The college says an interim report on urgent care clinics validates the concerns it has about the program.
An interim report on urgent care clinics in Australia has confirmed they are five times more expensive than a GP consult, says the RACGP.
The peak body says the report has validated many of the college’s concerns about UCCs, including cost, fragmented care and their value in addressing Australia’s patient care challenges.
The interim evaluation report assesses the impact of urgent care clinics in their first six months of operation. It provided nine measures of success, including:
- Timely treatment: in the period to 30 September 2024, median waiting times at Medicare UCCs were estimated at 14.5 minutes. This was shorter than the median waiting times at EDs for triage category four which is 31 minutes and category five which is 24 minutes, noting that these waiting times are not directly comparable. A small proportion of Medicare UCC patients (12%) waited longer than 60 minutes to be seen. In EDs, 32% of patients in triage category four are seen outside of the 60-minute benchmark and 12% of category five patients are seen outside the 120-minute benchmark.
- Safe and quality treatment: the Medicare UCC Program implements a robust clinical assessment process prior to opening to ensure clinics meet safety standards and are ready to operate in accordance with the Medicare UCC Operational Guidance.
- Coordinated care: In the period to 30 September 2024, 89% of presentations had a clinical handover provided by at least one method outlined in the Operational Guidance (provided directly to usual GP, uploaded to MyHR or paper copy given to the patient). A small proportion (11%) had a clinical handover provided by ‘other’ means. Approximately 68% of presentations had a handover directly back to the patient’s usual GP/practice in the period to 30 September 2024. A further 10% of presentations had information uploaded to MyHR (but not provided directly to the patient’s usual GP). Approximately 11% of presentations received a hard copy of a discharge summary only, which is consistent with the proportion of patients (11%) that did not identify a usual GP/practice. Commissioners reported receiving feedback from local GPs that electronic provision of a discharge summary was their preferred method of receiving clinical handovers.
- Cost effectiveness: the annualised Australian Government funding support for Medicare UCCs is estimated to be $246.50 per presentation, excluding the five ACT Medicare UCCs, where MBS claims cannot be made, and the seven Medicare UCCs in which Module data, including MBS items, was not yet reported at the time of undertaking the analysis. Across all Medicare UCCs, the annualised Australian Government’s funding is $216 per presentation. These preliminary results do not include contributions to the operation of Medicare UCCs by state and territory governments.
The full list of findings are in the report available here.
The college has already spoken out about the federal government’s budget commitment to fund an extra 50 bulk-billing urgent care clinics by mid-2026 prior to a full evaluation of the program.
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RACGP president Dr Michael Wright said they stood by this position.
“The report confirms what we already knew. Urgent care clinics are an expensive model of care, which could be better and more efficiently delivered through existing general practices,” he said.
“The government’s election commitment to roll out more urgent care clinics will mean more than $1 billion will be spent on setting up these clinics, and the report states that each presentation costs $246.50.
“This sum is cheaper than a visit to a hospital emergency department; however, it’s significantly more expensive than a standard GP consult, which costs taxpayers a little over $42. So, your average urgent care clinic visit, seeing a GP who you may not even know, is more than five times as expensive as a consult with your regular GP.”
Dr Wright said all “specialist GPs are trained to perform urgent care, and all practices and GPs routinely provide urgent care to their patients”.
“Accessing urgent care through general practice improves patient health outcomes because continuity of care is embedded,” he said.
“The best, most cost-effective way to increase access to urgent care and ease pressure on hospitals is to support existing practices expand their current services, including offering more after-hours services.
“If the funding dedicated to urgent care clinics instead went to practices, we could be doing much more to help patients with urgent care needs. There’s no substitute for the high-quality care provided by a GP who knows you, and your history, including in urgent care situations.”
Dr Wright told The Medical Republic the college valued the work GPs who were staffing UCCs were doing, but there were other considerations that raised serious questions around whether the clinics were the best and most cost-effective option.
“It’s important to keep our community healthy. The concerns that I have relate to the cost compared to what you can get at a GP for a much cheaper price, which is not funded as much by the government, and this fragmentation of care,” he said.
“And then the other part is just around the workforce pressures. We’ve heard that they have been struggling to get workforce in in some of the locations and but we know already we’ve got a GP workforce shortage, and that’s one of the concerns that we have, that’s that this program is just going to overstretch an already stretched GP workforce.”
“There is also a risk these clinics are creating competition for an already stretched GP workforce.”
Another major concern raised by GPs has been the lack of communication between urgent care clinics and a patient’s usual GP, and the interim report had validated this as well, said Dr Wright.
“The report reveals that only 68% of patient presentations to urgent care clinics had an electronic discharge summary to their usual GP. This constitutes inadequate clinical handover; because without this information, a GP may not even know that their patient went to an urgent care clinic, let alone what health issue they were being treated for,” he said.
“Best practice clinical handover involves one health practitioner providing patient information to another, it’s much more than simply handing a patient a letter to give to their GP.
“If the transfer of care isn’t done properly and in a timely way, there is a risk of fragmenting care, which results in poorer patient health outcomes, including preventable hospitalisations.
“Proper clinical handover is particularly important for patients who have multiple, chronic health conditions that must be carefully monitored by a GP they know and trust.”
The RACGP president also reiterated concerns regarding GP workforce pressures.
Echoing concerns raised by rural doctors and their peak bodies about the appropriateness of UCCs in rural and remote areas, Dr Wright said these areas were feeling huge workforce pressures even without the challenge of properly resourcing and staffing a UCC.
“We’ve got such a broad range of practices providing all around the country, and there’s no one-size-fits-all,” he told TMR.
“That’s the challenge with some of these solutions, they don’t recognise that what works in Brisbane or Sydney or Melbourne, is different to what you need to have in Broken Hill.
“That’s where the college can help. We’ve been hearing stories from our members all around the country, and we can say, ‘look, this is our really high-quality care is being provided in this community – support us to do it’.”
