3 | Optimizing scope of practice

The tools linked below can help your organization identify and address gaps between the current and full scope of practice for registered nurses and registered practical nurses (RNs and RPNs) in your primary health care setting. 

# Gap Analysis 

Gap analysis is a process of finding gaps between the full scope of practice for a profession and the current functions being fulfilled by that profession in your organization. If your RNs and RPNs are not practicing to full scope, a gap analysis can help you figure out what's missing from their role and find opportunities to make the most of their expertise. 

These two tools from the Registered Practical Nurses Association of Ontario (RPNAO) can guide you in doing a gap analysis.

• Primary Solutions for Primary Care outlines the full RN and RPN scope of practice.
• The Gap Analysis Tool will lead you through a process of comparing the current roles of RNs and RPNs in your organization to the full scope of practice. For each of the 30+ role description recommendations in the Primary Solutions document, you can flag whether your RNs and RPNs are performing the task consistently, inconsistently, or not at all, and then record change strategies for incorporating those tasks into their roles. 

# Barriers and Enablers of Full-Scope Practice

To expand the scope of practice for nurses, it is crucial to address both the enablers and barriers to implementation. This article, How Do We Achieve Full scope?  is part of a Primary Care Nurse Toolkit produced by the Registered Practical Nurses Association of Ontario (RPNAO). It identifies some of the key enablers for your organization to enhance and barriers to address in order to reach the improvement goals identified in your gap analysis. 

• Key enablers include effective team communication, trust, role clarity, access to education, and a supportive organizational culture.
• Barriers identified include staff readiness, time constraints, lack of resources, and heavy workloads.

A pressing need in primary health care is mental health. Social workers have an essential role to play in addressing this need. 

Social Work and Primary Care: A Vision for the Path Forward is a report as well as a vision document that emphasizes the importance of integrating social workers more fully into primary care as a way to meet rising demand for mental health and chronic disease management. Social workers in primary care provide a range of services, including assessments, crisis management, counseling, and support for patients with complex health needs. 

The report also discusses several barriers to fully utilizing social workers, including underrepresentation in primary care teams as well as pay disparities. It calls for increased access to social workers in primary care across Canada, ensuring they can practice to their full scope and are better represented in leadership roles. 

# Social Work in Primary Care e-Learning Modules

Team Primary Care is a federally-funded initiative that is building capacity for effective interprofessional collaboration in primary care settings. The program funded researchers and leaders from 25 professions to develop learning resources in support of this. In addition to the Social Work and Primary Care report linked above, Team Primary Care funded the development of a free, public curriculum about the role of Social Work in Primary Care. It consists of six e-learning modules that take about 30 minutes each to complete. Each also contains additional, optional resources to explore. They are intended for new or practiced social workers who wish to work in primary care settings, as well as for other health professionals who want to learn more about social workers' roles in primary care. 

Physiotherapists (PTs) and occupational therapists (OTs) working to their full scope of practice within interprofessional primary healthcare teams can be an effective way to increase capacity for patient attachment and ease the workload for primary care providers. 

In a primary care setting, patients can directly access PTs and OTs, without first seeing a physician or nurse practitioner. Within their scopes of practice, these rehab professionals can address a wide range of conditions including, but not limited to, neuromusculoskeletal injuries and diseases, heart and lung disease, stroke, brain injury, spinal cord injury, cancer related sequelae, incontinence and pelvic dysfunction, chronic pain/conditions and pre- and post-surgical recovery.

This letter from the Ontario Physiotherapy Association (OPA) outlines the benefits of including PTs working to full scope in primary health care teams. It notes that between 20% and 30% of primary care visits are for musculoskeletal conditions and asserts that the addition of a physiotherapist can increase attachment rates by an average of 450 rostered patients. 

This document from the Rehabilitative Care Alliance (RCA) was developed for OHTs. It describes the value of Community-based rehabilitation in outpatient, at-home, and primary care settings, and can be useful for population health planning. It includes several case studies demonstrating how community-based rehabilitative care supports the Quintuple Aim. 

To support the development of Interprofessional Primary Care Teams and local health networks that are inclusive of these occupations, these organizations are also available to support proposals and help make the case for having their members join the team. This support will continue through future cycles of expansion funding.

# PT and OT Learning Modules from Team Primary Care

Team Primary Care is a federally-funded initiative that is building capacity for effective interprofessional collaboration in primary care settings. The program funded researchers and leaders from 25 professions to develop learning resources in support of this. 

• Preparing Physiotherapists for Team-Based Primary Care is a series of eight e-learning modules which aim to help physiotherapists develop competencies for physiotherapy practice in team-based primary care settings.
• Occupational Therapy and Primary Care is a free, two-part course designed to enhance the capacity of OTs to participate in collaborative primary care teams. It is available to members of the Canadian Association of Occupational Therapists.

# Additional PT Resources for Primary Care Teams

Physiotherapists in Primary Care Teams: Optimizing Attachment, Access, and Outcomes (2025) is a new guide from the OPA for integrating physiotherapists in a primary care team. It includes information about the role of PTs in a primary health care team, from first contact to care across the lifespan, as well as guidance to support HR decisions, such as information about scope of practice, service contracts, and considerations for implementation of PT services. It is a companion to this primary care "hub," which the OPA developed for physiotherapists who want to develop their readiness for working in primary care. 

This suite of resources from the UK supports implementation of First Contact Physiotherapy, a model where people with musculoskeletal conditions can access PT care at the start of their pathway. 

# Additional OT Resources for Primary Care Teams

The Canadian Association of Occupational Therapists also has a variety of resources on their website to support integration of OTs into primary health care teams:

• What Do Occupational Therapists Do? (fact sheet on OT in general - spring 2025)
• OT Practice Document: Primary Care 
• Occupational Therapy and Primary Health Care (fact sheet)
• Occupational Therapy and Primary Care: A Vision for The Path Forward describes the current role of occupational therapists in primary care throughout the client lifespan, as well as opportunities to enhance it by emphasizing health promotion. It defines key characteristics of occupational therapy in primary care such as describing ways in which occupational therapy has been traditionally practiced in primary care, as well as presenting a vision for the future of occupational therapy in interprofessional primary care teams.

Kinesiologists are regulated experts in the science of human movement and exercise, applying their knowledge to health care. Kinesiology covers prevention and management of chronic diseases and physical injury, rehabilitation of physical injury, and improvement of overall performance.

Since 2013, Kinesiologists have been regulated professionals in Ontario. The Kinesiology Act defines the practice of Kinesiology as “the assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance.” Kinesiologists and their standards of practice are governed by the College of Kinesiologists of Ontario.

# Case Example: Kinesiologists Supporting Diabetes Management

Kinesiologists at Guelph Family Health Team (GFHT) have are Certified Diabetes Educators who helping clients who have or are at risk of developing diabetes to look after their health and wellbeing. They work under physician supervision through signed medical directives, supporting people with diabetes through pharmacological, lifestyle, and psychosocial interventions. They help clients choose and follow exercise plans that first address diabetes and chronic pain, then work outward to improve outcomes for as many comorbidities as possible.

For decades, Alliance members have embraced the roles of Community Health Workers and Community Ambassadors. This report, published in Healthcare Policy, describes the vital ways community health workers contribute to advancing health equity in Canada. They assist clients in accessing necessary care, deliver health education, and offer guidance and counseling to those in need. 

The report argues that formally recognizing and supporting these roles, alongside integrating Community Health Workers and Multicultural Health Brokers/Multicultural Liaison Workers into health systems, can significantly enhance care delivery and address barriers faced by marginalized communities. 

For more about the potential of how these roles help to make primary care more accessible to people in your community, especially those clients who experience systemic barriers to care, check out the case example of the Thorncliffe Community Hub in Chapter 8 of this toolkit. 

Certified Chronic Disease Educators work with clients to support self-efficacy, monitor their health outcomes, and provide support for the clinical team managing their condition. 

Staff in numerous different roles can be trained as Certified Educators for a variety of conditions. For example, Kinesiologists at the Guelph Family Health Team work in their Diabetes Care Program and have been trained as Certified Diabetes Educators (CDE). They work under physician supervision through signed medical directives. This enables them to work to their full scope of practice, addressing diabetes patients through pharmacological, lifestyle, and psychosocial interventions.

Below are links where you can access training and certification for Chronic Disease Educators:

• Certification for Asthma, Respiratory, COPD and Tobacco Educators (Canadian Network for Respiratory Care)
• Diabetes Educator Certificate Program (Michener Institute at the University Health Network): This training can help learners prepare for the certification exam from The Canadian Diabetes Educator Certification Board
• International Heart Failure Certification (American Heart Association)
• Mental Health Nursing Certificate Program (Michener Institute at the University Health Network). 

BestCare is a service delivery model and program of KT/practice facilitation supports for optimizing the role of Certified Chronic Disease Educators in interprofessional teams. BestCare equips Certified Educators to support management of: 

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Chronic Heart Failure (CHF)
• Atrial Fibrillation 

Certified Educators participating in BestCare work under medical directives to confirm diagnoses and optimize medication, undertake case management, and support client/patients in self-management of their chronic conditions. 

Team Primary Care is a federally-funded initiative that aims to build a strong interprofessional primary care workforce across the country, as a key step in addressing the crisis in access to care. They are building capacity for effective interprofessional collaboration in primary care settings by sharing innovations that are ready for spread, developing learning and QI tools for better collaboration, helping organizations integrate new staff, and supporting people to work to the full scope of their professional practice. 

To support this last goal, Team Primary Care convened an Interprofessional Collaborative Table with representatives from 30 professions within primary care. Researchers and leaders from 25 of these professions were funded to develop learning resources that would empower richer integration of their professions into interprofessional primary care. Resources include pre- and post-licensure training, tools to support workflow and role integration, and detailed role descriptions to support decision-makers.  This page contains links to all of these resources.