Nurse-led clinics ‘another slap in the face’

Five urgent care clinics (UCCs) announced for the ACT on Wednesday go against operational guidelines that they be led by GPs, the RACGP has said.
 
The clinics will operate out of existing nurse-led walk-in centres, in contrast to guidance published by the Department of Health and Aged Care that the UCCs ‘be GP led, with staffing mix based on availability, local need and context’.
 
According to ACT Government’s media release, three new nurse practitioners and three new advance practice nurses will staff the UCCs, while an advanced scope physiotherapist, and an extra radiographer and sonographer will be employed at one of the clinics.
 
RACGP President Dr Nicole Higgins is strongly critical of the move.
 
‘Today’s announcement was frankly another slap in the face for ACT GPs and Canberrans,’ she said.
 
‘Canberra’s hospitals have the worst wait times in the country, and unfortunately Chief Minister Andrew Barr has shown yet again that he doesn’t understand how to fix the problem, or how the health system works.’
 
Dr Higgins said the set-up is in contrast to the best value model of urgent care supported by the RACGP, which advocates basing UCCs in existing general practices where GPs work collaboratively with nurses.
 
She said such clinics are better equipped to provide more immediate treatment, and a wider range of services to patients, while the ACT model is likely to lead to inefficiency, duplication of care and higher costs.
 
‘Ultimately, this will leave Canberrans waiting longer in the emergency department, or to see their GP,’ she said.  
 
‘This comes after Andrew Barr decided to impose an extra payroll tax on general practices, which will make care harder to access and more expensive, as most practices will be forced to pass on the costs to patients.’
 
Wait times in the Canberra’s hospital emergency departments have deteriorated according to ACT Health’s annual report for 2022–23, while the city also has the lowest bulk billing rate in Australia.
 
The five ACT-based clinics form part of the Federal Government’s election commitment to set up 58 UCCs, a pledge designed to reduce the pressure on the hospital system.
 
The RACGP, along with the AMA, submitted feedback in April this year for consultation on the proposed model to base the UCCs in existing walk-in centres.
 
‘This ACT model has been presented as a fait accompli rather than developed in consultation with GPs,’ a letter co-signed by RACGP NSW and ACT Chair Professor Charlotte Hespe stated.
 
‘There is no evidence available to us that alternative models were considered.’
 
The submission highlights the existence of GP after-hours clinics, as well as a locum medical service in the city. 
 
‘Please note that we do not currently advocate for either of these options: we simply do not have enough data to know what options might provide a viable solution,’ the letter states.
 
‘However, it is telling that no mention has been made in any consultations about considering any option for an urgent care clinic apart from the solution that is now to be implemented very shortly.’
 
Associate Professor John Adie, the inaugural Chair of RACGP Specific Interests Urgent and Emergency Presentations to Primary Care, said the timeframe for setting up the UCCs is likely to have played a part in the existing set-up.
 
‘What it’s taken New Zealand 30 years to put together, we are trying to do in a much shorter time,’ he told newsGP.
 
‘A lot of the issues are teething issues, because as there’s more training, there’s going to be more GPs, nurse practitioners, and hopefully community paramedic practitioners working in the urgent care space.’
 
Associate Professor Adie has previously spoken of his support for the introduction of urgent care clinical standards, and advocates a similar model for Australia as for New Zealand.
 
Having trained in New Zealand, he said that he is accustomed to an urgent care practitioner-led model.
 
‘We don’t have urgent care practitioners over here in Australia, so my preferred model is the GP model,’ he said.
 
‘Just like when I was working in emergency department, even though I was vocationally registered in general practice and urgent care, there was always a consultant that I could refer to even if I didn’t have to talk to them on the shift him or her.
 
‘That was the model that I worked under, which is the model that I’m proposing for Australia.’
 
The five UCCs announced on Wednesday are joint funded, with the Federal Government contributing $7.1 million over three years.
 
They are expected to be fully operating as UCCs early next year.
 
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