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TORONTO – Ontario is proposing to further expand pharmacists’ scope of practice by adding to the list of minor ailments they can assess, allowing them to administer more vaccines and order some lab tests.

But while pharmacists see the proposal as an overdue solution to easing the burden on other aspects of the health-care system by leaning more on their professional expertise, doctors are raising concerns.

The government in early 2023 granted pharmacists the ability to assess and treat 13 minor ailments, including pink eye, hemorrhoids and urinary tract infections. In the fall of that year six more were added to the list, including acne, canker sores and yeast infections.

Now, the government is proposing to expand the list to include sore throat, calluses and corns, mild headaches, shingles, minor sleep disorders, fungal nail infections, swimmers’ ear, head lice, nasal congestion, dandruff, ringworm, jock itch, warts and dry eye.

As well, the Ministry of Health is looking for feedback on what lab tests and point-of-care tests might be required for pharmacists to order and perform as part of assessing and treating those conditions.

The government is also considering funding pharmacists to administer tetanus, diphtheria, pertussis, pneumococcal, shingles and RSV vaccines for adults, in addition to COVID-19 and flu vaccines. The province is proposing to allow pharmacy technicians to administer the same vaccines as pharmacists.

“Our government is focused on improving access to care in communities across the province and we have seen the success of our minor ailment program, connecting over 1 million people to treatment for minor ailments,” Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, wrote in a statement.

Justin Bates, CEO of the Ontario Pharmacists Association, said the minor ailments program has been going well so far, and further expanding pharmacists’ scope can help avoid visits to family doctors and emergency rooms.

“We want to build health-care capacity through looking at pharmacies as a health-care hub and the pharmacists’ trusted relationship with their patients and to leverage that, because they are underutilized when it comes to what scope they can do,” he said.

But doctors are pushing back on the scope expansions.

“The bottom line here is that pharmacists are not doctors,” said Dr. Dominik Nowak, president of the Ontario Medical Association. “Doctors are trained for years and thousands of hours to diagnose and treat conditions.”

Nowak said that sometimes the symptoms that would seem to suggest one of those minor ailments are really a sign of a more serious condition, and it takes a doctor to recognize that.

“When I look at a lot of the minor ailments list, I think to myself, there’s nothing minor about many of these,” Nowak said.

“Many of these ailments rely on the patient … one, knowing the diagnosis themselves, so the patient’s own opinion. And last I heard, most of my patients haven’t been to medical school. And then two: it also relies on the patient’s own opinion about whether this is something minor or something serious.”

Bates said he has been “disappointed” at some of the messaging from doctors, and added that any notion that there is an increased risk to patient safety is “misinformation.”

“I want to support OMA and primary care, and I do – in hiring more doctors, solving some of their issues – but it shouldn’t come at the expense of other health professions gaining their … appropriate scope of practice,” he said.

“So it’s not a zero sum game here. We want to have physicians be comfortable with this, but … the way that some of these doctors are responding, it’s almost like hysteria.”

The government’s proposal on its regulatory registry is open for comment until Oct. 20.

This report by The Canadian Press was first published Sept. 16, 2024.

VANCOUVER – The president of the Union of B.C. Municipalities says communities have billions of dollars worth of infrastructure that will need replacing in the next decade and the province needs to step in with new funding to help.

Trish Mandewo says a call for $650 million in additional infrastructure money each year is one of a series of requests the organization is making to provincial leaders days before B.C.’s provincial election will be called.

They’re also asking for a percentage of the provincial property transfer tax to support housing projects, and a share of the growth in the carbon tax to help pay for responding to extreme weather.

Local politicians are gathering for their annual convention in Vancouver this week and are expected to cover a range of topics including housing, the toxic drug crisis, growing financial pressures, and a host of other issues.

Mandewo, who is on Coquitlam City Council, says the municipalities are looking for a new, flexible revenue stream to help fund an estimated $24 billion in infrastructure replacement that’s expected to be needed in the next 10 years.

She says without the additional money, municipalities won’t be able to build “complete communities” without raising taxes.

“So it’s the individual taxpayers that are going to be paying for that, because local governments have no other way of raising funding,” she said.

Mandewo says municipalities are facing rising costs due to extreme weather events like fires, floods, droughts and heat domes and the scale of what’s required for mitigation and adaptation exceeds their tax base.

“We are asking for a new dedicated revenue source so that we can support emergency planning and risk assessments, which have been asked of us,” she said.

Municipal leaders are going to spend the week discussing more than 200 pages worth of resolutions at the conference. Mandewo says issues surrounding addiction and toxic drugs are front and centre in members’ minds.

Resolutions include calls for more overdose prevention sites, more complex care beds for people struggling with addiction, and more money directed at community safety.

“Local governments have been trying to deal with it as much as we can, because we are the ones that are closest to the communities,” she said.

“That issue is not selective, whether you’re a small community or a large community.”

Premier David Eby is scheduled to address the conference Thursday. B.C. Conservative Leader John Rustad and Green Leader Sonia Furstenau will speak Friday.

A series of “cabinet town halls” are also scheduled where municipal leaders will get a chance to question cabinet ministers on housing, public service and emergency preparedness.

This report by The Canadian Press was first published Sept. 16, 2024.

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In an era of increased strike activity and union power, labour experts say it’s not surprising to see more calls for government intervention in certain sectors like transportation.

What’s new, experts say, is the fact that the government isn’t jumping to enact back-to-work legislation.

Brock University labour professor Larry Savage says for decades, companies in federally regulated sectors, like airlines, railways and ports essentially relied on government intervention through back-to-work legislation to end or avoid work stoppages.

“While this helped to avert protracted strikes, it also undermined free and fair collective bargaining. It eroded trust between management and the union over the long term, and it created deep-seated resentment in the workplace,” he said.

Barry Eidlin calls it a “Canadian tradition.”

“Canadian governments, both federal and provincial, have been amongst the most trigger-happy governments … when it comes to back-to-work legislation,” said Eidlin, an associate professor of sociology at McGill University.

Savage said the use of back-to-work legislation peaked in the 1980s, but its decline was mainly to do with the fact strikes were becoming less common as unions’ bargaining power softened.

But since the right to strike was enshrined in the Canadian Charter of Rights and Freedom in 2015, Savage says the government appears more reluctant to use back-to-work legislation.

Eidlin agrees.

“The bar for infringing on the right to strike by adopting back-to-work legislation got a lot higher,” he said.

However, the experts say the federal government appears to have found a workaround.

In August, Canadian National Railway Co. and Canadian Pacific Kansas City Ltd. locked out more than 9,000 workers — but federal labour minister Steve MacKinnon soon stepped in, asking the Canada Industrial Relations Board to order them to return and order binding arbitration, which it did.

The move by the government — using section 107 of the Canada Labour Code— is “highly controversial,” said Savage.

Section 107 of the code says the minister “may do such things as to the minister seem likely to maintain or secure industrial peace and to promote conditions favourable to the settlement of industrial disputes or differences and to those ends the minister may refer any question to the board or direct the board to do such things as the minister deems necessary.”

“The reason why it’s a concerning workaround is because there’s no Parliamentary debate. There’s no vote in the House of Commons,” Savage said.

Eidlin is concerned that the government’s use of section 107 could set a precedent similar to what decades of back-to-work legislation did: removing the employer’s incentive to reach a deal in bargaining.

“This has a corrosive effect on collective bargaining,” he said.

But Eidlin noted that the Teamsters union representing railworkers is challenging the government’s move.

The breadth of the government’s power under section 107 is “something that the courts are going to have to decide,” he said.

If the courts rule in the government’s favour, the status quo could essentially return to the way it was before 2015, said Eidlin.

The rail stoppage isn’t the first time in recent memory that the federal government used section 107 to intervene in a labour dispute.

When workers at B.C. ports went on strike last summer, then-federal labour minister Seamus O’Regan used the section to direct the board to determine whether a negotiated resolution was possible, and if not, to either impose a new agreement or impose final binding arbitration.

More recently, the government declined a request by Air Canada to intervene in its negotiations with its pilots before the two sides reached a deal at the bargaining table over the weekend.

The last few years have really been a litmus test for that 2015 change, Eidlin said, as workers are increasingly unwilling to settle for sub-par collective agreements and employers “still have that back-to-work reflex.”

With a recent uptick in strike activity, “of course, there will be more interest in government intervention in labour disputes as a result,” said Savage.

This report by The Canadian Press was first published Sept. 16, 2024.

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