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Nurse Practitioner Primary Care Program (NPPCP)

June 14, 2024

The Nurse Practitioner Primary Care Program (NPPCP) is an exciting initiative from the Government of Alberta for nurse practitioners (NPs) that aims to support and improve Alberta’s primary health care system and facilitate Albertans' access to primary care providers.

The NPPCP compensates NPs who practise comprehensive primary care and operate their own independent clinics, or practise independently in team-based care settings. NPs will provide services based on their scope of practice, training and expertise.

The CRNA is currently developing standards and guidelines to support this initiative. In the interim, the frequently asked questions (FAQs) on this page are to provide NPs with direction and guidance to ensure patient safety and public protection. These FAQs will be updated on a regular basis.

If you have a questions that has not yet been answered, you can ask our experts a question here.

Frequently Asked Questions

 

Practising as an NP in Alberta

Registrants of the CRNA can find more information about self-employed practice inside of College Connect.

Log into your College Connect account and navigate to Manage Your Practice > Self-Employed Practice.

For further guidance, you can reach out to our practice consultants.

NPs receive their entry to practice education within differing streams of practice with a focus on a specific demographic (adult, family all ages (FAA), neonatal and child).

NPs must have the knowledge, skills, training, competency and currency to provide patient care in the primary care setting as an MRP.

Typical health care services delivered in primary care settings include, but are not limited to:

  • Providing first contact accessibility, ongoing care and continuity for comprehensive health care needs
  • Managing chronic health conditions
  • Diagnosing new health conditions
  • Ordering diagnostic testing and developing treatment plans
  • Health promotion
  • Assessment and testing through programs such as Screening for Life
  • Referrals to specialists when indicated
NPs are encouraged to self-assess their knowledge, skills, training, competency and currency to determine if they are able to provide effective and safe care in a primary care setting as the MRP.

Registrants of the CRNA are required to follow the standards of practice at all times, regardless of their practice setting.

Additionally, the CRNA's guidelines and scope of practice documents can provide further guidance.

If you have questions about a specific standard of practice, reach out to our practice consultants.

Patients and their families require health care services provided in a safe, competent and responsible manner that aligns with regulatory expectations (including the provider practising within their scope of practice).

Within the NPPCP, patients can expect their health care needs to be provided in a similar manner to other providers (i.e. professional services, privacy, continuity of care).

The CRNA is currently developing formal regulatory guidance that addresses the unique role of NPs in the health care system. In the meantime, the FAQs outlined on this page will provide direction to registrants regarding the CRNA’s general expectations.

NPs are regulated by the CRNA, not by the CPSA; however, to ensure patient safety, the CRNA encourages NPs to familiarize themselves with the expectations physicians are held accountable to by the CPSA. The CPSA’s regulatory guidance for physicians can be viewed as expectations NPs are also held accountable to.

If there are questions related to the CPSA’s standards in relation to NP practice, please contact the CRNA, NOT the CPSA.

The CRNA would like to acknowledge the CPSA’s expertise and leadership with the development of their standards of practice which outline very clearly, expectations for the delivery of patient care in an independent practice setting. The CRNA is very appreciative that the CPSA is supportive of referring NPs to their standards of practice.

New-to-practice NPs are encouraged to seek mentorship from experienced, competent NPs or physicians during the first 18 months of practice, or when transitioning from one practice area to another (e.g., moving from acute care to primary care). Mentorship serves to bridge the gap between education and professional practice (or changing practice areas), enabling NPs to fully understand their scope of practice while developing the necessary knowledge, confidence and competence.

Mentorship can involve coaching, teaching, advising and support.  To be most impactful, the mentor should have the expertise in the skillset the mentee wants to develop. A clinical mentor helps:

  • Answer clinical questions
  • Develop new skills
  • Identify opportunities for improvement
  • Share learning opportunities

Non-clinical mentorship is also encouraged. Non-clinical mentorship may cover topics such as business considerations, contract negotiations, workplace challenges and self-care.

The NPPCP provides NP mentorship support. More information can be found in the Nurse Practitioner Primary Care Program guide, page 5.

NPs must be aware of potential conflicts of interest when providing uninsured services (e.g., uninsured aesthetic treatments), alongside publicly funded health services. The CRNA expects NPs to act in the patient’s best interests and not be affected or influenced by other competing interests such as financial, non-financial, direct or indirect transactions. Equitable access to publicly funded health services in accordance with the CNA Code of Ethics should be prioritized.

When offering uninsured services, NPs must avoid using their position to promote uninsured services or products to patients. 

Patients receiving uninsured NP services should not receive preferential access to publicly funded services. NPs participating in the NPPCP program have additional requirements (Nurse Practitioner Primary Care Program guide, page 6).
 
Patients receiving publicly funded health services should not feel obligated or offered incentives to access uninsured services. Patients should be able to clearly distinguish between uninsured services and publicly funded health services to avoid any perception of NP influence. The NP may want to consider business practices that include separate physical spaces, distinct operating hours and unique advertising such as signage, phone numbers and websites.

Referrals to NP uninsured services should only occur when no viable alternatives exist for the patient’s needs. 
 
If an NP provides both uninsured and publicly funded health services, documentation of any conflict-of-interest disclosure must be made in the patient’s record.

 

About the Nurse Practitioner Primary Care Program (NPPCP)

For questions related to the funding of the NPPCP contact the NPAA or refer to the Government of Alberta website.

NPs participating in the NPPCP must be familiar with all relevant information sharing and privacy legislation, including the Health Information Act. NPs participating in the program must also be familiar with any relevant information sharing and privacy related standards of practice or other policies.
 
If you are an NP seeking additional information on information sharing and privacy, should reference the Privacy and Management of Health Information Standards or visit the Nurse Practitioner Association of Alberta.

Additional resources include:

Alberta Health (AH) HIA resources are available to assist with understanding the rules governing and protecting health information in the custody or under the control of a custodian:

Regulated professional staff must make the public aware of their names and professional designations. Registrants of the CRNA are required to practice using their legal names.

For non-regulated clinic staff the public should be aware of their names and job titles.
 
For role clarity, NPs who have also have an academic doctoral credential may include their credentials behind their name or in conversations with patients and their families.

 

Setting up a Primary Care Clinic

Information about the NPPCP, including the application, can be found on the Government of Alberta website. You can also contact the Nurse Practitioner Association of Alberta (NPAA) for more information.

You do not need to send your initial application for the NPPCP to the CRNA. Applications to the NPPCP can be made only through the Government of Alberta at this time.

The CRNA is currently developing and updating standards and guidelines for practice to outline clear expectations of registrants when providing patient care in independent practice settings.

The CPSA Standards of Practice can be reviewed for reference as outlined above.

For guidance on developing skills and competencies, you can reach out to our practice consultants.

Athabasca University offers an opportunity to take additional education for NPs who also wish to be dually licenced for family all ages (FAA).

Choose a name that clearly reflects your area of practice and services. Follow the CRNA's Advertising Standards and the Code of Ethics. Keep it factual and transparent. Your name should not mislead, imply superiority or create unrealistic expectations. You are responsible for how your clinic name is used across all platforms — oral, print and/or electronic. Signage should help people identify your clinic without solicitation. These guidelines apply to all clinic types (e.g. uninsured services and publicly funded health services) no matter the services offered.

 

Privacy

A PIA is required by a custodian any time there are:
  • New administrative practices or information systems relating to the collection, use and disclosure of individually identifying health information
  • Changes to existing administrative practices or information systems relating to the collection, use and disclosure of individually identifying health information Privacy and Security Polices for Custodians provides NPs with a template for the development of policies and procedures custodians can use when submitting a PIA to the Office of the Information and Privacy Commissioner of Alberta (OIPC) 
Custodian as defined in the HIA (2000). A custodian includes the following:
  • hospital boards, nursing home operators, provincial health boards
  • ambulance operators, regional health authority, the Health Quality Council of Alberta, licensed pharmacies
  • health-care professionals that are designated under the Health Information Regulation (Alta Reg 70/2001).

Registrants should follow the Documentation Standards for patient records. Additional information can also be found in the Privacy and Management of Health Information Standards.

 

Absence/Closing/Relocating/Leaving a Clinic

The CRNA expects NPs to arrange for coverage of their clinical practice when they are away or unavailable (e.g. vacation, after hours coverage, etc.).

For example, a call schedule could be developed for weekend or evening coverage, or longer absence arrangements could be made with a colleague to provide coverage.

When closing or leaving a practice, the CRNA expects NPs to consider patients they have been providing care for and endeavour to assist the patients to find another care provider.

NPs must do their best to not abandon patients, in accordance with the Canadian Nurses Association Code of Ethics for Registered Nurses.

All outstanding testing and investigations must be followed up with or arrangements must be made with another provider to do so. The patient must be well informed, preferably in writing, of what to expect and who they should be working with. NPs should also ensure all outstanding referrals have been completed.

Patients, other health professionals and health institutions need to be given adequate notice that the NP is closing or leaving the practice. Notice is required since patients must find another health care provider, so other providers need to know where to send outstanding consultations, etc..

NPs must make arrangement for the disposition of patient records, as outlined in the Privacy and Management of Health Information Standards, and the Privacy and Security Policies for Custodians.

Contact the Office of the Information and Privacy Commissioner (OIPC) of Alberta with privacy and management of patient information legislative requirement questions at generalinfo@oipc.ab.ca.

An NP must notify the CRNA with a change to practice location in accordance with the Health Professions Act (HPA, Part 2, 4.0 (b) iii and 4.1).


The CRNA expects NPs to notify all health providers who they refer to or are referred to them, as well as professional working relations, of the location change. 

Patients on an NP's panel must be given adequate notice, preferably in writing, prior to the relocation. Current patients should have the option of receiving care at the new location. If it is an option and a patient prefers to stay at the current clinic, the NP must provide access to the patient's outstanding investigations, consultation reports and any other information regarding the patient's health needs.

 

Oversight

The CRNA is responsible for regulating NPs and RNs in Alberta. The CRNA does not regulate clinics. Instead, the CRNA is responsible for regulating NPs' practice within clinics.
 
If an NP is engaged in independent practice, or if the NP is the clinic director, they are accountable and responsible to ensure the clinic meets the requirements for the safe delivery of patient care (e.g. supervision, infection prevention and control measures, properly credentialed and trained staff, protection of patient health information).
 
Please see the clinic director questions below for more information.

All NPs are accountable for the care they provide to their patients and to follow the applicable legislation, regulations and the CRNA’s Standards of Practice.

Federal and provincial legislation often refers to a “medical practitioner” as someone who can practise medicine. The terms “medical practice” and “medical director” are most commonly associated with physician practice.

Clinic director is therefore the preferred term for an NP in this role, rather than medical director.

In practice settings with multiple providers and staff, a clinic director is responsible for overseeing the non-clinical aspects of the clinic (e.g. staffing, advertising, infection prevention and control requirements, and safe handling of health records) and assisting with establishing policies and procedures for the clinic to guide safe patient care.

A clinic director is accountable for the overall leadership of the clinic to ensure the safe, competent and ethical delivery of patient care.

Clinic director responsibilities may include, but are not limited to:  

MRP refers to a regulated health care professional (usually a medical doctor or NP) who has the overall responsibility for directing and coordinating the care and management of a patient over a specific period of time.

The designated MRP at an institution or health care site is typically identified in the site’s policies and procedures. Adapted from Canadian Medical Protective Association.

Within the NPPCP, NPs are identified as the MRP for the patients on their panel. The NP is accountable to ensure the patients health care needs are met, including completing any required referrals, ordering tests or procedures and ensuring follow-up is completed within an appropriate amount of time as dictated by the urgency of the patient’s care needs.

In Alberta, nurse practitioners can form corporations to offer professional services without the CRNA’s approval. This is different from the requirements faced by other health care professionals such as physicians, dentists, chiropractors and optometrists, who must obtain approval from their respective regulatory college and a permit for a professional corporation.
NPs can form a corporation by following the Government of Alberta’s guidelines for incorporating a business, which can be found here. It is recommended to consult with the Canadian Nurses Protective Society, an accountant and a lawyer to explore the options available to you.

News & Announcements

Expanding Primary Care in Alberta with Nurse Practitioners

Resources for Nurse Practitioners

Nurse Practitioner Primary Care Program (Government of Alberta)

Nurse Practitioner Association of Alberta

Standards of Practice

The CRNA acknowledges that physicians have been providing autonomous primary care to patients as the most responsible practitioner for a considerable amount of time. The College of Physicians and Surgeons of Alberta (CPSA) has standards of practice that are designed to support autonomous primary care. Some of the guidance in the FAQs has been adapted from the CPSA's standards of practice with their permission. Patients are entitled to safe, competent and ethical care whether they are being treated by a physician or an NP.