RACGP warns rushed UCC rollout risked patient safety

As urgent care clinics (UCCs) expand across Australia, the RACGP has detailed concerns around their funding, warning that ‘political pressure’ to quickly establish services had created risks to patient safety.
 
With the rapid establishment of UCCs, the college says this is ‘not always matched by sufficiently robust governance arrangements’ and gives in to pressure – creating additional burden on the healthcare workforce.
 
It comes as part of the RACGP’s submission to the Australian National Audit Office’s (ANAO) ‘Performance audit: Award of funding for Medicare UCCs’, reiterating that services provided by UCCs could be delivered through local general practices if adequate funding and support were available.
 
The college maintains its position that UCCs must complement, rather than compete with general practice.
 
‘While UCCs have a role within the health system, their integration with broader care pathways and long-term cost-effectiveness require ongoing evaluation,’ RACGP President Dr Michael Wright states.
 
‘Government pressure to establish services at pace has not been matched by adequate governance arrangements, creating risks to patient safety and placing unsustainable demands on the workforce.’
 
As part of the audit, the ANAO will examine whether the Department of Health, Disability and Ageing (DoHDA) appropriately established the UCC program and effectively developed, implemented and managed grant agreements with Primary Health Networks for the clinics.
 
It will also look into DoHDA’s effective implementation of funding agreements with states and territories for UCCs.
 
It comes as newly released documents reveal the Federal Government has said it needs to ‘combat criticism’ of clinics.
 
The RACGP argues that oversights during the setup of the clinics, now with 137 operating across the country, could lead to fragmentation of care and limit appropriate integration with existing primary care services.
 
It is calling for greater transparency around future arrangements and a focus on integration of care and services throughout the award of funding.
 
‘Without clear expectations regarding integration, continuity of care and collaboration, there is a risk that urgent care services may contribute to further fragmentation across the primary healthcare system,’ Dr Wright says.
 
Funding agreements with states and territories have facilitated the establishment of UCCs, but the RACGP questions the lack of evidence showing they have effectively addressed the ‘longstanding structural challenges’ associated with coordination and integration between federal and state-funded components of the health system.
 
‘Effective federation funding agreements should establish shared accountability for health outcomes and support seamless patient pathways across primary care, community care and hospital services,’ Dr Wright said.
 
‘But ongoing evidence of fragmented care and integration challenges suggest these arrangements are not yet consistently delivering on these objectives.
 
‘We recommend future funding arrangements should place stronger emphasis on shared responsibility for patient outcomes, service integration and continuity of care across the healthcare system.’
 
Concerns regarding the extent to which UCCs have been integrated with broader health system pathways, including collaboration with state and territory governments and Aboriginal Community Controlled Health Organisations, have been raised in UCC interim evaluation reports showing a decrease in continuity of care through direct handover to a patient’s usual GP.
 
The ANAO audit should include the chosen clinic locations and independent assessment of these against locally determined need, the college recommends.
 
It also calls for flexible funding arrangements for rural and remote communities without access to UCCs to ensure equitable access to urgent care, as well as ‘responsive and culturally safe care’ for all communities.
 
Overall, measures must be introduced to strengthen similar programs in the future, the RACGP says, including any further expansion of UCCs.
 
‘It is essential to evaluate the planning, implementation and governance of Medicare UCCs as the audit progresses,’ Dr Wright says.
 
‘To determine their effectiveness, equity, continuity of care and address unintended impacts across the health system.’
 
The RACGP is currently leading development of nationally consistent, profession-led standards for UCCs in collaboration with the DoHDA to help strengthen program consistency and accountability.
 
It will address the ‘absence of minimum requirements’ of the current model to ensure that UCCs support integration with local health services and complement, not compete with general practice.
 
The ANAO is due to deliver the findings of its audit in March next year.
 
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ANAO funding audit general practice funding Medicare funding urgent care clinics urgent care standards