Patients score them 4.78 out of 5 stars, says Andrew Cohen, CEO of ForHealth, the corporate that owns a third of urgent care clinics. But is pouring more money into urgent care clinics further undermining general practice?

The ForHealth CEO joined health minister Mark Butler last week as they announced another $227 million in funding for 29 more urgent care clinics – bringing the total to 87.

Mr Butler says the fully bulk billed clinics will take the pressure off crowded emergency departments. The government’s press release noted that half of UCC patients “say they would otherwise have gone to an Emergency Department,” adding that children under 15 have accounted for almost one in three visits.

But the RACGP has called the move “misguided,” and other GPs have been scathing, calling it “a Band-Aid solution,” and “a PR stunt,” with “horrible ROI.”

“The urgent care clinics are like opening a chain of McDonalds in an area of famine. Fast and free and little else,” is how GP and chair of Australian Doctors Federation Dr Aniello Iannuzzi summed it up.

Existing urgent care clinics have not undergone a proper evaluation, says Professor Karen Price, GP, researcher and immediate past president of the RACGP. She says that means a lot of key questions are going unanswered.

“I’m still wondering who gets turned away from an urgent care centre. So are they not seeing chronic disease? Are they seeing people for an urgent blood pressure medication they’re about to run out of?” Professor Price asked.

Fragmented care and diverted funding

Professor Price says urgent care wings should be integrated into usual general practice. The current model costs an estimated four to five times as much as a standard GP consult, and could easily morph into an overpriced general practice.

“It’s certainly, at the moment, causing fragmentation of care. I get no correspondence back from an urgent care centre,” she continued.

In a LinkedIn post responding to the announcement, Dr Annalyse Crane of Kirrawee and Woolooware Family Medical Practices raised similar concerns, noting that she often receives radiology results with no history or visit summary or discharge summary for patients who have been treated at the nearby urgent care clinic.

“Families are told to call their GP for results and follow up as the locum GP in the UCC might only work one shift a week so there is no continuity of care,” she wrote. The urgent care clinic gets paid, while she squeezes in actioning the results between booked patients for nothing, she added.

Low-evidence care

Overall, Professor Price says the move away from general practice is demoralising and lacks evidence.

“It hasn’t energised the workforce, it’s actually demoralised the workforce, because everywhere we see an endometriosis clinic, and we see a menopause clinic, and we see a skin clinic, and we all know this is a low-evidence care to fragment patients into disease. We know that’s really poor primary care. Primary care is continuous, coordinated, comprehensive, first contact,” Professor Price says.

What GPs on the ground have to say

Healthed asked GPs for their views on the matter in a national survey that opened on 14 May.

Of the 1939 GPs who responded, 60% said the clinics are “politically popular, but not addressing the fundamental issues,” while the same proportion felt “funding would be better used to help existing practices stay open and accessible after hours.”

However, 56% also felt the clinics would indeed ease pressure on EDs, and 53% felt they were a good way for patients to access GPs after hours.

Just over half (53%) of surveyed GPs said the clinics would exacerbate continuity of care.

Many GPs acknowledged both pros and cons. For example, of those who said the clinics aren’t addressing the fundamental issues, 47% do think they will reduce pressure on EDs.

What your colleagues are saying

“The major issue in my area is lack of doctors…not a lack of clinics.”

“There are not enough GPs to run the existing clinics – where are they going to manifest the staff?”

“I work in an ED. We are over-run with patients who can’t get into see local GPs for up to a month. The urgent care centres will be a great in between service. They won’t take work away from GPs but help provide a place for people to go when they can’t get into GPs or after hours.”

“Concept is useful to provide after-hours care. Should be open from 5pm to midnight. Will reduce after hours ED pressure and should have summary to regular GP. Should be close to EDs so can be triaged to the clinic.”

“Like all political quick fixes, this is poorly thought out and there for a grand announcement only, no prior evaluation of what resources are needed (especially staff), and totally inadequate for the problem even if they could be staffed. Pay existing GPs better and increase incentive for younger doctors to become GPs…”

“Another nail in the coffin of genuine continuity-of-care general practice.”