No fees at nurse-run service

By NZNO president Grant Brookes

Québec City, the venue for the GNU meeting (see Related coverage, below), is also home to Coopérative de Solidarité SABSA, a small, innovative primary health care (PHC) service with a growing reputation. When the nurses at Coop SABSA offered to give up their weekly staff meeting to show us around, Nuku and I eagerly accepted.

Established initially as a voluntary organisation in 2011, Coop SABSA is unique. Unlike other PHC services in Québec, the cooperative is a nurse-run, not-for-profit organisation that doesn’t charge consultation fees.

Canada is usually thought of as a country with universal health coverage. Canadian citizens, permanent residents and some temporary migrants are eligible for free health care (with certain exceptions) by presenting their health card.

For GP consultations, most doctors charge a fee for service. The card, however, ensures reimbursement under a public Medicare insurance scheme.

But among vulnerable populations, some do not have a health card. SABSA nurse Maureen Guthrie estimated the proportion of the population denied access to PHC as a result could be as high as 10 per cent. It’s this group, living in downtown Québec, who are cared for by her team.

The service has six staff and sees around 300 patients a month – either by appointment, at a walk-in clinic or through home visits.

Much of the care involves long-term conditions management of non-communicable diseases or HIV-related conditions. There are regular clinics provided by a visiting psychiatrist and other specialists.

Two GPs are available on-call, but most of the prescribing is done by nurse practitioner Isabelle Têtu. Less than five per cent of consultations result in an onward referral to a doctor.

“If we did a survey of emergency rooms around here,” said Guthrie, “they would tell us there’s been a drop in presentations since we opened.”

Initial support to establish Coop SABSA came from the nurses’ union, FIQ Santé, which contributed C$300,000 in seed funding over two years. Today, one salary is paid by the government and the team receives small grants from pharmaceutical companies and donations from local GPs, but fundraising is an ongoing issue.

“Nurses need to take their place professionally,” said Guthrie. “It wasn’t easy at the beginning, but we just ignored what people said, because we knew we were doing it for the patients. Nurses have to trust themselves that they can do it.” •

Related coverage:

‘Global nurses unite in Québec‘

‘Do online votes aid union democracy?‘

(First published in Kai Tiaki Nursing New Zealand, February 2018. Reposted with permission)