In a disappointing (but not necessarily surprising) turn of events, nurse practitioner-led walk-in clinics cost almost double what the ACT government had claimed.
Canberra’s nurse-led clinics cost an average of $194 per presentation in 2023, a far cry from the territory’s initial claim of less than $110 per consult.
The disparity, which stemmed from a decision not to include overhead costs in the initial calculation, was revealed this week by the Canberra Times alongside a slew of emails released under freedom of information laws.
Even without the overhead costs added in, Canberra Health admitted that the average cost per service was actually closer to $128, almost $20 more than previous estimates.
Of course, the news that these walk-in clinics cost taxpayers roughly five times the Medicare rebate for a regular level b consult did not come as a shock to many GPs.
Of course. We all knew it. https://t.co/VDM4DDuHip
— Adj Prof Karen Price, 20-22 RACGP Past Prez (@brookmanknight) June 17, 2024
To be clear, the Canberra nurse walk-in clinics predate the federal government’s Medicare Urgent Care Clinics.
The ACT never opened GP-led clinics as part of the nationwide UCC rollout, and instead used the money to increase the number of nurse practitioners across the existing centres and employ physiotherapists.
Unbelievably, $194 per visit is actually a steal; rough calculations published in The Australian earlier this year pegged the cost-per-consult price at around $285 across the newly rolled out Medicare urgent care clinics.
The thing is, it’s hard to know what the cost per visit for these clinics is meant to be because there have been no robust independent evaluations to find out.
The nurse-led Canberra model has been evaluated once. That was at the initial trial site in 2011.
At that time, the cost was determined to be $196 per visit.
The federal government won’t be delivering an evaluation of the Medicare urgent care clinics until 2026.
Related
Regardless of whether the real price-per-visit to an urgent care clinic is $110 or $194 or $285, we do know one thing for sure – that it’s far more expensive to the taxpayer than seeing a GP.
Part of the reason the ACT decided not to employ GPs for their walk-in clinics was that there was a relatively smaller pool of GPs in the territory compared to other jurisdictions.
“Part of the issue is that we can’t magic-up GPs,” former Department of Health and Aged Care first assistant secretary Simon Cotterell told a senate estimates committee last year.
“They need to be already here in order to operate the Medicare-based urgent care clinics.”
GP researcher Professor Louise Stone told The Medical Republic that the biggest risk with nurse-led models was diagnosis.
“Look, 99% of kids with cough and cold symptoms and a bit of a fever will have a cough or a cold and one of them will have meningitis,” she said.
“And … I think we’re underestimating that diagnostic complexity, which is a GP superpower.
“Nurses are amazing when it comes to management … but when you take on undifferentiated people and don’t include a doctor on your staff, then you’re missing that piece of the equation.”
As for whether the dearth of GPs in the territory is enough to justify an entirely nurse-led clinic model, Professor Stone pointed out that GPs were not the only health profession in shortage.
“It’s not like we’re overloaded with nurses and they’ve got nothing to do,” she said.
“We are short of nurses, we are short of physios, we are short of GPs – we’re short of everyone, and we have limited resources.
“In my view, the job of a government is to work out the most effective and efficient deployment of those resources, and that’s not nurse-led clinics.”
