FAQ

What is a Main Agreement?

A Main Agreement is a formal, legally binding contract between a healthcare profession and the Government of BC. It sets out clear terms for things like compensation, benefits, working conditions, and professional supports.

Other health professions — including physicians (through Doctors of BC) and midwives (through the Midwives Association of BC) — already have Main Agreements. These agreements provide consistency, stability, and fairness in how their work is supported across the health system.

Why are we talking about an NP Main Agreement now?

The need for a Main Agreement has been discussed for years, but the urgency has grown as the NP profession expands and gaps in support have become more visible.

There are three key reasons why we're talking about a Main Agreement now:

1. Rapid growth: The number of NPs in BC is expected to rise from about 1,200 today to 2,000 by 2028.

2. Inconsistent support: Current employment models create inequities and limit access to training, mentorship, and other professional supports.

3. Federal direction: The federal government has confirmed NP care must be treated as insured, physician-equivalent care under the Canada Health Act, requiring BC to act.

Together, these factors make it essential for NPs to consider whether a formal Main Agreement with government is the right approach to ensuring fair compensation, consistent supports, and a clear framework for the future.

What might an NP Main Agreement include?

A Main Agreement would set out the terms that shape NP practice across BC. Based on what other professions have in their agreements, it could include:

• A comprehensive compensation framework for a variety of flexible funding models, which could include salaried employment, service contracts, sessional contracts, and a variation of the LFP model for NPs

• Benefits like extended health and pensions, including continued transition planning for pensions and other benefits currently held in employment programs

• Practice supports such as a provincial locum program and workplace staffing supports

• Funding for professional development, mentorship, and continuing education

• Clear recognition of the different practice settings where NPs work, with appropriate supports and compensation models

• Administrative and operational supports

• Dispute resolution mechanisms

These examples show what’s possible, but the exact contents would be shaped by NPs themselves in collaborations with the Government of BC. Every NP would have a voice in determining priorities, and no agreement would be finalized without NP approval through formal engagement and voting.

Would having a Main Agreement mean NPs have more say in our remuneration, or would government still decide unilaterally?

A Main Agreement would give NPs a formal seat at the table. Right now, government and other groups like HEABC and the VPs HR largely sets NP compensation frameworks without a formal negotiation process. With a Main Agreement, NPs — through NNPBC and elected NP leaders — would directly negotiate pay, benefits, and practice supports with government, just as physicians and midwives do.

Of course, like any negotiation, government and NPs would both bring forward their positions, and the final agreement would be the result of that process. The key difference is that NPs would collectively set the agenda, guide negotiations, and vote to ratify any agreement before it takes effect. That means NPs would have direct influence and final approval of decisions.

Would a Main Agreement open up options for NPs to work in a variety of areas or is it mainly about standardizing pay across employers?

Both. A Main Agreement would create a framework that does two important things:

1. Expand flexibility: Right now, NPs are limited by rigid compensation models. A Main Agreement could introduce more flexible funding models — like service contracts, sessional contracts, or potentially MSP-based mechanisms — that give NPs greater choice in how and where they practice.

2. Level the playing field: At the same time, a Main Agreement would set consistent standards for pay, pensions, leave, and other supports across different employment models (PCN, health authority, or other publicly funded clinics). That means NPs could move between roles or combine roles without losing stability or benefits.

In short, a Main Agreement is about both expanding practice options and ensuring fairness, so NPs can use their skills where they’re most needed while knowing they’re supported consistently across the system.

Who would a Main Agreement apply to?

A Main Agreement would apply to all Nurse Practitioners in BC who are publicly funded, whether they are employed by a health authority or working under an independent service contract.

Right now, NPs work under different and sometimes inconsistent models, which can create inequities and gaps in support. A Main Agreement would bring these models under one coordinated framework, ensuring fairness and consistency across the profession.

Importantly, NPs themselves would guide what goes into the agreement and would vote on any final deal. This ensures the agreement reflects the different realities of NP practice and provides the stability needed to grow and sustain the workforce across different models of employment.

How would a Main Agreement apply to health authority NPs?

Right now, compensation for NPs employed within health authorities is governed by the Compensation Reference Plan (CRP), which is used to define salaries and benefits for non-union, management and executive roles in BC's health sector.

But the CRP was never designed for clinicians and has had to be stretched to fit NP roles. For example, the process for adjusting hourly rates, incentives, supports and more remains complex, despite important efforts to improve it. More importantly, these adjustments occur without a clear mechanism for NP engagement and voice. This is just one area where a Main Agreement could be an advantage for health authority NPs.

It's worth noting that for health authority NPs to be fully included in a Main Agreement, they would need to move out of the CRP. That transition could only happen once an alternative framework was in place, like a Main Agreement, so that benefits and pensions are fully protected and clearly defined under a new framework.

The different models of remuneration for NPs are quite different in terms of sick time, vacation and pensions. Who has to give up what to come together as one Main Agreement?

A Main Agreement isn’t about taking away benefits from some NPs — it’s about setting a consistent, fair standard across the profession. Right now, supports like sick time, vacation, and pensions vary depending on whether you’re in a health authority role, a PCN contract, or another model. That creates inequities and uncertainty.

Through a Main Agreement, NPs would collectively decide the priorities to bring forward in negotiations. The goal is to lift all models up to a fair and sustainable level, not to reduce what anyone currently has. And because any agreement would be subject to a ratification vote by NPs, no one would move forward with terms that don’t reflect NP priorities.

Will health authority NPs lose their Municipal Pension Plan or benefits?

That is not the intention. The guiding principle of a Main Agreement is continuity and improvement. If health authority NPs move from the Compensation Reference Plan (CRP) into a Main Agreement, that transition would only happen after clear terms for compensation, benefits and pensions are negotiated and approved by NPs. The goal is to protect existing entitlements and close current gaps, not reduce them.

Have other contract-based providers received benefits such as sick time or leave?

Yes. Under their Master Agreements, physicians and midwives — many of whom are independent contractors — have negotiated access to benefits such as parental leave, continuing education funding and rural incentives. A Main Agreement for NPs could create similar mechanisms so benefits and supports extend to all NPs providing publicly funded care, regardless of compensation model.

What inequities would a Main Agreement help address?

Currently, NPs doing similar work may receive very different overall compensation depending on their funding model. While PCN contract NPs may earn higher direct pay, they lack benefits such as pensions, paid leave or sick time. Meanwhile, employed NPs may receive a lower salary compared to PCN contractors but receive benefits. A Main Agreement will likely include even more contract types and compensation models. Negotiating an overarching agreement with all NPs in all sectors and all compensation models will aim to bring fairness, consistency and long-term security across the entire profession, accounting for the nuances of each model.

If I work across settings (e.g., HA and PCN), will I lose higher pay in one model?

No. A Main Agreement is designed for fairness and flexibility, not levelling down. Like physicians, NPs could have multiple funding models within one framework — salaried, sessional, service or potentially MSP-linked — allowing practice across settings without losing compensation stability.

Could the agreement open new work options (e.g., specialty clinics, sessionals, on-call work)?

Yes. A Main Agreement could define structured options for episodic or specialty care, on-call coverage, rural incentives and other targeted needs, similar to other professions’ agreements. For example, on-call work could be formally recognized and compensated, addressing a long-standing gap (e.g. MOCAP for physicians and midwives could be explored to extend to NPs providing similar on-call services).

What about NPs who aren’t NNPBC members?

A Main Agreement would apply to all publicly funded NPs in BC, whether or not they are NNPBC members, because it governs system-wide employment and compensation frameworks. Currently, a large majority of NPs are voluntarily members of NNPBC. Like physicians and midwives, whose associations also have voluntary membership but represent their professions through main or master agreements, NPs benefit from a strong, unified voice. As NNPBC continues to lead this work with transparency and accountability, we hope even more NPs will see the value of belonging to and strengthening that collective voice.