‘Cautious optimism’ for new state-funded GP-led clinics

A commitment to 50 Federally funded urgent care centres around the country was one of the significant healthcare promises in the run-up to the May election.
 
Now, as hospitals report record attendances, new primary care spending has been announced at a state level in a bid to prevent patients who do not need urgent care from presenting to emergency departments.
 
This weekend (21 August), the Victorian Government announced five new priority care centres, to be funded by $14.3 million in state money, four of which will be located in Melbourne and a fifth in the regional hub of Ballarat under the auspices of Grampians Health.
 
A government press release stated that expanded access will come at a time when Victorian EDs ‘are the busiest they have ever been’, with 486,701 reported presentations in the past quarter.
 
To be GP-led, and based in existing primary care infrastructure, the clinics are described as ‘for people with conditions that require urgent attention but not an emergency response’.
 
Accepting walk-ups, referrals and pre-booked appointments, the clinics are slated to open ‘over the coming months’ with planned operating hours stretching across seven days a week and 16 hours a day, according to the state government announcement.
 
For RACGP Victoria chair Dr Anita Muñoz, the move is a welcome one, albeit with the caveat that ‘the devil will be in the detail’.
 
‘I’m cautiously optimistic that this plan will add something to the health landscape in Victoria,’ Dr Muñoz told newsGP.
 
‘If we have partners at the state government level that are willing to talk about innovation and investment in general practice, I don’t want to shut that conversation down.’
 
There have been concerns raised by other GPs based in the state, including whether MBS funding will cover the operation of the clinics, and querying if adequate numbers of GPs will be available to staff them. Australasian College for Emergency Medicine Victorian Chair Belinda Hibble meanwhile told Nine Newspapers the centres are likely to have a ‘very small impact’.
 
While acknowledging some ‘scepticism and uncertainty’ about how the model will function, Dr Muñoz said recent initiatives in Victoria, including state-run GP-led respiratory clinics, give her confidence.

In terms of staffing, she believes that previous experience with the respiratory clinics, combined with the fact there are only five centres to begin with, suggests an accessible workforce should be found.
 
‘I don’t think that you will be able to universally ask every general practice in the state to extend their hours in this manner,’ she said.
 
‘But I hope … there would be sufficient staff to work in in those five locations.’
 
However, Dr Muñoz emphasises that adequate funding is essential, and that existing Medicare rebates will not be sufficient to allow the new set-up to work.
 
‘I have made it very clear that the MBS item numbers do not cover the cost of treating these kinds of urgencies in the community setting without charging a gap,’ she said.
 
‘If the state is willing to invest in general practice, I applaud that. But that needs to cover what the true cost of delivering this care is, particularly if that care is to be bulk billed.
 
‘I hope that the funding envelope will be sufficient to cover those costs.’
 
The priority care clinics are planned to run initially for a year in Victoria and may overlap with the Federal urgent care centres, which the Department of Health and Aged Care (DoH) told newsGP would ‘become operational progressively from mid-2023’.
 
A DoH spokesperson said further details about the clinics should be expected in the October budget.

When responding to Labor’s then-election pledge for the Federally funded urgent care centres, RACGP President Adjunct Professor Karen Price said she welcomes innovation that does not fragment care.
 
‘A model that seeks to reduce duplication of primary care services and build on existing general practice clinics and infrastructure is something we would be happy to explore,’ she previously told newsGP.
 
‘We have long been calling for support for after-hours access for acute care in general practice – this should take place in suitably resourced GP-led clinics, we don’t need to reinvent the wheel.’
 
The Victorian Government initiative is the latest model to emerge using different models to the traditional Federal funding. 
 
Earlier this year, funding for ‘up to 12’ urgent care service centres was announced for Western Sydney, to be backed by a $10.9 million grant from the NSW State Government.
 
General practices in Western Australia have also been participating in an urgent care network, run in partnership with the state government’s health department, since 2019.
 
These developments are in addition to priority care clinics backed by the South Australian Government that were also initiated at around the same time, while an extension for state-funding for after-hours clinics in Tasmania has recently been confirmed.
 
While welcoming the Victorian initiative, Dr Muñoz is realistic about the impact it is likely to have.
 
‘It would be inappropriate for us to suggest that these priority care clinics will solve all the issues of ED and I don’t think anyone is suggesting that,’ she said.
 
‘Like all wicked problems, there’s not a single solution but many solutions that are working together to provide an overarching improvement on a very complex system.’
 
If the system works, however, Dr Muñoz would be happy to see it expanded.

‘I do also hope that if we can demonstrate success with this model, then we’re building the argument for across-the-board investment in general practice to do similar work if they receive appropriate funding,’ she said.
 
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