06/03/2026
"Improving primary health care access: Lessons from Canada and Scotland
It’s the foundation of the health care system, but the struggle to access primary care across Canada has become acute
By Andrew Longh
Summary
Access to primary care varies by province, provider, and income
In 2024, one in five Canadians lacked access to a regular family doctor or nurse practitioner. The percentage of Canadians with a regular family doctor declined in seven out of 10 provinces between 2015 and 2024:
Prince Edward Island (declined from 88 per cent to 53 per cent of Canadians 18 and over with a regular family doctor);
Newfoundland and Labrador (declined from 86 to 67 per cent);
Nova Scotia (declined from 86 to 72 per cent);
New Brunswick (declined from 88 to 76 per cent);
British Columbia (declined from 82 to 75 per cent);
Ontario (declined from 87 to 85 per cent); and,
Saskatchewan (declined from 78 to 77 per cent).
Between 2015 and 2024, the share of Canadians with access to a regular nurse practitioner (NP) increased from 0.8 per cent to 2.1 per cent. Although NPs represent a small share of primary care provision overall, their role in building a stronger primary care system is important and growing.
In 2024, 80 per cent of the lowest-income Canadians had a regular health provider (family doctors, nurse practitioner or other provider) compared to 86 per cent in the highest-income quintile (Figure 3). This gap did not improve between 2015 and 2024.
Primary care reforms have focused on physician payment, rather than structural change
In 2025, Health Workforce Canada reported that there were 193 primary care policy interventions in 2024 and 75 in 2025 across all provinces and territories. Changing and increasing physician compensation remains one of the most common interventions across the country. But it’s not translating into increased access to primary care.
The lack of alternatives to the independent contractor model—where doctors and nurse practitioners are expected to own and operate a business—and investment in not-for-profit primary care infrastructure actively encourages the growth of investor-owned corporate chains. This privatization of primary care infrastructure has significant implications for care delivery, quality, and the commercialization of patient data.
Closing the primary care access gap requires strong federal leadership
Timely access to primary care remains a challenge across the country. Federal leadership is required to hold provinces accountable for addressing the primary care access gap:
All federal funding, including the Canada Health Transfer, should have strings attached to hold provinces and territories accountable for closing the primary care access gap.
The federal government should report annually on the progress of provinces and territories in achieving timely access to a primary care provider or team that also accounts for equity, including income, gender, age, and race and ethnicity.
The federal and provincial governments should focus efforts on increasing access to primary care providers and teams by implementing the lessons from Scotland’s reforms and the community health centre model."
It's the foundation of the health care system, but the struggle to access primary care across Canada has become acute
