GPs call for redirection of $28 million for urgent care centres

There was a line in this month’s Federal Budget that leaped out at RACGP WA Faculty Chair Dr Sean Stevens.

It wasn’t the big ticket items affecting general practice. It was this:
 
‘The Liberal National Government is investing $28 million for the development of four new urgent care centres in Perth that will help ease pressure on emergency departments, and provide greater choice for patients.’
 
The announcement for four new urgent care centres has been framed as a trial, even though Western Australia already has three such centres. The new funding will take the total to seven, all run by St Johns Ambulance WA, a not-for-profit organisation that runs Western Australia’s ambulance services. 
 
Dr Stevens told newsGP that by siphoning off ‘urgent’ cases, he believes the new clinics will fragment care and lead to deskilling of GPs, who will lose the chance to practice wound care and other urgent issues they routinely deal with. In addition, he said the new centres will be in direct competition with existing general practices, while receiving additional subsidies.
 
Even more remarkable, Dr Stevens said, is the fact that the announcement was a total surprise, coming without consulting GPs or the RACGP.
 
The announcement was also made prior to the Western Australian State Government’s launch of its own urgent care model.
 
In response, Dr Stevens and other RACGP WA members will lobby local Federal MPs to have the $28 million re-directed to general practice as a matter of urgency.
 
The matter has already been raised in a Senate Estimates hearing on Friday by WA Greens Senator Rachel Siewert, who asked Department of Health primary health deputy secretary Caroline Edwards whether a procurement process was undertaken for the urgent care centres.
 
Ms Edwards said no procurement had been undertaken as part of the budget process, and said there was a proposal made by the organisation [St John WA] selected by the government to trial these centres.
 
Dr Stevens told newsGP the announcement has created an uneven playing field and led to fragmented care.
 
‘The government is encouraging urgent cases to go to an urgent care centre rather than go to their GP, when GPs are set up to deal with a simple fracture or lacerations or febrile illness. This is their bread and butter,’ Dr Stevens said.
 
‘It creates an uneven playing field, since local GPs have all the usual running costs without such subsidies. They’re trying to compete with a big clinic dropped in with no consultation [and] clinics near the existing urgent care centres have seen a drop in demand.
 
‘These centres lead to fragmentation, since care is purely episodic. The government has gone for a shiny new clinic they can cut the ribbon on, but that doesn’t provide the area of cover, continuity of care or benefit to patients.’
 
Dr Stevens said that by contrast, the soon to be released WA State Government scheme has been developed in consultation with GPs, the RACGP and the AMA. 
 
It is expected to be a virtual urgent care clinic, using excess GP timeslot capacity to see urgent patients at short notice through a central website and app.   
 
‘It [will] run at a fraction of the cost [of the St John centres],’ Dr Stevens said.
 
The Currambine clinic of former RACGP Chair, Dr Tim Koh, is around seven kilometres from the existing Joondalup urgent care centre.
 
Dr Koh told newsGP that the Joondalup centre had directly affected the viability of his clinic’s after-hours service.
 
‘What we’re finding is that very often, the after-hours consults are unbooked because patients are seeking care elsewhere. So it’s hard to justify longer hours when there’s competition from other services subsidised by government,’ he said.
 
‘The urgent care centre makes it harder to look after these patients, as you end up with fragmented care. They go off somewhere, their care has changed, and they come back with very little to explain what’s transpired.
 
‘Rather than providing a needed service, they’re diverting patients away from their routine care, where they’re probably best served.’
 
Dr Koh said he had had existing patients of his return after a visit to an urgent care centre without having their medical problem solved.
 
‘There’s very little handover from the centre, and they’re not asking us for any of the information on the patient they consult. It seems like a low value service,’ he said.
 
‘They’re seeing someone new and often providing a bare minimum service without the knowledge of the ongoing issues they have. It’s duplication of care, basically.’
 
Dr Koh said the use of the phrase ‘urgent care’ was very non-specific, which could confuse patients as to which service to seek in a given situation.
 
But Michelle Fyfe, the CEO of St John WA, rejected the criticism.
 
She told newsGP her organisation’s centres help patients avoid unnecessary emergency department attendances, provide GPs with an environment to exercise urgent care skills, and give GPs in the community an ‘appropriate and trusted pathway for the unscheduled care of their patients who present with urgent but non-life threatening problems.’
 
Ms Fyfe also said the urgent care staff are almost all GPs who are RACGP fellows.
 
‘We strongly believe St John Urgent Care is a GP upskilling environment, rather than a potential contributor to de-skilling,’ she said.
 
Ms Fyfe added that the urgent care centres are aimed at patients who would traditionally attend an emergency department (ED) with Triage category 4 and 5 problems (semi-urgent or non-urgent), a cohort representing over half of all ED attendances.
 
She cited recent research by Associate Professor Alistair Vickery  that found GPs could potentially manage the majority of patients who attend the ED with urgent but not life threatening issues, if they had additional resources, such as ‘onsite and timely radiology; specialty splinting devices for fractures; access to timely specialist advice, for example, orthopaedic, plastic surgery, dermatology and ophthalmology; and additional space and staff for observation, rehydration, etc.’
 
‘This is a very concise description of a St John Urgent Care centre. St John Urgent Care is a framework which brings together all the necessary resources to enable GPs to manage patients who would otherwise attend ED with urgent but non-life threatening problems,’ she said.
 
‘The first question that our nurses ask … is ‘who is your usual GP?’ A discharge summary is sent to this GP as the patient is leaving the urgent care premises.’
 
She argues that a patient attending an emergency department for a broken arm does not fragment care, as it is a medical event occurring in isolation, and said it is similar for St John’s urgent care centres.
 
Ms Fyfe also rejects the claim that the funding creates an unfair playing field.
 
‘[We] have moved ahead in the area of urgent care, despite significant financial cost to the organisation over the past four years, because we sincerely believe urgent care is a missing piece of the primary care landscape in Australia,’ she said.
 
‘The funding we have received is a reflection of the fact that the model works. We do not believe this is evidence of an unfair playing field.
 
‘Any organisation or individual who takes on great personal risk and expense over an extended period to produce a service which yields real results for the health system would attract similar funding.’
 
Ms Fyfe said the proposed expansion is ‘very different in scale and clinical scope’ to the anticipated WA State Government model, and that there is room for both.  
 
Western Australia Health Minister Roger Cook said GPs are key stakeholders in delivering his government’s commitment to provide a network of urgent care clinics in Western Australia, and that their views should have been canvassed prior to the Federal Government’s decision.
 
‘If indeed there has been no consultation by the Federal Government with GPs before this announcement I find that disappointing,’ he said
 
‘GPs play such a critical role in the delivery of health services and should have been consulted.’

The Department of Health did not respond to requests for comment prior to deadline.
 

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