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

Jolyon Attwooll

23/08/2022 4:34:35 PM

Plans for five priority care centres in Victoria are the latest in a series of nationwide developments to increase access to after-hours general practices with a mix of funding.

Man in GP clinic with bandage
The state-funded priority care centres will be set up to address urgent medical issues that do not require emergency intervention.

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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BM   24/08/2022 11:35:48 AM

Good like finding GPs. I am presuming they are intending to be bulk or even mixed billing so that clinics are self sustainable. Even if they can find a few GPs, the 'pay' will have to be crap for a self sustainable model to work. Only if they are heavily resourced by government, equivalent to everyone being full fee paying patients, will the income be anywhere near reasonable for GPs.

Rural GP   24/08/2022 1:05:02 PM

I disagree : I run a small GP clinic, I, and my GP's would be very keen to work in a different model , seeing acute procedural medicine without having the constraints of General Practice. State Governments will find the money ( easy) but they will "whiteant" General Practice and fractionate care with $. Its the cream off the cake. They are not interested or respectful of primary health care, they just want an alternative for their A+E problem. This would be a disaster for General Practice: who will be left to manage mental health issues and chronic health care.? We need to keep acute care to keep us sane and viable. We just need adequate funding : States could pay us for Dressings, ECG's, HITH, IV cannula's and fluids, venesections or Medicare could step up. ( youre dreamin! )

Dr Bradley Arthur Olsen   24/08/2022 6:08:22 PM

It could work but would need to be bulk billed or they would just go to DEM, the goverment-state or federal would have to chip in a base hrly rate on top of this to entice local GPs, of course the local DEM would have to accept anything we cant handle , WITHOUT having a verbal fight with them If the price was reasonable I would do 1-2 nights a week

Dr Michael Charles Rice   28/08/2022 1:33:47 PM

ACEM: "EDs are dangerously overloaded because they see too many people who simply couldn’t access or afford the care they need in community settings over longer periods of time.
"Without access to appropriate care, people get sicker, their health deteriorates, and their acute conditions become chronic. Often, they also become socially marginalised.
"Then, when things get unbearable or unmanageable, and they are suffering immensely, they present to EDs for urgently needed help.
"The worst part is, this could all have been prevented by access to affordable, accessible, integrated primary and community-based care over time"

Invest in primary care at the same rate as this investment in "urgent" care and we WILL see a fall in demand for acute care. Better $$ value, too.