The Nurse Practitioners’ Association of Ontario (NPAO) supports Ontario’s efforts to modernize primary care funding, strengthen team-based care, and improve access and attachment for Ontarians. As Ontario transitions to the FHO+ primary care funding model, NPAO believes implementation must protect and strengthen the role of Nurse Practitioners (NPs) and avoid creating financial structures that inadvertently discourage their integration.
NPAO’s position is that NP funding should be dedicated, flexible, and sufficiently independent of physician compensation and physician-specific performance metrics to support NPs practicing to their full scope and contributing directly to patient attachment, access, continuity, and system capacity.
NPs are autonomous healthcare providers with the education, scope of practice, and regulatory authority to independently assess, diagnose, prescribe, order and interpret diagnostic testing, and manage patient care. NPs contribute significantly to primary care capacity across Ontario, including the management of complex and chronic disease, preventive care, episodic care, and longitudinal primary care attachment.
However, Ontario has historically lacked sufficient flexible, publicly funded pathways through which NPs can independently deliver primary care. As a result, many NPs working within Family Health Organizations (FHOs) are employed through funding structures controlled by or financially connected to physician practices.
This creates a structural vulnerability: NP workforce capacity can become dependent on physician funding and compensation models rather than being independently recognized and funded as primary care capacity.
The transition to FHO+ introduces changes intended to better recognize physician workload, including compensation associated with physician time spent providing indirect care such as charting, patient communication, and administrative work. The FHO+ is not a replacement of the FHO model but rather an enhancement intended to address long-term gaps and better positioned to deal with modern day healthcare practices.
NPAO recognizes the importance of appropriately compensating all healthcare professionals for the work required to provide comprehensive primary care. However, where practice revenue becomes increasingly linked to services or activities personally performed by physicians, there is a potential unintended consequence: physician practices may have less financial incentive or capacity to redistribute appropriate clinical work across the interdisciplinary team, including to NPs.
NPAO is also concerned that continuity measures must appropriately recognize care delivered by NPs. Measures that primarily attribute continuity to the same physician risk underrepresenting the longitudinal care provided by NPs and the contribution NPs make to maintaining patients within their primary care team.
Funding and performance frameworks should therefore recognize team-based continuity and NP-delivered longitudinal care, rather than unintentionally privileging one provider type within an interdisciplinary model.
NPAO’s Position on NP Funding Within FHO+
NPAO believes implementation of FHO+ and Ontario’s broader primary care funding strategy should:
- Establish dedicated and protected NP funding pathways that are not dependent on physician remuneration or physician-specific work performance metrics.
- Develop flexible funding models that allow NPs to practice as employees, independent providers, or within other publicly funded team-based models.
- Recognize NP-led patient attachment and longitudinal care within provincial primary care performance and continuity measures.
- Ensure FHO+ funding incentives support full-scope interdisciplinary practice, allowing care to be provided by the most appropriate healthcare professional.
- Protect existing NP positions during the transition to FHO+ and avoid unintended financial incentives that could reduce NP utilization.
- Recognize NPs as primary care capacity, rather than positioning NP services primarily as an extension of physician-funded care.
Ontario’s primary care transformation requires the province to maximize the capacity of its entire healthcare workforce. Creating sustainable and flexible NP funding mechanisms can increase primary care attachment, improve access and continuity, strengthen interdisciplinary teams, and support recruitment and retention of the NP workforce.
NPAO is committed to working collaboratively with the Ministry of Health, Ontario Health, the Primary Care Action Team, physicians, primary care organizations, and other system partners to ensure FHO+ and Ontario’s evolving primary care funding models support the effective integration of Nurse Practitioners.
FHO+ should strengthen interdisciplinary primary care, not create financial structures that inadvertently make the sustainability of NP roles dependent on physician remuneration.
Download the position statement here.
