MEDICUS May 2022

The myth of urgent care centres Dr Simon Torvaldsen Chair, AMA (WA) General Practice Group B y the time you read this, the election will be upon us. Disappointingly, health did not feature prominently in the early election campaigning. Fortunately, this has now changed with a major Labor commitment to General Practice but unfortunately, the Coalition did not see fit to match this commitment. The one initiative that Labor did initially announce was government-subsidised urgent care clinics. The stated aim being to reduce the pressure on hospital emergency departments and ambulance ramping. The plan involves grants to practices to operate urgent care centres, although it appears these grants will not be huge. The problem is that to qualify for the grant, every attendance must be bulk billed. This plan was dreamt up by Labor policy makers with zero consultation. The proposal received qualified support from the Royal Australian College of General Practitioners (RACGP), seized upon by Labor as “support from GPs”, but was strongly criticised by the AMA. Why were we critical? I expect most of you can see very good reasons. There are fundamental problems with the Labor proposal: ƒ It is useless in addressing the ED problems it is supposed to solve. “GP Urgent Care” patients do not arrive by ambulance, so ramping will be unaffected. GP-type presentations do not clog up EDs and cause bed block. This is caused by full hospitals, with no beds available for admissions. Ask any emergency physician and they will give the same answer. The cause of problems in our EDs is well known, and it is not a flood of “GP Urgent Care” patients. We already know that following the introduction of the current St John Ambulance urgent care centres in WA, ED attendances and ambulance ramping have increased, not decreased. ƒ Although the proposal tacitly acknowledges that the MBS rebate for GPs is inadequate (otherwise why is a further grant needed?), urgent care clinics do nothing at all to address the underlying problems with GP funding and recruitment. It is at best a piecemeal, Band-Aid solution that can achieve nothing in the longer term. ƒ It is another step towards fragmented care. We know this ultimately results in poorer long-term outcomes. ƒ It is said to be inspired by the “NZ model of care”. It is true that New Zealand has relatively lower ED presentations than Australia. However, a recent Commonwealth Fund analysis has shown the NZ health system to have worse health outcomes and lower cost effectiveness than Australia. Health is so much more than ED attendances. Why copy a model that performs worse than ours? ƒ The model has in-built perverse incentives, and the compulsory bulk billing will either see costs blow out uncontrollably, destroy regular General Practices, or both. Why see your regular GP when you can go to the “government clinic” and get everything “free”? Remember, we had the same problem with the home- visiting After Hours services until the rules had to be changed to curtail them. Government intervention into a private business model always has unintended consequences. ƒ The proposal is inherently very expensive, and as I have said, costs will blow out heavily and rapidly. In NZ, it costs around $40 to see a GP but more than $100 to attend an urgent care centre – the big difference being that the patient pays the cost in both cases. The clinics will not be any cheaper to run in Australia, but the Labor proposal has the taxpayer paying the extra $60 for each visit. No doubt Labor had good intentions, but they failed to consult with GPs, and so came up with a deeply flawed proposal that could harm our primary health system, without any potential to solve problems. Our criticism stung Labor and they subsequently engaged. We pointed out the need to properly support General Practice with implementation of the current 10-year plan, and the initiatives in the AMA Modernise Medicare campaign. The RACGP is also supportive of the 10-year plan and made both parties aware of this. Following personal discussion with AMA Federal President Dr Omar Khorshid and with the backing of the RACGP, G E N E R A L P R A C T I C E Continued on page 13 M AY 2 0 2 2 M E D I C U S 11