The ACT has gone its own way, ignoring advice from the national doctor peak bodies, much to the delight of nurses.
The federal government’s decision to merge five Medicare urgent care clinics in the ACT with existing Canberra Health Services nurse-led walk-in centres has drawn fire from both the AMA and the RACGP, who called the plan a “slap in the face for GPs”.
The MUCCs will be integrated with walk-in centres at Gungahlin, Belconnen, Dickson, Weston Creek and Tuggeranong.
Funding – jointly supplied by the DoHAC and the ACT government – will be provided for three new nurse practitioners, three new advance practice nurses, and an “advanced scope” physiotherapist at Weston Creek to treat patients with musculoskeletal injuries. The physiotherapist will also provide virtual assessments and support for nursing staff in other walk-in centres.
Also funded will be a radiographer and sonographer for the Weston Creek Medical Imaging Service to extend the service to provide after-hours imaging.
Although the announcement from Health Minister Mark Butler said the integration of the MUCCs into the walk-in centres was effective “from today”, his department’s press release also said “Canberra Health Services has commenced the recruitment of new staff and purchase of new equipment [and] it is expected the full scope of additional services will be available from early 2024”.
The RACGP said the move “cheated Canberrans with urgent care clinics that are not staffed by specialist GPs or doctors” and didn’t meet the federal government’s own minimum staffing requirements.
“Today’s announcement was frankly another slap in the face for ACT GPs and Canberrans. Canberra’s hospitals have the worst wait times in the country, and unfortunately Chief Minister Andrew Barr has shown yet again that he doesn’t understand how to fix the problem, or how the health system works,” said Dr Nicole Higgins, president of the RACGP.
“Every other state in Australia has rolled out urgent care clinics staffed by highly trained GPs and nurses working together collaboratively to provide high-quality emergency care to patients.
“Many are built within existing general practices, which strengthens existing community health services, and avoids duplication and wastage of public funds. This approach is in line with the federal government’s reforms to strengthen primary care, and support multidisciplinary care with GPs, nurses, and allied health, working in teams at the top of their scope, to provide the best care possible,” she said.
“But here in the ACT, there won’t be a single GP working in an urgent care clinic under Andrew Barr’s rollout, and Canberrans won’t be able to access an urgent care clinic within the general practice they know and love. Canberrans have been cheated.
“The best value model of urgent care for patients and government health budgets is GPs working collaboratively with nurses. General practice UCCs are more efficient and equipped to provide a wider range of services to patients, so it’s more likely they’ll be treated on the spot, and won’t need to be referred on to the hospital emergency department.
“When GPs are left out, it inevitably leads to inefficiencies, duplication of care, and higher costs. The evidence shows UCCs without GPs not only put more pressure on hospitals, they also put more pressure on general practice because patients are often referred to GPs because they can treat a wider range of urgent care issues,” said Dr Higgins.
“Ultimately, this will leave Canberrans waiting longer in the emergency department, or to see their GP.”
AMA president Professor Steve Robson was equally scathing of the ACT MUCCs plan, saying the consultation process conducted by ACT Health in the lead-up to the decision had been “woeful” and the concerns of local GPs had been ignored.
“What we have is an ACT government driven rebranding of existing centres led by nurse practitioners, which doesn’t align with the federal government’s own policy of these centres being led by GPs working collaboratively with other health professionals,” said Professor Robson.
“This clearly reflects the ACT government’s ideological need to market its nurse practitioner-led network of clinics despite the only available evaluation of these showing they are expensive and do not alleviate pressure on emergency departments.”
Dr Kerry Aust, AMA ACT’s president-elect, said the plan was “extraordinarily disappointing”, with input from the AMA ignored and local GPs written out of the model.
“ACT AMA previously expressed the view that the ACT government’s model was being presented as a done deal and not one that would be developed in consultation with local GPs, and that’s exactly what’s happened,” she said.
“This is despite Operational Guidance making it clear that these clinics were intended to be GP-led, with GPs working in collaboration with other health professionals to deliver high quality services to patients. It appears the ACT Government has very little understanding of the role and importance of general practice.”
On the other hand, the Australian Primary Health Care Nurses Association (APNA) was delighted with the ACT MUCC plan, saying the decision “recognises the success of the walk-in centres since 2010”.
“These clinics are an example of nurse skills being used effectively to improve access to timely care in conjunction with other ACT health services,” said APNA president Karen Booth.
The ACT walk-in centres have been part of the ACT Health system since 2010. Operating between 7.30am and 10pm 365 days a year, they provide around 70,000 occasions of care annually. Expanding the model of care to include allied health “responds to contemporary research which identifies multidisciplinary teams as being able to provide excellent patient care”, according to APNA.
The clinics are jointly funded, with the Commonwealth providing $7.1 million over three years to the ACT Government.
“We know that Canberrans have embraced the nurse-led walk-in centres across the ACT, and that’s helping take pressure off our two emergency departments,” said Senator Katy Gallagher.
“Thanks to funding from the Albanese government, these centres will soon have more staff and be able to treat a wider range of conditions. Canberra families are under pressure with the rising cost of living, and it will be a relief for them to know that treatment at these centres will continue to be free.”
ACT Chief Minister Andrew Barr said: “The extension of services to be offered at the Weston Creek walk-in centre will see Canberrans able to receive assessment, medical imaging, and treatment for a minor injury all in the same location, without the need to go to the hospital.
“We will continue to work closely with community-based health services, including general practitioners, to ensure we are delivering an integrated health system where Canberrans can access the right care in the right place and at the right time.”