Cost blowouts at nurse-led walk-in centres exposed

Matt Woodley

17/06/2024 6:26:44 PM

Internal emails show ACT public health officials recently buried around $10 million in additional annual expenses.

Nurse speaking to patient.
New estimates suggest nurse-led walk-in centres have a cost-per-service of around $194.

ACT health bureaucrats grossly underestimated the cost of its nurse-led walk-in centres, according to new emails released under freedom of information (FOI) laws.
The alleged cover-up, exposed by The Canberra Times, suggests the controversial initiative’s cost-per-service is approximately $194, almost double the ‘less than $110’ figure Canberra Health Services (CHS) initially spruiked last month.
The investigation also revealed that officials have not measured the number of walk-in patients redirected to emergency departments since October 2022.
RACGP President Dr Nicole Higgins told newsGP the actual costs reinforce that the money could have been better spent on general practice.
‘This is just more evidence that investment has to be put into the right places if you want to get outcomes,’ she said.
‘Funding drives results. If the Government had put this sort of money into general practice, it’d get much more bang for buck.
‘This model, it’s not free. It’s costing taxpayers five times more than what it would if they saw their GP.’
The now-public internal emails indicate overhead costs associated with running the centres account for much of the discrepancy between the initially provided figures and those unearthed by the FOI inquiry.
CHS officials had originally calculated an average cost-per-service of $109 by dividing the five centres’ allotted $12.6 million budget for 2022–23 by the 115,000 presentations that took place in the 2023 calendar year.
But internal spreadsheets released as part of the FOI request reveal that the centres actually cost $14.7 million to run in 2023, while officials decided not to include $7.6 million in additional operating costs when making their calculation.
In response to the newly published documents showing total annual expenditure had reached $22.3 million – $9.7 million higher than they had acknowledged – a CHS spokesperson reportedly noted that there had been a ‘back and forth’ between bureaucrats when responding to the initial media enquiry.
‘During this process, one area developed an estimate of the cost per service at walk-in centres that included a range of overhead costs,’ the spokesperson said.
They also reportedly said the $109 figure was a ‘rough estimate’ and that they had relied on the $12.6 million budget figure because it was considered the most relevant and the one in which they had the ‘most confidence’.
Meanwhile, measurements for emergency department redirections have reportedly not taken place in the past 20 months as officials have not had an ‘agreed methodology’ to calculate the figure after the Digital Health Record was rolled out in November 2022.
Walk-in centres were in-part designed to ease pressure on public hospitals, but wait times in Canberra’s emergency departments have deteriorated according to ACT Health’s 2022–23 annual report. The city also has the lowest bulk billing rate in Australia.
The last independent review of the walk-in centres took place more than 13 years ago and Dr Higgins said further evaluation is long overdue.
‘What it does is create a two-tier system where we’ve got fragmentation of care, duplication of services, and increased costs due to increased test ordering and referrals back into the emergency department and general practice,’ she said.
‘It’s a false economy. Investing in general practice in the first place would have saved taxpayers more money, but there aren’t many shiny ribbon cutting ceremonies in general practice.
‘Australia’s got one of the best health systems in the world. Let’s use what we have, but make sure it’s funded appropriately – and that means supporting general practice to keep people out of hospitals.’
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Dr Kent Fu   18/06/2024 7:27:28 AM

Not surprising at all.

Thinus   18/06/2024 7:56:55 AM

This is not new. The only difference being that the media is choosing to take note.
I wrote several blogs about this back in 2017/8 and never got anywhere

Dr Kyla Margaret Bremner   18/06/2024 11:37:53 AM

I can’t tell you how many five page discharge summaries I’ve received only to read at the end the plan: “See GP tomorrow”. Even patients with clear bacterial tonsillitis are not being treated and are told to see the GP for antibiotics. I even had a kid with croup given one dose of steroid and told to see the GP the next day for a script for two more days of Redipred. How on earth does that save the system money?

Dr Greg William Moritz   18/06/2024 1:27:07 PM

Greater cost of services, less expertise in relation to the services actually provided, greater fragmentation of care. Just what you'd expect of a farcical system set up by bureaucrats/ politicians. Oh yes - but the GPs won't pay payroll tax here if they bulkbill. Why would any young doctor consider going into general practice when clowns like this are pulling the strings?

Dr Annette Elizabeth Carruthers   18/06/2024 4:02:43 PM

When will bureaucrats learn that GPs are the most cost-effective part of our health system and should be invested in. There is a great case for nurses working with GPs in a team but not independently which will most likely result in high levels of referral to ED and their GP.
The Fin Review tells us today that surgeons are earning over $500k per annum. The discrepancy between GP and specialist incomes is the root cause of the current situation, it must be addressed.

Dr Abdul Ahad Khan   18/06/2024 4:27:41 PM

These Nurses are carrying on the enviable Task of a GP to the best of their abilities - they are grossly UNQUALIFIED, as they do not have a MBBS Degree nor Hospital Internship Trainings nor GP Registrar Training - I feel sorry for their Plight.

I feel even more sorry for the Innocent Populace .

Fresh MBBS Graduates will chose to pursue a Career as a GP, only if GP Work is made FINANCIALLY LUCRATIVE to them.

Apart from their Grand-Stands & their Talkfests, the RACGP & the ACRRM unlike the AMA, have done nothing to demand higher Medicare Rebates for us GPs at the Coalface - why do they not organise a one Day Nation-wide ' Stethoscope-down ' STRIKE by GPs ???

' STRIKE ' is not a Dirty Word - Nurses go on a Strike & Hospital Interns go on a Strike - that is the only way that the Govt. of the day can be made to go on their Knees & come to a Negotiation Table with our Colleges.
Pick up a Monday for such a Strike & get the Media involved & see what eventuates.
Dr. Ahad Khan

Dr Peter James Strickland   18/06/2024 5:02:26 PM

This is the whole argument about the rate paid by Medicare for GP consultations ---- the basic item 23 rebate should be in the $100 bracket, and that would save the govt $9/consult as per the report (above), keep GP practices viable, and give them the possibility of opening after-hours, have more GPs doing training and wanting to be GPs, and save 'bundles' in hospital A&Es. The Federal Health Minister, Butler, is NOT interested in GPs, as he is controlled by his bureaucrats (incl. medical) who have NO experience in how a general practice functions at all, and only interested in controlling the dollars, but unfortunately in the wrong areas for efficient patient management in dollar terms in the end --and the efficient area is general practice without doubt..

Dr Dhara Prathmesh Contractor   22/06/2024 8:26:15 AM

Abuse on health funds.
Non-medical practitioner initiated decision making to drive acute care clinic and nurse led clinics. Build those clinics cost not notated. Just the least expenditure exposed as yet!

Nurses are paid 3 times more than a doctor (an intern or a junior house officer) in those clinics!

Why do GP specialisation? If only nurse led clinics were sufficient to look after all health needs in the community.

Modern way of Tax evasion?

Dr Greg Saville   22/06/2024 11:00:15 AM

Notwithstanding the poor maths of the Canberra Times article (the increase is closer to 75% than 100%) it just goes to show that GP led urgent care clinics are the way to go. These clinics have kept ten of thousands of patients out of ED in the past year and provide excellent quality of care. The clinics are universally loved by the public. The RACGP leadership should just stop attacking the hundreds of young GP’s who work in these urgent care clinics (we are not, ahem, “window dressers”) and instead direct their ire to those health professionals giving substandard care to Aussies just to make a quick buck.

A.Prof Christopher David Hogan   22/06/2024 6:12:39 PM

There is no joy in being correct sometimes

Dr RM   23/06/2024 9:26:26 AM

Dr Greg Saville
Completely agree….
RACGP needs to support urgent care GP clinics and not attack them as they do serve a vital role in healthcare. I work as both an urgent care GP and in clinic. The roles are complementary (not competing) and offer a valuable service to the community to prevent ED presentations and allow GP clinics to not have to open on weekends/late nights/public holidays.
By RACGP opposing urgent care clinics it encourages and reinforces the govt to look at alternatives such as nurse led clinics or even potentially giving money to pharmacies to have in-house urgent care services.
Please RACGP please actually listen to your members and advocate for us.