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Doctors urge Government to think again on nurse-led walk-in centres

By Ian Bushnell - 8 August 2017 14
ACT Health Minister Meegan Fitzharris

ACT Health Minister Meegan Fitzharris at one of the ACT’s nurse-led walk-in centres. She is being urged to reconsider opening a new centre in Gungahlin.

The AMA is urging the ACT Government to consider alternatives to its popular nurse-led walk-in centres before pressing on with plans to establish more of them in the boom suburbs of Gungahlin and Weston Creek/Molonglo.

The move comes as the centres come under fire from a Canberra doctor who claims the cost and patient numbers do not justify the coming expansion of the program to Gungahlin.

Dr Thinus van Rensburg has been conducting a running battle with Health Minister Meegan Fitzharris and in an open letter accuses her of “spending millions of dollars from a limited tax resource on an unproven and un-needed venture’’.

AMA ACT branch CEO Peter Somerville agrees, saying the centres are a colossal waste of money but concedes that the established centres in Belconnen and Tuggeranong  are here to stay.

“We’ve been talking to the government about what problem it is they’re trying to solve,” he said.

This year’s ACT Budget committed $14 million over five years to a new centre connected to the Gungahlin Community Health Centre and a scoping study in Weston Creek. Construction of the new centre in Gungahlin is due to start early next year and be open by mid-2018.

However, the AMA was continuing to argue that there were cheaper and more effective alternatives to the present model that could be adopted and the Government should not charge ahead in Gungahlin.

Mr Somerville said that at more than $200 occasion of service, the walk-in centres were significantly more expensive than a GP and the low-level work being done did not alleviate pressures on hospital emergency departments.

“We do understand that in Canberra a lot of people say they have difficulties finding a GP or finding a bulkbilling GP,’’ Mr Somerville said.

But it was a complex matter and there were no circumstances where 100 per cent of patients were not bulk-billed, he said.

“Most practices bulk-bill young families, concession card holders, and older people,’’ Mr Somerville said. “GPs make adjustments for that.’’

Mr Somervile said one suggestion from the AMA was to integrate the walk-in model and its nursing resources into general practice through a tender system.

“GPs could bid for these additional resources on the basis that you’ll  locate in a certain part of the ACT like Molonglo or if they are already in existence and close to it,’’ he said.

GPs would commit to extended hours and open on a walk-in basis, with the nurse treating patients or triaging them through to the doctor.

“Here’s a way to integrate those nursing skills into that general practice, and many already have those nursing resources,’’ Mr Somerville said.

He said Capital Health Network was also conducting projects about how nursing resources could be integrated into primary care.

Dr van Rensburg says in his letter that the Gungahlin centre would be within walking distance of about a dozen existing GP clinics that are mixed billing or fully bulkbilling and have daily openings for patients.

He says the Minister’s response that presentations to the walk-in centres continued to increase was unsupported and called for more evidence.

“The Quarterly ACT Public Health Services report  showed in 2015-6 that  ED presentations continued to increase every single year  and that the two walk-in centres  saw an average of about 2600 patient combined each month,  averaging only three patients per hour at each site,” Dr van Rensburg says.

“One in five patients were seen with colds and 1000 people had their earwax seen to.

“We have no information regarding current costs and efficiency measures but there is no reason to not believe that these two clinics are every bit as inefficient as the 2011 review showed – and still only sees the equivalent of what three to four fully qualified GPs could easily do in a normal working day.’’

A spokesperson for the Minister said there had not been any further formal evaluation of the walk-in centres since 2011 when the Australian Primary Health Care Research Institute completed an independent evaluation, but performance was continually monitored by ACT Health, including presentations, costs and a range of quality and safety indicators.

Mr Somerville said the AMA would continue talking to the Minister but it appeared the Government was politically wedded to the model.

“We urge the Government: you’ve already spent enough money on this, it’s significantly costly please consider alternatives.”

The Minister’s spokesperson said the walk-in centres  were a genuine alternative to EDs for people with minor illness or injury particularly with their extended opening hours and availability on weekends and public holidays.

People with serious or complex care needs were advised to still seek medical care from a GP or the ED.

The spokesperson said walk-in centres provided a no-cost service in a market that had the lowest bulk billing rates in Australia and were important to support the health needs of disadvantaged Canberrans, as well as provide health care after hours and on weekends, when there were very limited alternative options available.

Walk-in centres aimed to complement GP services by providing referrals and updates back to a patient’s GP or specialist for the patient’s ongoing care.

The spokesperson said that the Minister had spoken with a range of stakeholders and was aware that some doctors had raised issues with the  model since its inception. She would continue to have discussions, including with the AMA, and  is open to suggestions on how the model could be improved, the spokesperson said.

ACT Health and Capital Health Network is organising an information forum at the Gungahlin Health Centre on 31 August and will soon invite local health providers to attend.

Have you been treated at a nurse-led walk-in centre? Do you think they do a good job and are worth the cost to the taxpayer?

What’s Your opinion?


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14 Responses to
Doctors urge Government to think again on nurse-led walk-in centres
TimboinOz 3:59 pm 12 Aug 17

““Most practices bulk-bill young families, concession card holders, and older people,’’ Mr Somerville said. “GPs make adjustments for that.’’

Well, Mr. Somerville, my otherwise excellent practice makes adjustments, but they do NOT bulk-bill. My wife and I are concession card holders and we have hit the safety-net threshold, to boot!

Ian said :

I think its a legitimate concern too. Why spend $200 a patient to replace a service that can be bought elsewhere for $37. Even if the availability of the service at $37 is limited, I dare say there’s plenty of room between $37 and $200 to meet the demand effectively.

Please tell me where I can see a Dr in Canberra for $37.

ChrisinTurner 10:18 am 11 Aug 17

And I thought my GP at $85 per visit was expensive! $200 a visit is ridiculous when we are struggling to pay for putting steel wheels on our public transport. Between FY17 and FY18 the ACT government is cutting “General Public Services” by $97Million(16%). Is this to pay for the tram or for nurse walk-ins?

bikhet 3:39 pm 10 Aug 17

sputnik said :

Begs the questions: How do GPs make it profitable? Or the other way around, is the infrastructure/maintenance cost of the walk-in clinics way too high? Or are the walk-in clinics (the ones that resulted in that $200 number) underutilised compared to GPs? (time/patient, number of patients per day)

Having a service provided by the Government almost guarantees the headline costs will be greater than for a service provided by the private sector. Not always the case when you take quality of service and hidden costs into account though.

sputnik 10:33 am 10 Aug 17

http://files.aphcri.anu.edu.au/research/act_health_walk-in_centre_report_final_v2a.pdf (last chapter)
Seems true that the numbers do not stack up at all for a walk-in clinic to replace/help GPs. It only really makes financial sense when its purpose is to relieve the EDs of the hospitals.

But in all fairness, it’s a bit like a comparison between buying and renting a house.
The walk-in clinics are owned by “us” and a large chunk of the costs are for infrastructure.
The GP costs are basically hire costs to the government.

Begs the questions:
How do GPs make it profitable?
Or the other way around, is the infrastructure/maintenance cost of the walk-in clinics way too high?
Or are the walk-in clinics (the ones that resulted in that $200 number) underutilised compared to GPs? (time/patient, number of patients per day)

Garfield 9:16 am 10 Aug 17

Whenever I think about the walk in clinics I come to the conclusion that they would have to be more effective with a doctor backing up the nurses. There are some things that nurses just can’t do and having a doctor there could reduce the number of people who have to be referred on to the hospital. That would reduce the pressure on emergency and save those patients the extra trip and wait.

Ian 9:56 pm 09 Aug 17

I think its a legitimate concern too. Why spend $200 a patient to replace a service that can be bought elsewhere for $37. Even if the availability of the service at $37 is limited, I dare say there’s plenty of room between $37 and $200 to meet the demand effectively.

miffed 7:06 pm 09 Aug 17

The concerns are not a turfwar issue. It is a legitimate concern about $200 of ACT tax resources being spent to provide a restricted service,in most cases during normal business hours, when a more comprehensive Medicare funded service is available for $37 to the taxpayer.
It is not free to taxpayers
Also keep in mind the broken hospital phones and lack of access to basic surget such as tonsillectomies and then consider if this is a good use of your and my taxes

dungfungus 9:50 am 09 Aug 17

Indeed the main purpose of the first walk in clinic at TCH was to relieve the burden being experienced on the nearby ED and it worked well for a while. The feedback I got was that it interfered with the management lines within the TCH system and it eventually became another waiting room for the ED.

I believe Mr Somerville’s proposal has a lot of merit but the power brokers in the ACT Health system won’t let it happen.

emd 6:25 pm 08 Aug 17

Oh and I like that they are open outside normal working hours. Must be very helpful for students or people who work full time on minimum wage, or just for families like mine where kids get sick or have minor accidents on the weekend and you’re not sure if it can wait til Monday for a GP.

No_Nose 6:23 pm 08 Aug 17

Affirmative Action Man said :

Just like lawyers want to control every aspect of the legal system doctors want to control every aspect of the health system.

They certainly kicked up a stink about pharmacists doing medical certificates for a day off work for a minor cold.

I know what I need and so does a pharmacist, I certainly don’t need a doctor to certify that I need to rest and keep my fluids up. If it lasts longer than two days then its time to see a doctor.

emd 6:21 pm 08 Aug 17

I’ve used the walk in clinics for everything from “do you think this is a fracture that needs a trip to x-ray or just a bad sprain?” to “does this kid have an ear infection?” to “I think I have something viral, how can I manage the symptoms til it passes?” And they have been great every time.

Able to deal with minor stuff that couldn’t wait days to see a GP, or provide advice that some GPs don’t bother with (at times when I had a GP that just liked to write prescriptions when I knew it was not bacterial).

The only reason I don’t go more often now is because they moved the clinic across town. Just last week I waited til after midnight at Emergency to check if a kid needed stitches – had there been a walk-in clinic open in my area, I would have seen them instead (and if they said it needed an Emergency doctor, at least I’d know I wasn’t wasting my time with the long wait at hospital).

Affirmative Action M 5:32 pm 08 Aug 17

Just like lawyers want to control every aspect of the legal system doctors want to control every aspect of the health system.

The AMA should work on why some specialists charge more than twice the recommended fee for procedures or finding out why it takes so long to deregister incompetent medicos or why the public can’t access information on the success rate of various procedures so they can compare & make more informed decisions.

Catanat 10:09 am 08 Aug 17

I went to the walk-in centre at Tuggeranong recently when I couldn’t get in to see my GP for something that needed to be treated quickly. I tried to see a doctor at a few other practices but their books were closed. The nurses and nurse practitioner were professional, friendly and informative and they sent the details of my visit to my GP so I could follow up with her a couple of days later. I wouldn’t hesitate to use them again – they were wonderful!
I’ve also taken my children to the walk-in centre at Woden, again because we couldn’t get an appointment at short notice with our GP. I was surprised when it was closed – on the occasions we used it, it seemed to be quite busy.
Not all doctors bulk-bill – mine certainly doesn’t for children’s appointments. If you need an appointment quickly with your own doctor, it can be difficult/impossible to get one and you can’t always wait for ages at a bulk-billing medical centre.
If you can’t afford an appointment with a GP for a minor issue, then the walk-in centre is a great alternative for primary health care.
Though I’ve only used them a few times over the years, I’ve found the walk-in centres to be very useful.
If there’s a better solution, I’d like the AMA to clearly outline what it would be and how it would work before this model is abandoned.
If we’re going to keep the walk-in centres, then perhaps the ACT Government / ACT Health could do more to ensure people know about the centres and how best to make use of them.

miz 10:06 am 08 Aug 17

Surprise! Drs don’t like walk in centres! Because of course they are seen as competition, and, god forbid, from nurse practitioners (not Drs)!
However I have found walk in centres great. The only drawback is their limited scope. If they could do something about that, that would greatly improve their contribution to the health network.
Oh and they should also look at parking vouchers for attendees – it is daft to have a free service but then you are hit up for parking there (noting that parking is free at the hospital).

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