Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental Scanreveals a significant difference between the place of residence and location of dialysis with many living outsideCDHA seeking dialysis in CDHA. This observation will require further investigation to determine optimalservice delivery when the NS PRP is linked to clinical service delivery planning.From a PRP population need basis there are 17.7 licensed nephrologist FTE or 1.0 FTE per 53,000 populationand 1.0 FTE per 39 patients on active renal replacement therapy. This ratio is consistent between CDHA and theother DHAs based upon location of dialysis and location of nephrologist i.e. 39.4 and 38.2 respectively.Discounting for relative academic work will change the ratio approximately +/- 6.0.In 2009/10 in Nova Scotia, there were 690 patients on active renal replacement therapy (RRT) and 1,055identified as pre-dialysis. This is consistent with Nova Scotia having the second highest prevalence of ESRD inCanada at 1,318 per million population. England has 1.0 Whole Time Equivalents (WTE) per 66,000 population(Source: NHS England Centre for Workforce Intelligence) with forty percent lower ESKD prevalence (800 permillion population). More importantly England plans for 1.0 WTE per 119 patients on active renal replacementtherapy. The service delivery model in England is premised upon a defined mix of Junior Doctors (44%) andConsultants (56%) and enhanced multidisciplinary team model that includes nursing, counselling, pharmacy,health care technology, diabetologists, general practitioners, dieticians, and psychology. The Joint ServiceCommittee on England nephrology workforce is recommending a ratio of 1.0 WTE Consultant to 100 patients 74 .This recommendation does not contemplate any change in other clinical scope of practice. Thisrecommendation includes renal transplant patients. Assuming a 56% Consultant 44% Junior Doctor (e.g.general practitioner) ratio then the recommendation is 1.0 WTE Consultant per 56 patients. Nova Scotia iscurrently at 1.0 FTE licensed nephrologist per 39 patients on RRT and approximately 1.0 FTE functionalnephrologist per 48 patients on RRT. Both the England and Nova Scotia ratios assume a percent academic/nonclinicalworkload.The 2006 England Royal College of Physicians member survey reported nephrologists working an average 55.3hours per week based upon a 53% response rate, of whom 58.9% responded to the >48hr question.23.2.8 NeurologyCurrently, and in comparison to, Nova Scotia:• There are 20.8 neurology specialist FTEs or 1.0 FTE per 45,242 population in Nova Scotia.• Benchmark(s):• In Canada there is 1.0 FTE per 43,355 (source: CIHI).• Royal College of Physicians Assoc. of British Neurologists recommend 1.0 FTE per 43,500 (seebelow).• A benchmark of 43,500 population per FTE was applied to the Base Case forecast in the FinalReport.Disorders of the nervous system are common. Some neurological conditions are inherited like Huntington’sdisease and to a lesser extent Alzheimer’s disease with others related to smoking, alcoholism, trauma, infectionor autoimmune dysfunction. People with diabetes are more likely to develop neurological problems comparedwith those without diabetes. Researchers highlight that diabetic patients have a three- to ten fold increased74 British Renal Association, JSC for Renal Medicine, 08.24, 5 June 2008, WORKFORCE REQUIREMENTS FOR NEPHROLOGYOVER THE NEXT 5-10 YEARS, Draft document from the Workforce Group, (Baker, R., Barker, L., Mason P. Chair)208 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental Scanrisk of thromboembolic strokes than the non-diabetic population, and stroke-related mortality and morbidityare increasing in the diabetic population 75 .Of all the identified modifiable risk factors for stroke, hypertension appears to be the most important, owing toits high prevalence and its associated three- to fivefold increase in stroke risk. Based on epidemiological data,approximately 50 percent of strokes could be prevented if hypertension were eliminated (Source: NHS EnglandCentre for Workforce Intelligence).England NHS workforce planning for neurologists uses a broad parameter of neurologists having an average ofthree clinics per week with five new patients per clinic, then this equates to one neurologist per 125,000population. Currently there is one neurologist per 150,000 in the United Kingdom.The Royal College of Physicians Association of British Neurologists conducted a detailed programmatic basedreview of neurology workforce requirements 76 . The review projected neurologist requirements for acomprehensive service including acute care (emergency care), scheduled outpatient care, and long-termconditions (e.g. MS, epilepsy and movement disorders. The provision of a adult neurology service requires oneFTE consultant neurologist per 70,000 population. The broader target of one FTE per 43,500 populationincludes stroke (stroke subspecialists), neurophysiology and neurorehabilitation.23.2.9 Palliative MedicineThe NS approach to palliative care is based on a service model which includes palliative care physician(s) ineach DHA. This role is integral to the function of established district specialist palliative care teams which areresources to primary care providers in a shared care model. This is secondary and shared care for patients withadvanced illness, often in their homes. The necessary resources required for this model are local 77 .23.2.10 RespirologyCurrently, and in comparison to, Nova Scotia:• There are 11.8 respirology specialists or 1.0 FTE per 80,173 population in Nova Scotia.• Benchmark(s):• The U.K. Royal College of Physicians’ 2005 Consultant physicians working with patients reportestimates a requirement of 1.0 FTE respiratory medicine consultants per 37,000 head ofpopulation 78 . The Sentinel Services are the incidence of lung disease, in particular asthma andchronic obstructive pulmonary disease (COPD).• In 2009/10 British Columbia had 75 adult respirologist FTE or 1.0 per 59,400 with an average of7,200 services per 1.0 FTE.• Nova Scotia in 2009/10 has 11.8 FTE or 1.0 per 80,173 performing an average 2,059 FFS andshadow-bill services per 1.0 FTE.• A report to the Canadian Thoracic Society Education Committee included a recommendation fromPGME Respirology Directors of 1.0 FTE per 50,000. The RCPSC 1988 recommendation was 1.0respirologist per 81,000, which is equivalent to about 1.0 FTE per 73,000 population. This75 Sood, M.M., Bueti, J., et.al., The Intersection of Risk and Benefit: Is Warfarin Anticoagulation Suitable for AtrialFibrillation in Patients on Hemodialysis?, CHEST October 2009 vol. 136 no. 4 1128-113376 U.K. RPCS, Assoc. British Neurologists, Local adult neurology services for the next decade, June 201177 NS Department of Health and Wellness, Provincial Hospice Palliative Care Project", Final Report & Recommendations inOctober, 200578 U.K. NHS Centre for Workforce Intelligence, August 2010209 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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Environmental Scan - Government of Nova Scotia

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