Without data both the government and GP lobby groups are flying in the dark on what UCCs are actually doing
It’s hard to see the strategic upside of sending the president of the most powerful GP representative group in the country onto national TV to face the federal health minister on the important evolving issue of urgent care clinics with a set of arguments that don’t stack up in any way.
This occurred last week on the ABC’s 7.30 program
RACGP president Dr Nicole Higgins was trying to prosecute the following arguments:
- that UCCs almost entirely replicate what a normal GP practice does
- that if the federal government spent the $720 million being spent on UCCs in “general practice” (never mind that her own members work in UCCs) then there won’t be any problem getting in to see your normal GP at any time
- that each UCC visit at a cost of about $300 per consult to the federal government can be substituted easily for a GP visit cost of just $43 per visit, thus creating much greater value to the public – and clearly showing up UCCs as wasteful duplication
- UCCs don’t take any pressure off local EDs (actually, she may have this one right, time will tell)
Here’s the transcript of some of what she actually said.
“These urgent care centres were designed to take the pressure off our emergency departments, but what they’re doing is also, if you like, duplicating the services that we’ve already got, which exist in general practice …
“If we funded general practice to the tune of what we’re doing urgent care centres, we’d be able to increase that capacity and see people on the day and [maintain] continuity of care seeing a regular GP…
“Urgent care centres are promoted as being free, but they’re not. They are so much more expensive [per] episode of care. Say, if you’ve got a [a child with a sore ear], if you took your child to the GP [it will cost] just under $43. If you took your child to the urgent care centre, it would cost the taxpayer just under $300. If you took your child to the emergency centre, that’s around $650. So you can see it cost the taxpayers so much more than somebody seeing their GP.”
Unfortunately for the college, the ABC reporter decided to edit in a few right of replies to her arguments from federal health minister Mark Butler and although the government hasn’t got any data to prove that UCCs are actually helping local EDs by reducing presentations, he did have a couple of points to make which outed the RACGP as playing the man not the ball on the whole UCC debate.
The first problem for the GP lobby group’s arguments is that UCCs see a big proportion of their patients outside normal GP practice hours – after 5pm on weekdays and after 12pm on weekends. The show said that over a third of UCC consults were out of normal GP hours, but TMR has talked to centres which claim the figure can be as high as 40%.
So up to 40% of Dr Higgins’s argument about UCCs simply duplicating what normal GP practices can do was immediately, even embarrassingly, wrong.
But that does leave us with 60-70% of UCC consults in play as potentially duplicating what a normal GP practice can do.
The problem with those consults of course, which the show did not get into, is that a large percentage of UCC presentations are consults a normal GP practice won’t or can’t do – such as a broken arm or a severe cut requiring a lot of stitches. A further large percentage of UCC presentations are patients who can’t get in to see their local GP when they want or need to, but don’t want to go to ED.
Notably, and not talked about on the show either, nearly all UCCs are co-located with a normal GP practice and patients are triaged between the services. That triage data is being carefully audited by the federal government to make sure that what Dr Higgins claims is happening isn’t happening. On the data available so far, it doesn’t look like it is.
HSD visited a few UCC centres a couple of weeks back to check on all their processes and the triaging in the centres we saw is pretty well governed and strict.
At least half of the consults in normal general practice hours are simply not consults a normal practice is going to see. And of those that overlap, how many are worried patients or parents who would very likely have gone to an ED because they couldn’t get to see their local GP?
We might be getting down around the possibility of 10-20% duplication of services at best, which is a long way off the near 100% Dr Higgins seemed to be pushing.
Even an observant patient watching that program would have done some of the maths and wondered what this strange group representing GPs around the country was getting at. Certainly one that had been seen at a UCC would probably be sceptical.
Finally, to the idea that spending another $240 million per year (which converts roughly to the $740 million the government is spending over three years on UCCs) would solve the GP access problem overnight.
The total MBS GP funding for GPs is somewhere north of $8 billion per annum. Adding $240m to that each year? Every bit extra is needed and it’s going to help for sure. But it’s not even going to put a scratch on our current GP access problem.
Even if the government did turn around and increase MBS rebates to make up for 10 years of freezing them (they won’t), it’s not going to help the access problem.
The Greens came up with that sort of money and more this week in their magical Robin Hood healthcare platform , one component of which is to launch 1000 UCCs (the federal government only has 72 in its plans so far). It’s a fun read if you like fantasy.
The access problem is about a shortage of GPs more than it is about how much we are paying them, and that’s a long-term fix.
The RACGPs position on UCCs is putting at significant risk its overall credibility with patients, a lot of its own members and, most importantly, the federal government.
Patients aren’t known to follow the nuances of the politics of medicine and general practice.
But we know they are loving UCCs, whatever they are actually using them for. The numbers on that front are clear.
What isn’t clear at all is whether UCCs are doing what the government keeps saying is one of the major reasons for them being: reducing pressure on our EDs.
The government isn’t planning on producing this data until 2026 for some reason, and the GP groups are rightly suspicious of why the government wants to take so long, especially when it is spending $240m a year on the initiative.
After spending nearly all of its $720m it doesn’t feel likely that the government will back out of the program, whether the data says that the centres are doing what the government wants them to do or not.
Both sides aren’t dealing in the facts, the data on what these new centres actually are doing as far as ED admissions are concerned, and data which will tell us much more precisely what they are doing.
It wouldn’t really be that hard to start generating some of that data on the government’s part, so you do have to wonder what DoHAC is playing at.
For the RACGP’s part, whether UCCs are duplicating GP services or not, it is playing a losing hand by failing to recognise love their local UCC. That anything they do publicly (like go on national TV) to trash them will at first fall first on deaf ears and, if they persist, eventually might start degrading any sympathy with patients that the organisation has cleverly managed to build in the last few years based it managing to communicate the financial problems facing the profession?
As far as government is concerned the RACGP does have to maintain brand reputation and an air of professional competence if it wants to continue to be heard in Canberra.
The federal government sees the college arguments against UCCs as banal, defensive, ignoring patient’s needs and without any basis in fact. That it’s destructive grandstanding for grandstanding’s sake. It thinks the college is trying to woo members by trying to look tough instead of engaging in rational argument (and it looks like it might have a point so far).
The government is currently wondering whether the college is a group it should be meaningfully bringing into the tent on its bigger plans for the future.
The next couple of years are the years the college really needs to be in that tent.
UCCs may not be what the government say they are – a solution to our ED crisis – but it’s clear they aren’t duplicating GP services either.
But we are spending $240m a year on them; patients love them and attend them in droves; they employ a lot of GPs including RACGP members (over 200 at least); and the government loves them for what they are doing politically.
It might be time for the RACGP to lean into the idea of UCCs a bit more, especially if these new entities aren’t really taking their patients or money.
It might also be time to get some hard data on the centres, as regardless of whether they are helping much with our ED issues, they are doing something for the system in terms of patient need.