more_vert
LABOR has a tough job convincing doctors its plan to create 50 new urgent care clinics isn’t Super Clinics 2.0, if a recent InSight+ poll is anything to go by, but a few prominent voices say it’s an innovative model worth trialling.
In the only major health announcement of the election campaign so far, Labor said it would spend $135 million over 4 years to “deliver” at least 50 urgent care clinics under a pilot program aimed at relieving overwhelmed emergency departments (EDs) across the country.
Clinics would be located within existing general practices and community health centres, with protocols to ensure close cooperation with nearby EDs and ambulance services.
The clinics would provide bulk-billed services for non-life-threatening injuries, such as sprains, broken bones, wounds, minor ear and eye problems, and minor burns. Each clinic would be different, responding to local needs. They would be open extended hours and funded to include equipment such as x-ray machines.
Shadow Health Minister Mark Butler explained the rationale:
“At the moment there are 4 million presentations every year to EDs for people in ‘non-urgent’ or ‘semi-urgent’ categories, who in many cases could quite adequately be cared for out in the community if that service existed,” he said.
Labor said there were already some promising examples of the model across Australia, and cited evidence from New Zealand that shows cities with urgent care clinics have significantly lower ED attendance than cities without the clinics.
What do doctors think?
InSight+ readers have voted, with 62% of 205 respondents either disagreeing or strongly disagreeing that the Labor plan was a good one.
The plan has received a lukewarm response from both the Royal Australian College of GPs and the Australasian College for Emergency Medicine, who stressed that any initiative must build on established general practices and not fragment care – not repeating the failures of the Rudd Government’s $650 million Super Clinic program.
Australian Medical Association (AMA) President Dr Omar Khorshid criticised the plan as “piecemeal”, saying broader Medicare reform was urgently needed.
“These centres will do little to relieve the hospital logjam, will further fragment care and will unfairly compete with nearby general practices which, without this government funding, will not be able to keep their doors open after hours,” Dr Khorshid said.
New models of care needed
However, Professor Simon Willcock, Program Director for Primary Care and Wellbeing at MQ Health at Macquarie University, suggested urgent care clinics could be part of the solution to Australia’s strained health care system.
“The Labor proposal might appear to be a cynical election ploy,” he told InSight+. “However, the proposal provides a potential template for addressing some of the existing service integration difficulties.
“It can only result in serious health system improvement if there is a commitment across the health sector, including from state and federal governments, and from medical and nursing bodies, to dismantle some very entrenched views and models of health care service provision,” he said.
Professor Willcock said the governance of such clinics would need significant autonomy and flexibility if they were to improve urgent care access and health outcomes while remaining financially viable in the long term.
He noted that some urgent care clinic models, including the nurse-led walk-in clinics in the Australian Capital Territory and the Balmain General Practice Casualty, had ended up being “dependent upon large subsidies from the public purse”.
Another urgent care model, the Walk-In Specialist Emergency (WiSE) clinic at Sydney’s Macquarie Park, had proven financially sustainable, but was premised on a flat service fee ($260) applied to all clients, he said.
Professor Stephen Duckett, at the University of Melbourne, said Labor’s urgent care centre pilot was a step in the right direction, but not a panacea.
“It addresses one component of the overall emergency department flow problem,” he wrote in The Conversation.
“It has yet to be evaluated,” he wrote. “So we should have an open mind about whether the approach really works prior to investing too much in it.”
A local example
Inner Sydney GP Dr Linda Mann is one reader who supports Labor’s proposal, based on her experience of the Balmain General Practice Casualty.
The clinic, which runs out of the old Balmain Hospital, began as a joint initiative of the local division of general practice and area health service and is now in its third decade, employing salaried GPs.
“It’s exactly as advertised: urgent care provided by GPs,” said Dr Mann, who previously worked at the clinic and was on its management committee.
“It’s the place I recommend my patients go after hours or if they need an x-ray for anything that’s not an emergency,” she added.
Dr Mann said her experience gave her confidence that Labor’s planned Medicare urgent care clinics could be successfully implemented.
“I know there are legitimate concerns about fracturing of care and lack of continuity, but these can be overcome by sending detailed, very rapid discharge summaries,” she said.
AMA (New South Wales) Council chair Dr Michael Bonning also works as a GP in Balmain, where he too has witnessed advantages with the General Practice Casualty model.
“It’s a setting more amenable to medium-term care than regular general practice,” he said.
“For instance, in a normal general practice, it is difficult to monitor an asthmatic child for 4 hours to make sure they’ve had a good trial of Ventolin [GlaxoSmithKline] and know they won’t rapidly deteriorate, but you have more capacity to do that sort of thing in general practice casualty.
“It’s also much nicer, from the patient’s perspective, to be seen in an appropriately resourced primary care setting than to wait many hours in an emergency department,” he added.
Overall, Dr Bonning said urgent care centres were worth a try.
“It’s a good idea, provided it’s done in a co-commissioning model, with strong input from local GPs, primary health networks and community health organisations,” he said. “Our system has to evolve to deal with increasing demand.”
Nevertheless, he stressed that Labor’s pledge was small in scope.
“They’re talking $135 million across 50 clinics in a health care system worth $130 billion a year,” he said. “That’s not a policy. That’s a pilot.”
Subscribe to the free InSight+ weekly newsletter here. It is available to all readers, not just registered medical practitioners.
Loading ...
I agree with everything Ian Hargreaves said.
And what a great idea to pay GPs to work on a clinic attached to a hospital – with all the equipment and consumables available – and send to the ED if further management is needed. I would be happy to work there!
The sprains and broken bones need an x-ray, the wounds and minor burns need expensive sutures and dressings, which cannot be billed under bulk billing. Who will supply PPE, or fund sick leave when the ‘asthma’ case turns out to be Covid?
Why not harness the extra capacity of the existing, public-funded facility, the hospital? Accredit local GPs to work in the ED, use some spare space (all hospitals found space for Covid testing/vaccinating clinics) and have salaried GPs doing shifts. Triage the ‘minor’ cases to them, the average GP would be 5-10x more time efficient at treating those cases than a new intern. There is backup if that minor guts ache is an AMI, or the minor wound has a nerve laceration. X-rays are available on site with wheelchairs and porters, and if demand is high, it’s far cheaper to fund an extra radiographer in an existing hospital than to build a standalone radiology facility in an ‘urgent care clinic’.
All that is required is to get around the ‘minor’ conceptual hurdle of our moronic division between state hospitals and federal Medicare. The logical solution (abolish the states) is politically doomed, the next best (hand hospitals, and thus all health, to the feds) probably equally difficult. But a few dozen bureaucrats on 6-figure salaries could probably nut out a funding system where Medicare reimburses the state government for salaries, consumables etc.
It won’t take 4 years, it can be implemented in a few weeks, and the net cost to the taxpayer will be zero (assuming all the patients were going to be seen in ED anyway, or go to their own GP the next day.)
Luckily there’s not just the old ‘major parties’ to vote for – people have realized that they’re both in the pocket of the mining industry, hence not interested in public health.
Both parties have no idea how to fix the predictable health mess we are in and have put out political health policies to sway the voting punters, not health policies.
There is a lack of understanding of the multitude of problems within healthcare services within Australia and it will take a bold vision and brave people to achieve the reforms that are required. Also remember that Australia is not the only country experienceing problems with healthcare and we are probably better off than many.
This vision must include health literacy driving wellness and prevention, alternatives to traditional models of care, appropriate / reasonable remuneration for all, equitable access to outcome based care driven by health data, and improved financial management of care.
Reforms need to include the removal of federal and state bickering over funding which creates disconnected care, improvements to PBS and Medicare driven by data to prevent duplication and inappropriate investigations / therapy, unification of acute health services, and service provision based on patient outcomes.
This is not an issue for an election campaign or for one term of parliament. It is one that requires support from all parties and 10-15 years of investment.
Super Clinics 2.0 (SC2) is an under statement. If Labour is elected, which appears likely, traditional General Practices will need to consider an exit plan as SC2 will lead to the end of many of our private practices. SC1 resulted in unfair competition with established practices resulting in many large rural communities’ loss of their long standing General Practices and GPs. Subsequent to SC1, numerous government funded GP services including those attached to EDs in hospitals have continued to use Locums who are not qualified GPs to provide GP services in the name of service provision and claiming to alleviate ED pressure when there is clear evidence that there is a lack of continuity in patient care and fragmentation of care resulting from such practices. Private GP services are unable to employ Locums who do not possess GP qualifications. ED departments are openly in competition with GPs for the ‘low lying fruit’ such as issuing repeat prescriptions and providing specialist referral letters. There is no understanding or awareness of Preventive Health and follow up care.
I wish my colleagues well in their future as GPs as I am approaching the end of my career and fear for my specialty which will no longer have a significant role to play as a result of ongoing strategising by various bodies including the professional bodies, state and federal political forces.