Urgent care centres a bridge too far for GPs

Tender documents obtained by TMR show that setting up a UCC may stretch interested practices to the limit.

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While GPs and practices in Tasmania can now apply to be considered for setting up an urgent care centre (UCC) under the federal government program, for many it will be out of reach.

Funding, the cost of equipment, and the question of where staff will come from are just three of the concerns raised – with the federal government having offered scant detail about how the clinics will operate. The RACGP has also suggested the timeline for setting up the clinics in Tasmania is too ambitious.

The federal government began seeking EOIs from general practices, via Tasmania’s health department, on 24 December 2022, with the submission period set to end on 1 February 2023. It intends for the clinics to be operational by 1 July 2023.

The Commonwealth and states have developed guidance that lays out the minimum standards for activity, infrastructure and staffing. According to the guidance, each clinic should:

• be open for extended hours, seven days a week – at a minimum, 8am to 8pm, Monday to Sunday, and on public holidays
• have an X-ray facility on site or easily accessible across all hours of operation
• have timely access to ultrasound and CT across the majority of hours of operation
• have timely access to laboratory-based pathology
• include a designated area for ambulances to stop and obtain ready access to the UCC
• be equipped with appropriate equipment and medications for diagnosis and treatment

The government hopes to establish UCCs in three areas judged to have the most urgent needs: the corridor along the north-east Tamar, the Southern region (Glenorchy) and the north-west region (Devonport and Latrobe).

Applicants lodge EOI applications via the Tasmanian government’s tender site at www.tenders.tas.gov.au which will be assessed by representatives from the Tasmanian health department and Primary Health Tasmania.

Interest is being sought from general practices “either individually or in innovative partnership with other primary care providers, that may have the capacity and capability to operate a UCC”.

While the federal government has committed $135 million nationally over four years to support the UCCs initiative, it’s yet to confirm funding allocation by jurisdiction, saying it intends to provide that information later this month.

UCC operators will automatically be eligible for an exemption from section 19(2) of the Health Insurance Act which prohibits MBS rebates where other government funding is provided for that service. The exemption will allow clinics to receive federal government block funding and MBS payments. However, specific conditions of the exemption are still under development.

However, Launceston-based Dr Toby Gardner, who runs his own urgent care centre, has concerns about the likely funding of the federal UCCs.

“We’ve looked at the numbers and we’ll probably put in an EOI just to see what they come back with, but realistically our biggest issue is that the funding looks like it’s not enough,” Dr Gardner said. “If they want to have a fully operational, fully bulk-billed urgent care service, then financially it’s not going to stack up for us compared with the current operation we’re running. We’d lose revenue by taking on that grant in its current state.”

He also has concerns about some of the required equipment.

“The reason we started out is because we actually already had X-ray on site, which is a huge cost, and we need that on site all the time,” he said. “Without that, we wouldn’t have started the whole centre.”

Dr Gardner’s clinic bills privately but with government-funded support and he believes the model works well.

“We have the staff and everyone here and the systems and everything in place so it would be a no brainer for us to continue what we’re doing,” he said. “The public have lapped it up, we’ve got a sort of hybrid private and state-funded model where the state government funds concession cardholders up to six o’clock on a weekday, and all day on the weekend.

“That’s something we lobbied the state for to try and help protect our emergency department and it’s worked really well. We’ve got numbers that are manageable but if it became a fully bulk-billed service, what would stop all these people just landing up on our doorstep, just like they do in emergency? We just wouldn’t be able to cope.”

Dr Gardner should know what he’s talking about. He is part of a group of people and clinicians interested in urgent care and led by Dr John Adie, Australian convenor of the Royal New Zealand College of Urgent Care.

Dr Adie has worked in large and small rural and urban general practices, as well as urgent care centres and EDs. His current role with Healius Medical & Dental Centres is to help establish the GP sub-specialty of urgent care in Australia.

However, Dr Gardner fears GP practices that are interested in setting up a UCC but lack his team’s experience may well struggle.

“I can’t see it being feasible,” he said. “There just hasn’t been enough information – most people don’t know how to do it. Of course, we had all the usual teething issues and it took so long to develop a core group of clinical doctors who could commit to a roster because, of course, now we’ll be working seven days a week. It’s a hard sell, trying to convince GPs who get into general practice because they don’t want to work on weekends.

“We’ve managed to get a group of us, and there’s a critical mass that you need, but of course that takes people away from general practice and we don’t have enough GPs. We’ve got a big general practice with 28 GPs so that works well in that we can use GPS from the practice and if we get surges in numbers we can take a GP off the floor to do emergency care for a little bit. The booked patients might have to wait a little bit longer, but that’s the way we manage it.

“But I can’t imagine setting up [a UCC] on a greenfield site with a small practice.”

Meanwhile, the RACGP’s Tasmanian chair, Dr Tim Jackson, also has concerns about the government’s claim the clinics will be up and running by 1 July.

“That is a short time period to try and get all this turned around,” he told TMR. “I think it will mean the clinics are more likely to come from existing general practices that extend their services. That’s probably not a bad thing as far as the RACGP is concerned because we don’t want something that fragments and steals a workforce from general practice more generally.”

The AMA, however, remains opposed to the whole idea of the UCCs

“The AMA’s position on UCCs is clear,” said AMA president Professor Steve Robson. “UCCs are unlikely to reduce pressure on emergency departments because much of the bed-block within emergency departments is due to patients waiting to be admitted, but are unable to because there is no available inpatient bed.

“UCCs are also likely to further fragment care as patients will not see their usual general practice and this may result in sustainability issues for general practices as they try to compete with the urgent care centres.

“If urgent care centres are to be established, they must use existing general practice infrastructure as opposed to establishing new community-based or hospital-based services. This will ensure these centres do not compete with general practices and prevent general practitioners being taken out of their community where they are needed.”

UCCs will likely need a roster system to operate successfully, which raises the question of payroll tax for rostered doctors considered to be employees.

At the moment, Dr Gardner does not pay payroll tax for doctors during their GP hours but he pays a payroll tax percentage on billings and an hourly wage and super when they work in urgent care.

If payroll tax provisions like those recently passed in Queensland emerge in other states, then for medical practices that have to pay payroll tax, this could be up to 5% of income generated, said Dr Jackson.

“This will then have to be passed on to patients, which will mean there’ll be more and more out-of-pocket costs and less bulk-billing,” he said.