20 November 2017

In praise of the Nurse-led Walk in Centres!

| JessP
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Nurse walk-in-centresI read with some concern the article in the CT over the weekend, with the expansion of the Walk in Centres (WIC) being ‘slammed by GPs’.

Please ACT Government, do not close the WIC!

Anyone with a bog standard cold, minor illness and perhaps in need of a medical certificate, appreciates the WIC as a fast and convenient service providing quality advice. I have had a more thorough review and examination by a WIC nurse than 90% of my visits to my GP. I find that the nurse advice is a lot more thorough and to the point. The last time I saw my GP for a bad cold he barely looked at me other than to ask a couple of basic questions, then he told me to rest and take paracetamol… this was after a 70 minute wait! I was barely in his office for 5 minutes. That will be $75.00, thanks.

The Nurse practitioner asked thorough questions, did my BP, listened to my chest and heart, checked my throat and ears and made me feel confident of the advice provided.

I accept that if I have a more major problem (or on the recommendation of the nurse), I should/will see a GP, but for a minor problem, paying $75 to see a GP is not an option! Yes, there is the Medicare rebate but the cost is still there.

How about instead of Doctors whining that the WIC are a waste of resources, they recommend low-level consultations to them by advising patients of the option? So that they can spend more time on the patients who actually need them.

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The reason it is so difficult to get an appointment with a G.P. is because doctors are rejecting this difficult specialty as being vastly underfunded compared to other specialties. They are voting with their feet.
Can a nurse do what a G.P. does? There are certainly some tasks where they are as good, or better. (Dressings, Spirometry, B.P. checks).
Yet, complex diagnoses and multi-factorial illness often lurks beneath the surface of even a simple presentation.
This is what G.P.s are specialised in recognising. Nurse training does not equate to medical training and G.P. specialty training. Diagnoses will be missed by these nurse clinics at higher rates and a far higher cost than a G.P. visit. The patient receives a taxpayer-funded Medicare rebate for a G.P. to assess them and sort them out- not to have a 25 minute B.P. and throat check, a chin wag and a cup of coffee.
If you want that, then pay for it privately without Medicare’s involvement.

Regarding minor illnesses, some of them do turn out to be something more serious. This is when the specialty of primary care (traditionally known as general practice) comes into its own.
You went to a G.P., were assessed quickly and efficiently and you did not turn out to have a life-shortening illness. Good for you.
You paid $75 but you conveniently neglected to mention that you got the Medicare rebate of $37 and some change. So for just over $37, you were assessed for a big standard cold and sent home. Compare that to any other medical specialty and you may realise the bargain you got.

JessP: Why should the taxpayer be expected to fund any consultation which has been made purely to satisfy the bureaucratic requirements of employers such as happens when workers take sick days. Any patient who presents to a G.P. solely for a sick cert must currently forego their Medicare rebate. Nurse-clinics should have the same rule….

JessP: As a G.P. I would like to correct a few things you have said. “Anyone with a bog standard cold, minor illness and perhaps in need of a medical certificate, appreciates the WIC as a fast and convenient service providing quality advice.”
You left out the fact that it is far more expensive for the taxpayer to fund a nurse walk-in centre than a G.P. visit.
Why does a patient with a big standard cold need to see a health professional at all?….

Let’s make this easy to understand.
If you walked into a shop and they try to sell you a pair of running shoes for $188 or a 12 speed good quality bicycle for $37 which one would you choose? Both will get you to your destination but one is grossly over priced while the other one is a bargain.

The difference between a taxpayer funded $188 visit to the Walk in Clinic and a taxpayer funded $37 visit to a GP is the same scenario.

And at the end of the day the payer is the same – you. The taxpayer.

Nothing to do with a turfwar and nothing to do with the costs of private charging GPs – it is plain & simple a terrible waste of limited resources

Merlin Geikie said :

Yes indeed, the GP is an expensive luxury, that I sure can’t afford, The pay ‘step’ is more than the Medicare schedule!
The Nurse Walk In Centre is a great way to reduce the cost of what is a small and very lucrative business for GPs.
Due to the fact that we are steadily becoming less able to afford GPs, folk on low incomes, and pensions, are having to forego medical treatment altogether, or go to Dr Google!
The fact that GPs are complaining, is a good indicator in itself, that the Walk in Centre outpaces their crowded surgeries and undercuts their ‘professional’ fee.
Alongside the Nurse can be, expert software access, and a couple of simple digital machines which can make consultation and diagnosis, of the vast bulk of medical problems, cheap and easy, a lot safer, and less anxiety ridden.
Please politicians, save money on expensive, over paid GPs and get nurse and experst software systems working, safer, more reliable and way cost saving.

Can you explain why a GP charges about half for a consultation than what it costs the taxpayer for a visit to a walk-in centre with limited resources?
A GP also covers the full spectrum of diagnosis and referral to specialists. If some GPs do not bulk bill, the difference you will pay after the Medicare rebate is only about $35 – surely you are not that poor?.
You should instead rejoice that we have such excellent services available. Choices weren’t meant to cost nothing.

Merlin Geikie said :

Yes indeed, the GP is an expensive luxury, that I sure can’t afford, The pay ‘step’ is more than the Medicare schedule!
The Nurse Walk In Centre is a great way to reduce the cost of what is a small and very lucrative business for GPs.
Due to the fact that we are steadily becoming less able to afford GPs, folk on low incomes, and pensions, are having to forego medical treatment altogether, or go to Dr Google!
The fact that GPs are complaining, is a good indicator in itself, that the Walk in Centre outpaces their crowded surgeries and undercuts their ‘professional’ fee.
Alongside the Nurse can be, expert software access, and a couple of simple digital machines which can make consultation and diagnosis, of the vast bulk of medical problems, cheap and easy, a lot safer, and less anxiety ridden.
Please politicians, save money on expensive, over paid GPs and get nurse and experst software systems working, safer, more reliable and way cost saving.

If you’re asking politicians to save money, then they have to close the walk in centres, as they’re costing the ACT taxpayer $188-200+ per patient visit. In contrast GP’s are costing the federal taxpayer $37 per patient visit, with patients contributing from $0-53 extra. If the ACT government could get some GP’s to hire additional nurses and offer an extended hours walk in service, there could be significant savings for the ACT taxpayer. Its also likely that outcomes for those walk in patients would be better with doctors on site for quicker consultation and prescriptions etc when needed.

Merlin Geikie6:40 pm 20 Nov 17

Yes indeed, the GP is an expensive luxury, that I sure can’t afford, The pay ‘step’ is more than the Medicare schedule!
The Nurse Walk In Centre is a great way to reduce the cost of what is a small and very lucrative business for GPs.
Due to the fact that we are steadily becoming less able to afford GPs, folk on low incomes, and pensions, are having to forego medical treatment altogether, or go to Dr Google!
The fact that GPs are complaining, is a good indicator in itself, that the Walk in Centre outpaces their crowded surgeries and undercuts their ‘professional’ fee.
Alongside the Nurse can be, expert software access, and a couple of simple digital machines which can make consultation and diagnosis, of the vast bulk of medical problems, cheap and easy, a lot safer, and less anxiety ridden.
Please politicians, save money on expensive, over paid GPs and get nurse and experst software systems working, safer, more reliable and way cost saving.

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