Peak bodies have doubled down on their opposition to urgent care clinics, yet a Healthed poll this week shows seven out of 10 GPs support them.

Last fortnight a council of seven peak bodies for doctors, including the RACGP, AMA and ACRRM, as well as Rural Doctors Association of Australia, Australian Indigenous Doctors Association, General Practice Registrars Australia and General Practice Supervision Australia, issued a joint position statement slamming urgent care centres as a shorted-sighted attempt to manage growing ED presentations without addressing the underlying under-investment in general practice, including after-hours primary care.

The group, collectively known as the National Council of Primary Care Doctors, has urged governments to invest more in general practice primary care services, including after-hours primary care.

Despite this, 70% of GPs in Healthed’s national survey of 795 GPs said that they support urgent care clinics in principle.

Almost two-thirds of respondents (65%) had at least one patient who attended a Medicare urgent care clinic (UCC) in the past month — while 10% had 10 or more patients visit a UCC in that timeframe.

More than three-quarters of surveyed GPs with patients who had visited an urgent care clinic in the last month felt it had a positive impact on timely delivery of care and reduced pressure on local emergency departments, while 64% also felt it had a positive impact on patient health outcomes.

Why are peak bodies so opposed?

The joint position statement noted that “reports indicate that clinical handovers from UCCs back to a patient’s regular GP practice are of inconsistent quality, if provided at all,” and expressed concerns that UCCs “are creating competition for an already stretched workforce supply” of GPs and RNs.

So far the government has invested $585.5 million into Medicare urgent care centres, with Health Minister Mark Butler announcing in May that it would fund another29 clinics, bringing the total to 87.

Newly sworn in RACGP president Dr Michael Wright, who also has a PhD in health economics, told Healthed that providing urgent care is a routine part of general practice – and we’d be far better off to invest there.

“The best solution to fixing the pressure on our hospitals and ambulances is better funding existing general practices, rather than spending millions setting up new clinics. That is not value for money,” Dr Wright said.

“People need GPs they can trust and who know their history,” he continued, adding that “the Urgent Care Clinic Model in Australia is yet to be properly evaluated.”

Professor Karen Price, former RACGP president, GP, and researcher agrees, saying urgent care clinics represent the government’s failure to adequately support general practice.

“We’ve watched them remove after hours care funding. We’ve watched them decrease mental health care funding. We’ve watched them reduce aged care funding.”

“Medicare has not been indexed. It has not been properly funded to support usual general practice doing this kind of work, which is what we’ve all done in the past.”

Professor Price also points out that each visit to urgent care costs taxpayers approximately $200 per head — cheaper than a trip to ED — but significantly more than if these patients were treated in general practice, which costs about $40 per head.

On-the-ground experiences don’t always match the high-level concerns

Around 200 GPs gave more specific examples of how access to urgent care clinics has affected their patients or practice – and while several raised concerns, positive examples out-numbered negative ones by about three to one.

While fragmented care, increased cost to the health system compared to primary care and lack of effective collaboration and communication with GPs has been a major concern among peak bodies, several surveyed GPs said that has not been their own experience, instead noting that they’ve received good support from the clinics near them.

“Letters are sent to GPs in a timely manner,” one GP noted.

“My patients can attend at times when I am not available. Communication from the local clinic is of a high standard,” said another.

“Care has been appropriate and competent, and patients have returned to my practice for review and follow-up.” – surveyed GP

Many GPs appreciated the after-hours availability, saying nearby urgent air clinics had been able to provide antibiotics for acute infections, including IV antibiotics in some cases, as well as fracture diagnosis and management without the need for ED.

“They dealt with fractures and then referred patients to appropriate specialists and back to GP to manage with no problems,” one GP explained.

“It complements my practice, especially after hours and on weekends,” as one GP put it, was another common theme.

“Easing the pressure on GP as difficult to accept walk-ins,” another GP said.

Which is not to say it is all sunshine and rainbows — 30% of GPs don’t support urgent care clinics, with many noting problems with continuity of care and increased workload, without adequate compensation for that work.

“It caused me more work and frustrated my patients because a more junior GP has not properly managed the problem in UCC which I now need to rework,” one GP recounted.

“Doctors at the clinic do not know the patients and tend to not do much in terms of diagnosis and management,” another said.

“We don’t get paid to read the correspondence or update the health records. It seems at times that patients get detailed and very lengthy assessments when it could be quite a minor issue; i.e. very expensive and expansive, with limited benefit to patient,” another GP commented.

More comments from your colleagues

Positive UCC experiences:

“Very good, complementary practice to ours, especially as our clinic doesn’t open on weekends.”

“Urgent care unit provides assistance when it’s not possible to get an appointment.”

“UCCs have helped provide care for patients who would otherwise have ended up in the A&E and the discharge summaries provided assist in continuity of care.”

“My patients can attend at times when I am not available. Communication from the local clinic is of a high standard.”

“They’re good for diagnosis and exclusion of fractures So patients do not have to attend ED for an X-ray.”

“Urgent care clinics are very helpful for fracture management and minor emergency cases.”

“One of my patients ended up having cellulitis after a minor procedure, and was able to attend the UCC at 8pm. She was assessed and antibiotics started in right time. Without UCC, she would have been left without proper treatment.”

“Urgent care clinics affected my practice positively by taking care of my patients when I was not available for patients.”

“Patients have felt attended to, well treated and wait times much less than a hospital-based ED.”

“Helpful with minor injuries, when it is hard to fit emergencies if one is fully booked.”

“Patients are happy that they can see a doctor when we are not available. I am happy that I get correspondence also.”

Negative UCC experiences:

“Very slow to get letters, often incorrectly managed, money could be better spent in GP.”

“Wasting consultation time by chasing results from urgent care clinics.”

“The urgent care clinic systematically refers to specialists in hospital because it dwells inside the hospital.”

“Patients don’t usually check back with their local GP.”

“Patients get referred back to the GP after insufficient care was provided.”

“People go to urgent care to avoid paying gaps for GP appointments, even for non-urgent care.”