Across Canada, provinces are taking varied approaches to address growing pressures in primary care. Many jurisdictions are leveraging Nurse Practitioners (NPs) to expand access for patients and strengthen their health systems. This includes developing and implementing flexible funding models that allow NPs to practice to their full scope – and compensate them appropriately for doing so.
In March, as anticipation for the 2026 Ontario Budget grew, NPAO and NPs alike looked forward to seeing continued investment in NPs, recognizing their vital role in Ontario’s healthcare system. Instead, NPs were notably absent from the Budget entirely.
This lack of clarity carried into April 1 when Ontario officially failed to meet the deadline required to respond to the expectations set out in the Canada Health Act interpretation letter, which directs provinces and territories to include NP-provided services in publicly funded health insurance plans. Without a clear plan, both NPs and patients are left facing uncertainty, and access to care remains constrained.
Following the deadline, Ontario Minister of Health Silvia Jones confirmed that the province will not introduce billing codes for NPs, meaning they will not be able to bill OHIP directly for their services, as physicians do. However, she did not outline an alternative approach for integrating NPs into the publicly funded system, continuing to leave critical questions unanswered.
NPs across Ontario are already making a meaningful impact, but their ability to do more across all the sectors depends on how we are funded, remunerated , supported, and integrated into the health system. Examining how other provinces’ structure NP roles offer valuable lessons for enabling Ontario’s NPs to deliver care effectively and sustainably
Where Access Gaps Are Largest, NPs Are Filling Them
One of the clearest trends across Canada is that provinces facing the most severe primary care shortages are relying more heavily on NPs. This is especially true in British Columbia, Alberta, and Saskatchewan.
NPs are uniquely positioned to strengthen meaningful access to care. With the ability to diagnose illnesses, order and interpret diagnostic tests, provide treatment and more, they deliver high-quality care that improves outcomes for both patients and the broader health system. And while this particular article is focused principally on the role of NPs in primary care, their contributions to specialty care cannot – and must not – be overlooked. Across the healthcare continuum, in a diverse set of practice settings, NPs are working hard for their patients.
Despite Ontario having one of the largest NP workforces in the country, significant gaps in access remain. Today, 11.5% of Ontarians, more than 1.5 million people, do not have a primary care provider. This is not a reflection of the work or scalability of nurse practitioners, but rather the result of structural barriers from a provincial system that is not fully optimizing its existing healthcare workforce.
Knowing that there remains a lack of primary care providers, there has been investment in the recruitment and retention of NPs, increasing the number of primary care clinicians available. This is no doubt important and is also a central pillar of NPAO’s work. However, the challenge is not just about supply, it is also about how that workforce is supported and sustained within the health system.
Compensation Models Directly Impact Patient Access
One lesson Ontario can take from its provincial peers is the relationship between how NPs are funded and how many patients they can serve. This can be achieved through flexible funding models – which essentially mean payment and resource structures that adapt to different care settings, patient needs, and provider choice in their service delivery role- rather than being tied to rigid physician-led models and employee positions, and salary based as the only funding.
In jurisdictions where we have outdated and restrictive funding structures this can limit the number and complexity of patients NPs can have on their roster, the viability of NP-led models of care and clinics, and the ability to respond flexibly to community need. This creates a paradox, where even as demand for care grows, system capacity remains artificially constrained.
Flexible Funding Models are the Future, and Other Provinces are Moving Towards it
When looking West to provinces like British Columbia, Alberta, and Saskatchewan they offer important examples of where the system is heading. While all three provinces have historically had lower NP supply compared to Ontario, they are now actively introducing more legislation that looks to integrate flexible funding models of NPs and find publicly funded avenues for NPs to practice and provide care as employees or independent contractors and clinic owners.
British Columbia
In British Columbia, NPs are supported through two complementary funding pathways – a Primary Care Network (PCN) contract model and a Health Authority employee model. The PCN model enables NPs to function with a high degree of autonomy in community-based primary care, offering competitive compensation alongside dedicated overhead funding to support clinic operations. At the same time, the Health Authority model provides the stability of salaried employment, including benefits, pension, and full integration within the broader health system. Together, these models create a balanced ecosystem – one that supports both entrepreneurial, community-driven structure, and team-based delivery across various healthcare settings and communities.
This dual approach is a key strength, as it allows NPs to choose roles that align with their preferences for autonomy and their community of practice, which in turn supports recruitment and retention. Just as importantly, it gives the system flexibility to deploy NPs where they are most needed, whether that’s attaching patients in primary care through PCNs or strengthening capacity within hospitals and long-term care.
For Ontario, the lesson is clear: a single, one-size-fits-all funding model is limiting. Ontario can better leverage its NP workforce by introducing more flexible modernized funding structures, particularly by pairing stable employment or work options with well-supported, community or population focused contract models that include adequate overhead funding and interprofessional team support.
Alberta
The province of Alberta has also taken significant strides in improving funding mechanisms for NPs and encouraging the growth of the NP profession to improve Alberta’s primary health care system, recognizing that NPs are a central pillar to their success.
In November 2023, the Government of Alberta announced a new payment model, that would allow NPs to set up their own practices, or work within pre-existing clinics, and get paid directly by the government. At the time, it was estimated that up to 50 NPs would sign onto this program during 2024, and once fully implemented they would be able to serve approximately 45,000 patients. Also included in the program’s budget is a $2-million panel management fund, offering a one-time payment of $75 per patient if NPs take on more than 900 people this year.
Moving forward to 2026, the Government of Alberta and Primary Care Alberta launched Alberta Find a Provider, a redesigned website that helps Albertans quickly connect with nearby NPs, family doctors, registered midwives, and clinics accepting new patients, helping reduce time and making it easier to connect with a primary care provider. The redesigned site replaces Alberta Find a Doctor and includes expanded search options to make it easier to find care close to home.
With the new payment model introduced in 2024, Alberta has seen an increase in primary care providers. Compared to the over 900 NPs working in Alberta in 2024, as of Dec. 31st, 2025, there are now 1,137 NPs with active licenses, including 141 added in the past year.
Saskatchewan
In mid-2025, the Government of Saskatchewan issued an expression of interest for Nurse Practitioners (NPs) interested in delivering publicly funded primary care through independent projects. The pilot program began with six NP contractors and has since expanded to 30, reflecting strong interest from NPs.
In March 2026, the province’s Patients First Health Care Planindicated that it aims to remove limits on the number of contracts available to NPs delivering publicly funded care. This approach reduces barriers for NPs who want to help address gaps in access to care, making it easier for patients to receive the primary care they need.
The government also committed $78,000 over two years to support registered nurses pursuing NP training through a return-for-service contract.
Investing in NPs through recruitment and retention strategies that are financially supportive not only benefits practitioners but also improves patient access by increasing the number of available providers.
Supporting Our NP Workforce in Ontario
Many conversations about healthcare workforce challenges in Ontario have been focused on numbers alone, asking how many providers are undergoing training and how many additional education seats for NPs. These are absolutely important initiatives, but they cannot exist in isolation. Ensuring we have the appropriate funding mechanisms in place to adequately support, recognize, and compensate NPs for their work is crucial in ensuring timely access to care for patients across the province. Â
NPAO advocates for accelerating the creation of multiple flexible funding models to facilitate the appropriate integration of NPs across the healthcare system and within healthcare teams.Â
If Ontario is serious about closing its primary care gap and beyond, there are clear steps forward:
- Adopt more flexible funding models that allow NPs to respond to community needs
- Modernize compensation structures to reflect full scope of practice
- Expand and support NP-led models of care
We can look to peers such as British Columbia, Alberta, and Saskatchewan for lessons on expanding publicly funded opportunities for NPs in primary care, models that ensure fair compensation, grant autonomy, recognize NPs as team leaders, and are designed sustainably to support both practitioners and the communities they serve, while improving access to care.
