Medicare urgent care clinics are a walk-in service but many people, like Chloe*, more accurately hobble in.
When the primary school teacher rolled her ankle over the weekend and struggled on her feet at work all day on Monday, she knew she would not be able to get an appointment with her regular GP, who is always booked out three weeks in advance.
She thought her only other option was the emergency department until her mother suggested the local urgent care clinic in eastern Sydney, which she points out would have the X-ray services she needed.
Like most urgent care clinics, Marboubra’s looks a lot like a mini emergency department with bays where two registered nurses can monitor patients working alongside a registered GP and one nurse practitioner. Both doctors and nurses are required by the government’soperational guidanceto have further skills in urgent care and emergency medicine.
It is open seven days a week, 365 days a year, from 7am to 9pm.
The clinics are designed to provide faster care to patients, almost half of whom would otherwise would be waiting as a lower-priority presentation at emergency departments for problems such as fractures or eye injuries. A government report found46% of patients when surveyedsaid they would otherwise have gone to an emergency department, increasing to 49% after hours.
They also provide their fully bulk-billed care for issues that need to be seen to quickly but a GP isn’t available, often after hours or on weekends, such as when a woman has aurinary tract infection, a child has a high fever or vulnerable patients, such as those on immunosuppressants, have an illness that could quickly escalate.
The Albanese government has opened 87 urgent care clinics since 2023, with the health minister, Mark Butler, pointing out that similar clinics exist in the US, UK, New Zealand, France and Denmark.
If re-elected on Saturday, they have pledged$644m for an additional 50 clinicsto be rolled out, ensuring 80% of Australians would be within a 20-minute drive of one, according to Butler.
Anne Ruston, the shadow minister for health, said if the Coalition is elected on Saturday they will maintain all existing UCCs and deliver an unspecified number of new ones,locations for some of which have been announced.
Ruston said when it comes to the new clinics Labor has promised, “we are taking a considered, case-by-case approach to … to make sure they are best placed to deliver on their intended purpose”.
Maroubra’s UCC is one of the 30 Medicare urgent care clinics run by ForHealth, Australia’s largest bulk-billing general practice provider. Most of these UCCs are colocated next to the general practice and other health services.
Andrew Cohen, the chief executive of ForHealth, says 10 years ago general practice in Australia had more capacity to handle walk-in appointments for what’s known as episodic care – minor injuries or acute illness that doesn’t involve ongoing management.
But the inability to get a walk-in appointment at a GP practice any more has become a dual driver of need for urgent care clinics alongside taking pressure offdemand in emergency departments, Cohen says.
The government’s firstinterim report evaluating the programpointed to data that 46% of patients who saw a GP for urgent medical care self-reported that they waited for 24 hours or more, 41.7% were seen within four hours and 12.5% waited between four to 24 hours.
Butler has said the urgent care clinics have been a “gamechanger for communities” and the 1.3 million patients who have used the service. Reporting from hospitals that have an urgent care clinic in their catchment has shown there is “clearly” a reduction in semi-urgent and non-urgent ED presentations, Butler says, citing examples of reductions in the Logan hospital of 10%, in the Ipswich hospital in the order of 20%.
However, health economists have questioned the government’s expansion of the clinics in theabsence yet of any comprehensive long-term evidence that they are meeting their goalof reducing pressures on emergency departments as well as the selection of appropriate locations.
The interim report published in March found the average cost per urgent care centre presentation was $246.50, less than half the cost of the average avoided emergency department presentation of $616 – providing a net saving to governments of about $368 per presentation.
But Cohen argues that price per presentation will reduce as clinics scale up. He says they are already seeing more patient visits a day as awareness among the community for the new service grows, and the expansion workforce capacity that has been announced at 12 sites will also bring that cost down.
Dr John Adie, an associate professor in urgent care at the University of the Sunshine Coast, says he is excited about Australia embracing the model that has been operating in his own native New Zealand since the 1980s, which he says is one of the reasons they have one of the lowest rates of emergency department admissions in the world.
Adie says the model also makes financial sense but it is important to base decisions around the clinics on research – for example, there is a grey area where patients will use the walk-in service for convenience, such as seeking to get a script for medication.
In Australia, the government’s operational guidance requires all patients to be triaged to assess whether urgent care is required, so that clinics may refer patients to other health services as appropriate, including where their condition may be out of their scope.
Dr Sneha Wadhwani, an urgent care doctor and ForHealth’s clinical director in NSW, says “in urgent care, we have no interest in providing routine, general practice that isn’t urgent care on a regular basis. That’s not what we’re doing.”
Dr Charlotte Hespe, a GP and the head of general practice and primary care research at the University of Notre Dame, says although she has no problem with urgent care centres themselves, she does take issue with the logic behind them.
The problem they are set up to address is the overflowing emergency departments populated with people who cannot afford the out of pocket costs at the GP to receive regular primary care, Hespe says.
“I see it as outrageous that [the government] think it’s OK to fund an urgent care centre which removes people out of continuity of care, general practice, prevention.”
Cohen says the safety net Medicare is supposed to provide is “collapsing” but the crisis is not universal – it is playing out in outer metro and regional areas.
At ForHealth, “we’re trying to repair that through episodic access [through urgent care clinics] and we’re trying to repair that through a return to historical levels of bulk billing”, he says.
In addition to urgent care funding, Medicare will receive a$8.5bn funding boostto triple the bulk-billing incentive to all Australians as well as adding a new 12.5% loading payment on rebates for practices that only bulk-bill.
Cohen says the bipartisan commitment has allowed ForHealth to expand its bulk-billing network nationwide. While currently only one in 10 of their practices are bulk-billing only, they expect that number to rise to six in every 10 from November.
Cohen says none of the investments in urgent care take away from general practice. “In all these policies, there are no losers, but there are parts of the sector that we would call failed markets that are now viable, sustainable, more attractive to GPs – that’s bulk billing, women’s health, outer metro and regional health. These are the winners in the mix and they need it.”
- First name only requested for privacy reasons