT Medical Association requested the NWT government consider the alternate process by contracting organizations such as College of Physicians to develop the standards of practice for physicians. The committee recognizes the position of the professions and accordingly makes the following recommendation.
The Standing Committee on Social Development recommends that the Minister engage the services of an independent body, such as other Colleges of Physicians, to develop standards of practice for physicians practicing in the NWT
The committee noted that while meaningful participation by physicians in discussions of standards for physicians is desirable and necessary, the NWT reality is that physicians are often working at maximum levels of their capacities with little time left for extensive consultation. Accordingly, the committee makes the following recommendation.
The Standing Committee on Social Development recommends that the GNWT work with the NWT Medical Association to ensure they have the ability to meaningfully participate when they are consulted on any proposed standards for physicians in the NWT.
The committee considered further comments by the College of Family Physicians of Canada on the Medical Professions Act. The College notes problems with the current legislation, the reliance on outdated certification requirements, differential and discriminatory treatment of family physicians compared to other specialists, and the inability to administer conditional licenses as current gaps not addressed by legislative improvements. The College states that "consultation with the local physician leadership from the Territorial Physician Executive would be beneficial in gaining further understanding" of these requirements. Further, committee makes the following recommendation.
The Standing Committee on Social Development recommends the Department of Health and Social Services consult with the local physician leadership from the Territorial Physician Executive to understand certification requirements, differential treatment of family physicians compared to other specialists, and the administration of conditional licenses.
The Standing Committee on Social Development recommends that the GNWT provide a response to the recommendations contained in this report within 120 days.
I'll now pass it on to MLA Caitlin Cleveland, MLA from Kam Lake. Thank you.
Thank you, Member for Monfwi. Member for Kam Lake.
Thank you, Mr. Speaker. I respond to all of the above.
The clausebyclause review of Bill 40 was held on March 19, 2022. At this review, committee moved ten motions. The Minister concurred with all ten motions.
This concludes the Standing Committee on Social Development's review of Bill 40. The committee thanks the medical profession and the public for their participation in the review process, the Department of Health and Social Services for the collaborative effort to improve the proposed changes, and everyone involved in reviewing this bill for their assistance and input.
Following the clausebyclause review, a motion was carried to report Bill 40: An Act to Amend the Medical Profession Act, as amended and reprinted, as ready for consideration in the Committee of the Whole. This concludes the Standing Committee's review. Thank you, Mr. Speaker.
Thank you, Member for Kam Lake. Reports of standing and special committees. Member for Kam Lake.
Thank you, Mr. Speaker. Mr. Speaker, I move, seconded by the Member for Great Slave, that Committee Report 3119 (2), Standing Committee on Social Development Report on Bill 40, An Act to Amend the Medical Professions Act, be received by the Assembly and referred to Committee of the Whole. Thank you, Mr. Speaker.
Thank you, Member for Kam Lake. Motion is in order. To the motion?
Question.
Question has been called. All those in favour? All those opposed? Any abstentions. The motion is carried. Report of Bill 40, An Act to Amend the Medical Professions Act, will be moved into Committee of the Whole later today. Thank you.
Reports of standing and special committees.
Colleagues, we will take a short recess. Thank you.
SHORT RECESS
