Here are the questions that the AMA and RACGP want the incoming urgent care centre audit to answer.
Are UCCs cheaper to run than emergency departments? What about general practices?
Those are the two top questions that the RACGP and AMA have submitted to the Australian National Audit Office performance audit of the award of funding for Medicare urgent care clinics.
The audit, which is not due to table until March next year, will only be examining three specific facets of the UCC program: whether the Department of Health, Disability and Ageing appropriately established it, whether DoHDA effectively developed and managed grant funding and whether DoHDA effectively developed and managed federation funding agreements with states and territories.
In short, it won’t comment on the merits of government policy, but it will assess whether the implementation of that policy was efficient and whether it will achieve the intended benefits.
While the audit criteria are set, the ANAO is also open to submissions. So far, both the AMA and RACGP have published theirs.
The RACGP’s asks
The royal college of GPs said it “surmises” that concerns about potential mistakes made during the establishment of UCCs were still widespread amongst its members.
“Specialist GPs argue that services provided by UCCs could be more efficiently delivered through local general practices if adequate funding and support were available,” the college wrote.
“While UCCs now have a role within the health system, their integration with broader care pathways and long-term cost-effectiveness require ongoing evaluation.
“Government pressure to establish services at pace has not been matched by adequate governance arrangements, creating risks to patient safety and placing unsustainable demands on the workforce.”
More broadly, the RACGP recommended embedding greater consistency, accountability and quality across the UCC program and to implement forthcoming RACGP-developed standards.
College president Dr Michael Wright told The Medical Republic that the college was continuing to engage constructively with governments and that the standards form part of this work.
“The concerns detailed in our submission primarily relate to the initial planning, governance and implementation of Medicare Urgent Care Clinics as they were established at pace,” he said.
The college also questioned the geographic placement of UCCs.
“It appears a disproportionate number of UCCs have been established in Labor-held electorates (approximately two thirds of UCCs),” the RACGP submission said.
“Similar questions have been asked regarding the number of UCCs established in marginal seats.
“Given the lack of transparency regarding commissioning decisions, it is difficult to view the chosen locations objectively.
“The RACGP recommends the ANAO audit the chosen locations and independently assess these locations against locally determined need. All communities deserve equitable access to high-quality urgent care.”
What the AMA wants
In its submission to the ANAO, the AMA said it wanted clarification “that Medicare UCCs provide GP-led, short-term care for urgent, non-life-threatening conditions that require timely assessment, while preserving usual general practice as the preferred setting for routine, ongoing and after-hours care”.
UCCs, it said, should be more than a “publicly subsidised walk-in substitute” for GP care.
The association also pointed to perceived shortcomings identified by the interim UCC evaluation.
“Claims of ED avoidance should rely on linked service-use data, including transfers and subsequent ED presentations, rather than patient-reported intentions about where they would otherwise have sought care,” the association wrote.
“The AMA argues Medicare UCC attendance figures, or reductions in Category 4 and 5 presentations, cannot by themselves demonstrate reduced hospital pressure.
“The program evaluation should assess whether care substitution improves patient access or transfers activity into a more highly subsidised and less continuous model.”
It also argued that the cost-effectiveness of UCCs had never been adequately investigated.
“The current comparison is incomplete because it tests Medicare UCC care against ED care,” the AMA said.
“The Second Interim Evaluation report estimated federal funding at about $206 per Medicare UCC presentation and about $236 per presentation assessed as avoiding an urgent care-equivalent ED visit.
“When compared with the estimated $617 for equivalent ED care, these figures indicate a significant cost saving. However, they do not fully answer the value-for-money question.
“A robust assessment must add a third comparator: equivalent urgent or after-hours care delivered through community general practice. This would show whether Medicare UCCs represent better public value than strengthening existing general practice capacity, not merely whether they cost less than an ED presentation.”
AMA president Dr Danielle McMullen told TMR that ANAO audits were an important process to assess value for taxpayer funding.
“The government has committed billions of dollars to urgent care clinics, and so it’s really reasonable to ask whether that investment is delivering the outcomes promised,” she said.
“And I think we do need to be clearer on what those expected outcomes are, and be more transparent and accountable for those.”
