New Brunswick’s auditor general is raising questions about how the Holt government locates and tracks collaborative care clinics, the centrepiece of its push to improve health care access.
Paul Martin said in an audit released Tuesday that it wasn’t clear whether the Department of Health chose the right locations, nor how many patients were being taken off waitlists.
“The department did not have adequate information to demonstrate that collaborative care clinics were improving access to primary care where it was needed most,” Martin said in the report, which he presented to the legislature’s public accounts committee.
“Gaps in cost analysis, performance monitoring and patient attachment data also limited the department’s ability to assess results, address unmet needs and demonstrate value for money.”
Martin said the clinics represent “a significant change” in how primary care is delivered in New Brunswick and it’s important to ensure decisions are being made correctly.
“Let’s fix this on the way through and get the best bang for our buck for New Brunswickers,” he told the MLAs on the committee.
Premier Susan Holt and Health Minister John Dornan, announcing a collaborative care clinic in Bathurst last winter. (Charles-Étienne Drouin / Radio-Canada)
The audit called for a provincial plan using “documented community health needs and access gaps to guide the implementation, funding and resourcing of collaborative care clinics.”
In an appendix to the audit, the department said it agreed with, and was implementing, that recommendation and all the others in the report.
Premier Susan Holt promised in the 2024 election campaign to open 30 collaborative care clinics by 2028.
The clinics employ doctors and a range of other health care professionals to provide a range of services depending on patient need.
Holt officially announced the the 19th clinic in Moncton on Tuesday. Some of the clinics she has announced are new, and others are the conversion of existing facilities into clinics.
Martin’s audit looks at the first 14 clinics the government announced between April 1, 2025, and March 31, 2026.
He said the first seven locations were chosen based on the Liberal government’s 2024 election commitments, and the next seven were based on recommendations from the two regional health authorities.
Martin said that because pay contracts for doctors do not force them to join collaborative clinics, and clinics aren’t required to be put where the needs are highest, the Health Department “does not have full control over where clinics are established.”
Liberal MLA Benoit Bourque, a former health minister and a member of the public accounts committee, said the party chose the clinic locations listed in its election platform based on New Brunswick Health Council data.
He asked Martin whether the fact voters elected a Liberal government based on that campaign platform brought “a certain credibility” to the locations.
“Would that also help validate the selections that were made by the government?” he asked.
Martin said it was beyond his purview to look at campaign platforms, and he could only examine what information the Department of Health had when it picked locations.
But the department funds the clinics and is responsible for assessing if they are improving access to care. The department should use data to make decisions on locations and identify how to meet primary care needs in places where doctors don’t adopt the clinic model, he said.
The report also says there was no comprehensive analysis of what the clinics would cost.
Martin said the department told his office it has a target of 1,400 patients attached to each doctor — enough to cover everyone in the province, he calculated — but because only 45 per cent of doctors plan to join collaborative care clinics, it will fall short of attaching everyone.
The province signed a new four-year, $270 million contract with doctors earlier this year that offers incentives for those who join collaborative care clinics.
Martin said the department has not assessed the long-term cost or sustainability of the clinic model beyond the terms of that contract.
The audit also says that pay agreements for doctors who bill Medicare, and for those who work directly for the province, do not incorporate all the access-to-care targets that the department provided to Martin’s office.
The auditor general also scrutinized Holt’s clinic update earlier this year and found “reporting inaccuracies,” including math errors and incorrect values being used in calculations.
“Without a reliable method to identify and verify newly attached patients, the department cannot accurately assess or publicly report the model’s impact on patient attachment,” the report said.
Holt’s April news conference provided updated numbers on the first four collaborative care clinics she announced, in Fredericton north, St. Stephen, Tantramar and Lamèque.
She hasn’t updated clinic-by-clinic numbers since then.
Last week, the premier announced the government was switching to a new way of measuring access to primary care that would rely on Medicare data, rather than an annual survey by the New Brunswick Health Council.
Based on the new methodology, 70.2 per cent of New Brunswickers registered with Medicare were attached to a doctor, nurse practitioner or collaborative care clinic as of this month.
Martin said in the audit that numbers provided by the department also suggest that the collaborative care model won’t be enough to link all unattached New Brunswickers to a primary care provider.