Dalla Lana School of Public Health

Options for increasing access to quality community primary care report

March 20/2026

Executive Summary

Canada is facing a primary care crisis, with millions of people lacking access to a regular primary care provider. Expanding the scope of practice for non-physician providers has emerged as a promising strategy to address health system gaps by enabling these professionals to safely perform tasks beyond their traditional scope of practice. This brief synthesizes the current global evidence on expanded scope of practice across nurse practitioners (NPs), pharmacists, and paramedics practicing in high-income countries.

Emerging insights from Ontario have found that expanding health professionals’ scope of practice, allowing NPs to order more diagnostic imaging and pharmacists to administer influenza vaccines, changed care delivery, increased service use in community settings, and reduced avoidable physician visits and hospitalizations. Overall, these reforms improved access to care, particularly in rural and underserved areas, and generated substantial system value, including significant cost savings and a high return on investment.

A review of the global evidence underscores that NPs, pharmacists, and paramedics, can increase access to, and effective delivery of, critical elements of community-based care. The evidence shows consistent improvements in patient experience, including greater satisfaction, access, continuity, trust, and person-centred care, alongside benefits for population health through strengthened primary care, prevention, and early intervention, particularly for rural, underserved, and high-needs populations. Expanded scopes of practice were generally cost-neutral or cost-saving although economic evidence remains limited and mixed.

Together, these findings highlight potential options for increasing access to quality community primary care by leveraging non-physician providers. Importantly, there are ways of deploying these providers that go beyond the current set of policy instruments being used and a rapidly deepening literature on how best to deploy them.

1. Expanding health professionals’ scope of practice holds significant promise for advancing health system performance, with indications of improved access, patient and provider experience, equity, and system efficiency, while potentially reducing avoidable acute care use and costs.
2. Clear legislative and regulatory frameworks are essential to legitimize expanded roles, reduce role ambiguity, and enable health professionals to practise to the full extent of their training and competencies.
3. Successful and sustainable scope expansion depends on workforce support including targeted education and training, adequate resourcing, organizational and interprofessional support, and protections that address workload, role clarity, and professional well-being.
4. Further multidisciplinary research is needed to better understand long-term patient and system outcomes, economic effects, and differential impacts across settings, particularly to clarify and quantify the emerging benefits of expanded scopes of practice for rural and underserved communities.

Read the full report below.