Family Practice Programs

POLICY MANUAL

August 2022

Department of Health
and Community Services
Family Practice Programs Policy Manual 2022

Program Description
The Department of Health and Community Services (hereinafter referred to as the
“Department”) has launched the Family Practice Programs consisting of two new
initiatives to improve access to primary care in the province. The Family Practice Start-
up Program and the New Family Physician Income Guarantee aim to attract and retain
new, qualified family physicians to provide primary healthcare services in Newfoundland
and Labrador on a fee-for-services (“FFS”) basis. These funding programs are designed
to support new family physicians in opening or taking over an existing family practice by
helping to alleviate financial barriers associated with these processes. The Department
notes that the terms and conditions of the Family Practice Programs are subject to
change.

Definitions
Default: Failure to complete the Service Agreement, in part or in whole, or failure to
comply with any term or condition of the Service Agreement.
Funding: Financial assistance provided under the Family Practice Programs to a
Recipient in return for the Recipient’s commitment to fulfill a service obligation.
Medical Services Division: The Medical Services Division is part of the Department of
Health and Community Services, and is responsible for administration of the Family
Practice Programs.

Recipient: A family physician who is eligible for Funding under this Program Manual,
has been selected for receipt of the Funding and who enters into a Service Agreement
to receive the Funding.
Regional Health Authority (RHA): Corporations established under the Regional Health
Authorities Act SNL 2006 cR-7.01 responsible for providing the delivery and
administration of health and community services in the health regions in Newfoundland
and Labrador. There are four (4) RHAs: Eastern Health, Central Health, Western Health
and Labrador-Grenfell Health.
Service Agreement: An agreement entered into by a Recipient and the Department,
setting out the terms and conditions of the Funding and of the service obligation.

Eligibility Criteria
The Family Practice Programs are limited to FFS family physicians that are setting up a
new family practice or joining and existing family practice in a permanent capacity.
Recipients will receive funding in exchange for a Service Agreement.
The eligibility criteria for funding under the Family Practice Programs are as follows:

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 New family physicians who will be practicing in Newfoundland and Labrador,

including:
o Physicians entering a FFS family practice for the first time.
o Physicians practicing family medicine in another province who intend to
relocate to Newfoundland and Labrador to practice FFS family medicine.
 Full or provisional licensure under the Medical Act, 2011.
o Note: provisional licensure requires RHA sponsorship, and applicants are
responsible for arranging and maintaining sponsorship for the duration of
their provisional licensure.
 Certification from the College of Physicians and Surgeons of Newfoundland and
Labrador.
 Family physicians can apply before opening or joining a family practice.
 Medical residents are eligible to apply in any year of their residency.
 Family physicians currently completing a Service Agreement under the Medical
Resident Bursary Program are eligible to apply to roll into the Family Practice
Start-up Program and complete their Service Agreements concurrently.
 Family physicians currently completing a Service Agreement under the Medical
Resident Bursary Program are eligible to apply to the New Family Physician
Income Guarantee.
 Recipients are permitted to simultaneously apply for/hold both Family Practice
Start-up Program funding and New Family Physician Income Guarantee funding
with Service Agreements to run concurrently.

Family Practice Start-up Program

The Family Practice Start-up Program provides funding to new FFS family physicians
that are setting up a clinic or joining an existing family practice in Newfoundland and
Labrador in exchange for a five (5) year provincial Service Agreement.

Amount and Disbursement

Individual awards of $150,000 will be available on a one-time basis to new family
physicians who meet the eligibility criteria, or an amount of up to $150,000 for current
Medical Resident Bursary program recipients as detailed further herein in the Medical
Resident Bursary Program Rollover. Recipients of the Family Practice Startup Program
funding will receive a lump sum payment of Funding upon signing the Service
Agreement. Funding received under this program may be used at the discretion of the
Recipient.

New Family Physician Income Guarantee

The New Family Physician Income Guarantee provides new FFS family physicians who
open a new family practice or join an established family practice with a guaranteed

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minimum income over their first two years of practice equivalent to that of a salaried
family physician ($198,724 per annum).

Amount and Disbursement

New family physicians who open a new clinic or join an established clinic billing on a fee
for services (FFS) basis, and are accepted for funding under this program, will for the
first two years of family practice have their income guaranteed to be at least equivalent
to the minimum level paid to a salaried physician (Step 1 of the Family Physician Salary
Scale under the Memorandum of Agreement between the Newfoundland and Labrador
Medical Association and the Department).
Where the total of FFS billings submitted to MCP plus any income or other financial
incentives from the Department or RHAs over each full year of practice are less than the
Step 1 salary over the same period, funding recipients will be paid the difference
between these amounts (note: Family Practice Start-up Funding will not be included in
income guarantee calculations). If this total exceeds the salaried amount, the income
guarantee will not apply. Income guarantee payments will occur semiannually, and will
be dependent on FFS billings and other financial or income sources during that period.
Recipients must submit FFS billings to the Medical Care Plan (MCP) within ninety (90)
days of service delivery.

Medical Resident Bursary Program Rollover

Medical residents who are currently receiving funding under the Medical Resident
Bursary Program in exchange for a service agreement with the RHA may apply to the
New Family Physician Income Guarantee and the Family Practice Start-up Program, in
accordance with this Program Manual and subject to the eligibility criteria for each of
these new initiatives.
Service years completed under the Medical Resident Bursary Program will be counted
towards the Recipient’s Family Practice Start-up Program Service Agreement, and will
total no more than five (5) service years between these two programs. Funding for
Medical Resident Bursary Program rollover recipients under the Family Practice Start-
up Program will vary depending on their resident bursary service agreement, and will
total no more than $150,000 between these two programs. Resident bursary funding
recipients can only apply for rollover funding, and are not eligible for full funding under
the Family Practice Start-up Program.
As an example, if a family medicine resident received $50,000 under the Medical
Resident Bursary Program in exchange for a three (3) year Service Agreement, they
would receive an additional $100,000 in return for an additional two (2) year Service
Agreement upon rolling into the Family Practice Start-up Program. Thus, they would
receive a total of $150,000 in funding for five (5) years of service.

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Recipients will be required to enter into a new two (2) year Service Agreement under
the New Family Physician Income Guarantee. Service years completed under the
Medical Resident Bursary Program cannot be rolled over into the New Family Physician
Income Guarantee, however the Service Agreements for these programs can be
completed concurrently.
Service Agreements for the New Family Physician Income Guarantee, the Family
Practice Start-up Program, and the Medical Resident Bursary Program will total no
more than five (5) service years between the three programs.

Community of Practice
The selection of the practice community location is at the discretion of the Recipient.
The practice community must be located within the province of Newfoundland and
Labrador. Upon signing the Service Agreement, Recipients are required to provide
comprehensive primary care in the community declared in the funding application for
the duration of the term outlined in the Service Agreement. If the need arises for the
Recipient to change practices and/or practice locations during the term of the Service
Agreement, they are required to notify the Medical Services Division in writing.

Application Process
Applicants are required to coordinate with the regional physician recruiter for the
relevant RHA to submit the following to the Medical Services Division:

 A completed and signed Family Practice Program Application Form;

 Proof of eligibility for licensure with the College of Physicians and Surgeons of
Newfoundland and Labrador; and,
 A letter providing further details relating to the new practice as outlined in the
following paragraphs.
If joining an existing family practice: The applicant is required to provide a letter of offer
from an established family practice outlining the start date, location of practice, and
confirmation of the amount of time that will be dedicated to providing comprehensive,
continuous care to patients at the practice.
If starting a new family practice: The applicant is required to provide a letter outlining the
approximate opening date, location of practice, and confirmation of the amount of time
that will be dedicated to providing comprehensive, continuous care to patients at the
practice.
Applications can be obtained by contacting the RHA physician recruiters or the Medical
Services Division, or by visiting the Department’s website. Forms should be sent by mail
or email to:

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Nicole Babichuk, Manager of Programs

Medical Services Division
Department of Health and Community Services
1st Floor, West Block, Confederation Building
P.O. Box 8700
St. John’s, NL A1B 4J6
MedServicesPrograms@[Link]

Evaluation Process
The Medical Services Division will review all applications, and will confirm eligibility of
applicants under the Family Practice Programs. The Medical Services Division will notify
all applicants and the RHAs of decisions and will send a letter of approval and a Service
Agreement to each successful applicant.
Applicants must sign and return the Service Agreement to the Medical Services Division
within thirty (30) days of receiving the agreement to receive funding under the Family
Practice Programs. Recipients are required to contact the Medical Services Division if
they need additional time to review and sign the Service Agreement. The Medical
Services Division will send the Service Agreement to the Deputy Minister of the
Department for signature. The Medical Services Division will keep the original signed
Service Agreement, and provide a copy to the Recipient.

Establishment or Joining of a Family Practice

Recipients of funding under the Family Practice Programs will establish or join a family
practice as per the Service Agreement no later than six (6) months after signing of the
Service Agreement. If the Recipient has not joined or established a family practice after
the six (6) month period, they are required to contact the Medical Services Division to
discuss options for extension.
Recipients will contact the Medical Services Division within thirty (30) calendar days of
practice being established/joined to advise that practice has commenced and to provide
updated contact information, if necessary. Recipients are responsible for informing the
Department of any change in contact information such as name, address, email, and
phone number that were provided at the time of signing the Service Agreement.
Timely communication is important to ensure that the service obligation period is
accurately calculated. The Medical Services Division will monitor the fulfillment of
service obligations as outlined in the Service Agreement and will be responsible for
notifying the recipient of default or completion of the service obligation.

Service Deliverables
Funding Recipients are expected to establish long term patient attachment, continuity of
care, and comprehensiveness of care. Funding Recipients are encouraged to avail of

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Family Practice Renewal Program (FPRP) initiatives for support in opening or joining a
family practice. Recipients are also encouraged to be aware of and engaged in Primary
Health Care reform in the province, and to implement the new directions that may arise
from the recommendations of the Health Accord Task Force NL.
Funding Recipients are expected to fulfill the service deliverables as outlined in the
Service Agreement, including:

 Open a new family practice or join an established family practice in a community

in Newfoundland and Labrador within six (6) months of signing of the service
agreement.
 New Family Physician Income Guarantee: commit to practicing in the community
as a family physician for a period of two (2) years (the “Service Obligation”).
 Family Practice Start-up Program: commit to practicing in the community as a
family physician for a period of five (5) years (the “Service Obligation”).
 Provide the full range of primary healthcare services appropriate to a family
practice, including preventive, acute, and chronic care services.
 Maintain provisional or full licensure under the Medical Act, 2011, and
certification from The College of Physicians and Surgeons of Newfoundland and
Labrador for the duration of the service agreement.
 Maintain sponsorship from the RHA (provisionally licensed recipients only).
 Provide on-call or other services as required by the RHA.
o Existing service commitments to the RHAs are permitted under the Family
Practice Programs.
 If on-call or other services are not required by the RHA, Recipients are expected
to provide after-hour care options to their patients through their clinic as part of
their comprehensive care.
 Connect with the FPRP to obtain membership in a Family Practice Network
(FPN), where one exists.
 Implement the use of EMR/electronic documentation and HEALTHe NL, where
appropriate to the practice.
o Recipients are also encouraged to avail of current technology enablers,
including telehealth, remote patient monitoring, self-management
programs, virtual care platforms and 811.
 Provide primary care services for a minimum patient panel size. Patient panels
are expected to be balanced in composition and reflective of the practice
community (i.e., age, sex, complexity). Panel size targets are intended to reflect
the timeline required to build a family practice. For Recipients without existing
RHA service commitments, patient panel size targets will be as follows:
Year 1: minimum panel size of 800 patients.

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Years 2+: minimum panel size of 1,200 patients.

For Recipients with existing RHA service commitments, patient panel size targets
will be reduced by ~25%, and will be as follows:
Year 1: minimum panel size of 600 patients.
Years 2+: minimum panel size of 900 patients.
 Recipients are required to notify the Department of the number of patients
registered with their family practice over such period(s) as may be specified by
the Department. The Department may also, on occasion, review patient panel
size information included in MCP accounts submitted by the Recipient to the
Department’s Audit Division.
 If minimum panel size targets are not met by the Recipient in any year of the
service agreement, they will be required to meet with the Department to discuss
panel characteristics and barriers to meeting minimum panel size requirements.
Remedial measures may be required by the Department to help the Recipient
increase patient panel size in subsequent years.
o If the Department is dissatisfied with the actions being taken to increase
patient panel size by the Recipient, the Department has the right to
terminate the Agreement and arrange re-payment of the funds by the
Recipient.
 Comply with all policies under the Family Practice Programs.
 Complete the Family Practice Program exit survey upon completion or
termination of service agreement.

Transition to Blended Capitation

Recipients of funding under the Family Practice Programs are eligible to transition from
FFS to a future blended capitation model of payment while completing their Service
Agreement. Recipients must provide three (3) months’ notice to the Medical Services
Division prior to transitioning payment modalities.

Taxation
Funding paid to Recipients under the Family Practice Programs may be subject to
income taxation. Recipients are responsible for taxes assessed by the Canada
Revenue Agency in relation to payments made under these programs. Recipients have
the responsibility and opportunity to seek, obtain, and consider advice from independent
financial advisors and income tax professionals on the income tax treatment, income tax
impact, and other financial implications associated with the receipt of Funding under
these programs. Recipients may wish to refer their advisor(s) to the CRA Technical
Interpretation on these matters, identified as 2017-0682691e5 on
[Link] Please note that,

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this referral to the website and interpretation is not offered as, nor should be considered
as, income tax or financial advice from the provincial government.

Service Agreement Provisions, Default, and Repayment

Service agreements are legally binding contracts. Key conditions in such agreements
will include, but are not limited to, the following enumerated items.
1. Failure to comply with the Service Agreement constitutes a default of the Service
Agreement and said default includes the following:
 Having made a materially misleading or inaccurate statement in the
funding application;
 Purporting to confirm statements in the application and/or in the Service
Agreement as being true when they are not in fact true;
 Failure to comply with any term or condition of the Service Agreement;
 Failure to maintain provisional or full licensure;
 Failure to maintain provisional licensure sponsorship with the RHA;
 Failure to complete the service obligation; or
 Termination of the Service Agreement by the Recipient.
2. Recipients must notify in writing the Medical Services Division of the decision to
terminate the Service Agreement at least three (3) months prior to the
termination date and arrange for termination of payments and/or re-payment of
funding in accordance with the Service Agreement.
3. If the Recipient defaults on their Service Agreement, they will be required to
repay the prorated amount of the funding based on the number of months of
unfulfilled service obligation and interest. In all instances where the Recipient will
be charged interest under the Service Agreement, interest on the amount to be
repaid by the Recipient will be calculated on the unfulfilled portion of the service
obligation.
 Interest on the amount to be repaid by the Recipient will be calculated
retroactively from the date the money was advanced to or on behalf of the
Recipient, and will compound on the outstanding balance as of the end of
each month.
 The interest rate will be the prime rate posted by the Bank of Canada for
major lenders plus two percentage points.
4. In the case of default or overpayment, the Medical Services Division will provide
repayment details in writing to the Recipient describing the prorated amount
owing, interest and the repayment procedure.
5. Recipients are expected to practice for a minimum of 44 weeks of each year. To
the extent that less than 44 weeks of practice are provided in a year, the Service
Agreement will be extended by the same amount. Recipients are asked to advise

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the Department when less than 44 weeks will be worked in a year so that the
Service Agreement can be appropriately extended. The Department will also
monitor MCP claims data to verify the number of weeks worked each year.
 Requests by the Recipient for extension of the Service Agreement require
approval in writing by the Medical Services Division. All extension
decisions will be communicated in writing to the Recipient.
 Requests for extension must provide the reason for postponement.
Eligible reasons may include serious personal illness, maternity/parental
leave, serious family illness, death of a family member, or request for
additional training.

Responsibilities
Recipient Responsibilities
The Recipient is responsible for the following:
1. Reviewing and complying with the terms and conditions of the Family Practice
Programs and Service Agreement(s).
2. Providing written notification to the Medical Services Division if they are unable to
fulfill their Service Agreement at least three (3) months prior to the termination
date of the Service Agreement and arrange for termination and/or repayment of
the funding in accordance with the Service Agreement.
3. Providing written notification to the Medical Services Division of any Leave in
excess of eight (8) weeks.
4. Providing written notification to the Medical Services Division of any change in
contact information such as name, address, email and phone number provided at
the time of signing the Service Agreement.
5. Providing written notification to the Medical Services Division of any changes in
practice location.
6. Providing written notification to the Medical Services Division of any changes in
practice payment modalities.

Medical Services Division Responsibilities

The Medical Services Division is responsible for the following:
1. Maintaining all policies, terms and documentation including updating approved
changes to the Family Practice Programs.
2. Receiving and reviewing all applications submitted under the Family Practice
Programs, and providing notification of approval to successful applicants.
3. Establishing a written Service Agreement with the Recipients of the Family
Practice Programs.

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4. Sending copies of signed Service Agreements to Recipients of the Family

Practice Programs.
5. Arranging payment of Funding from the Department to Recipients under the
Family Practice Startup Program.
6. Liaising with the Medical Care Plan (MCP) and the RHAs to arrange income
guarantee payments for Recipients under the New Family Physician Income
Guarantee.
7. Tracking the fulfillment of Service Agreements by Recipients funded under the
Family Practice Programs.
8. Maintaining ongoing communication with Recipients funded under the Family
Practice Programs while joining/opening a family practice and throughout Service
Agreement completion.
9. Notifying the Recipient within thirty (30) days of any changes to the Family
Practice Programs.
10. Enforcing collection of defaulted amounts for Recipients under the Family
Practice Start-up Programs and transferring the collected amounts to the
Provincial Government Department of Finance.
11. Distribution and collection of the Family Practice Programs exit survey upon
completion or termination the Recipient’s Service Agreement(s).
12. Maintaining a financial database of funding recipients, Service Agreement details
(i.e. amounts, location, and service obligation), defaults and collections.
13. Preparing an annual report to the Deputy Minister of Health and Community
Services. This report will include details of funds awarded that fiscal year,
including the number, amount, location, service obligations, and fulfilled and
defaulted Service Agreements.

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