GPs speak out amid walk-in centre concerns

GPs are calling for an independent evaluation of the Australian Capital Territory’s nurse-led walk-in centres, citing fears of patient safety and access to quality care.
 
There are now five of the centres operating across the ACT, all of which are staffed with advance practice nurses and nurse practitioners and offer free care for non-life-threatening injuries and illnesses.
 
But GPs in Canberra say they have now seen multiple incidents where the centres are interrupting continuity of care and medical complications are being missed.
 
This is an issue Dr Emily Rushton, a Canberra-based GP, knows all too well.
 
She told newsGP the clinics’ inability to access a patient’s full medical history and the protocolised model of care are leading to complications.
 
Offering one example, Dr Rushton said she had a patient with severe liver disease who visited one of the walk-in centres and was put on flucloxacillin rather than a readily available and safer alternative.
 
‘These are very highly trained, very skilled nurses, but a nurse is not a GP, and they’re being expected to work as GPs without the medical backup and the training of a GP,’ she said.
 
‘You’re relying on the patient to communicate what conditions they have and what medications they’re taking, and sometimes patients don’t necessarily understand the significance of their conditions.
 
‘The walk-in centres have expanded out into the communities and gradually their scope of practice has increased but we are yet to see proof that the centres offer value for money or reduce the load on the hospital.’
 
Last year, an investigation from The Canberra Times found the controversial model’s cost-per-service is around $194, almost double the ‘less than $110’ figure Canberra Health Services quoted initially.
 
The walk-in centres are part of a national network of 58 Medicare urgent care clinics (UCCs) across Australia, but unlike the UCCs, they do not have a GP on site.
 
When they were announced last year, the RACGP labelled the move ‘another slap in the face’ for GPs, and said they are operating in contrast to guidance from the Department of Health and Aged Care that the UCCs be GP-led.
 
Dr Rushton, alongside her ACT GP colleagues, has a long and growing list of concerns with the centres, saying there instead needs to be a more integrated model of care, where walk-in clinic staff and GPs work from the same health record and are incentivised to collaborate.
 
She specifically raised concerns about the potential absence of preventive and whole-of-person care available in this healthcare model, saying it is a fragmentation of care.
 
‘What that means is that the patient, who may have touched base with a GP for something like a skin infection or an injury, then may not be seen for many years by a GP and all of that preventive care is going by the wayside,’ Dr Rushton said.
 
An ACT Labor spokesperson told newsGP that the centres have ‘proven themselves to be a popular and successful option’ for treating patients with non-life-threatening injuries and illness.
 
‘Robust processes are in place within Canberra Health Services to support treatment protocols and service expansion based on appropriate data and evidence, such as enabling the treatment of children between one to two years of age,’ they said.
 
‘A re-elected Labor Government will continue to ensure transparent performance reporting about walk-in centres and the broader ACT public health system is provided to the community.’
 
‘Walk-in centre presentations cost significantly less than an average emergency department presentation.’
 
They said the introduction of the centres has been associated with a ‘statistically significant decline’ in the proportion of primary care type presentations to ACT emergency departments.
 
But moving forward, Dr Rushton said there must be a thorough and independent evaluation of the ACT’s walk-in centres to ensure that residents know their money is being spent effectively.
 
‘It is greater support for GPs and GP-led multidisciplinary care clinics that is the key to solving this problem,’ she said.
 
‘We also need to make general practice a more attractive specialty – and that starts with recognising the skill and the complexity that general practice involves.’
 
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Australian Capital Territory fragmentation of care nurse practitioners scope of practice urgent care clinics walk-in centres