They’re not the political distraction and complete waste of money that some have made out.
A few weeks ago I began working a day or two a week in the local urgent care centres around where I live.
My main reason? So I don’t forget how to be a doctor since I stopped doing the FIFO emergency locums a year or so ago and a large part of my practice now is in skin cancer work.
While the government’s interim report suggests that UCCs are five times more expensive than a patient seeing their own GP – a figure leaped on by the RACGP and other detractors – it’s not quite as clear-cut a waste as that suggests.
Not every UCC visit is a tricked-up general practice consult. Some of them are replacing emergency visits, and while attending a UCC costs on average $246 for a consult, the same episode in ED would cost more than double that at ~ $600.
From the GP perspective, I’ll be the first to say I’d rather my patients be able to access me, or another GP in my practice, for their ongoing and urgent medical needs. Continuity of care is one of the cornerstones of good medicine, especially in general practice.
But with the erosion of funding in general practice, coupled with hours of unpaid administrative work each shift, it’s common for GPs to move across to ED work, leave general practice for salaried roles and even to retrain in another speciality.
As with my shifts in ED, where I witnessed firsthand waste and inefficient time management – which is part and parcel of working in hospitals – there is no doubt waste in the UCC model.
The “free” healthcare at point of service is funded in reality by a reported government grant of $1 million per UCC to enable bulk billing of all patients who show up. Many medications are provided for free, as are emergency supplies and consumables, similar to fast track in ED.
At the same time, it is incorrect to suggest, as many do, that the UCC simply replaces access to your local GP or that their existence encourages patients to bypass their GP.
The rules are quite restrictive. In the exclusion criteria it’s clearly stated that UCCs are not intended for non-urgent presentations, nor routine scripts and similar endeavours. Doctors are not to order any tests that need further follow-up that is not urgent – an MSU cc-ed to their local GP for follow-up is okay, but not vitamin D levels.
What does this mean in reality, especially if the UCC is co-located within a mixed billing practice?
In my experience it means that we turn away people who are presenting for routine scripts that are not urgent.
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It means that we say no to people requesting a medical certificate they need from their GP. It means that we encourage them to return to their GP and provide a bridging script if needed for one to two days.
So, graphics like this one on LinkedIn that suggests that using the UCC for “sore throat” or “runny nose” or “can’t see your regular GP for a week and have run out of a script” aren’t entirely accurate.
Every local UCC will amend their criteria slightly to suit their local demographic.
Do I feel guilty as a GP working in UCC? Yes.
Did I feel guilty as a GP working in ED? Also yes.
Is it the best use of funding that could be diverted to regular general practice by way of raising patient rebates to lower the gap fee?
No.
And at the same time …
It is an alternative for people who either will not or cannot afford to pay to see a GP who needs to charge a gap and still get decent care for urgent issues.
It is also an alternative for GPs like me and others who are burnt out, or simply need to work on an ad hoc basis thanks to their personal circumstances.
Do we simply leave general practice, or do we aim to provide good care on an urgent basis to those who cannot or will not be able to afford to see us and pay for the services?
The money will be spent regardless, and this may end up being like the outpatient clinic equivalent for other specialities in public hospitals, where people can seek care if they cannot or will not see a private non-GP specialist.
Is it ideal care? No.
Do I still miss the continuity of care of having my own regular patients with whom I have a long-term relationship? Of course.
At the same time, given my current circumstances, I am glad to have the opportunity to be able to provide good GP care to people, even if it’s episodic.
Yes, in an ideal world, we’d all have patient rebates that are adequate and allow us GPs not only to work with healthier margins but also work longer hours such that we can provide urgent care to our own patients as and when needed, including after 8pm and on weekends.
Until that happens – which at present is a distant dream – this is a viable alternative with care provided by GPs, instead of GP alternatives. At least people are seen by doctors who have still undergone and successfully completed RACGP training.
In a less-than-ideal world, this is still a better alternative than many others out there.
Dr Imaan Joshi is a Sydney GP; she tweets @imaanjoshi.
