Changing primary care capacity in Canada (4C): A cross-provincial mixed methods study to inform workforce planning

There are more primary care doctors and nurses (primary care providers) per person than ever before in Canada. Yet, many Canadians cannot access the primary care they need, and primary care providers are reporting record levels of stress and overwork. To help understand this, we will examine how Canada's primary care needs and the system's capacity to provide this care are aligned, and develop tools to plan for the future. We will interview family physicians and nurse practitioners in four provinces (British Columbia, Ontario, New Brunswick and Nova Scotia) to understand factors shaping their workload and changes over time. We will ask about patient characteristics, health conditions people have, and factors in the healthcare system (including changing practice guidelines and time spent on paperwork and administration). We will use province-wide population data to track factors that reflect primary care need and capacity. Factors that reflect patient need include age group, gender, health conditions, services used, and measures of social context. Factors that reflect system capacity include family physician and nurse career stage, service volume, and roles providers take on outside of community-based care. Finally, we will build analytical models to compare primary care needs and capacity under different future scenarios to guide system planners. We need this information to help health system leaders plan to meet the needs of a growing and aging population. When need is much greater than capacity, this unfairly affects people with fewer social or economic resources to navigate access to care, making systems less equitable. Findings and planning tools will be useful across Canada, as all provinces and territories are facing the same challenges of ensuring access to primary care, given changing patient populations and health system resources. This can help ensure primary care is more accessible to everyone in the future.