Doctors, health policy experts and consumers have clashed over whether Medicare Urgent Care Clinics should be judged by their impact on emergency departments or their role in improving access to affordable primary care.
Medicare Urgent Care Clinics have become the focus of an increasingly polarised debate, with emergency physicians warning the model is failing to relieve hospital pressure while patients, health policy experts and primary care leaders argue the clinics are filling a critical gap in affordable healthcare.
The discussion intensified after The Age published a report quoting emergency physicians and GP leaders who argued urgent care clinics were having little impact on emergency department demand while worsening workforce shortages in general practice.
Melbourne emergency physician and the Australian Medical Association’s federal council emergency medicine representative Dr Sarah Whitelaw told the newspaper that the clinics were having only a “minuscule” impact on overcrowded emergency departments.
“The clinics do nothing to solve our problems,” Whitelaw said.
“It is so frustrating every time we hear the phrase ‘reducing emergency department pressures’ because they haven’t decreased our waiting times in any way.”
Victorian AMA president and emergency physician who works in rural and metropolitan EDs, Dr Simon Judkins also told The Age that emergency departments were dominated by patients requiring admission rather than those with minor injuries.
“It’s not because of patients who need lacerations fixed up; they’re full of patients who’ve got complex care issues, who need hospital admission, and the hospitals are completely full,” he said, arguing investment would have been better directed towards general practice and hospital capacity.
AMA federal vice-president Associate Professor Julian Rait also questioned the workforce impact of the clinics.
“It has a very distorting effect on the workforce basically; it’s robbing Peter to pay Paul,” he said.
Camperdown GP Dr Robin O’Neill said federally funded urgent care clinics could pay doctors substantially more than traditional practices.
“The government has now created a two-tier system where federally funded urgent care centres can afford to bulk bill and offer higher rates of pay to doctors,” he told The Age.
“This in turn is causing pressure and workforce shortages in regular general practice clinics, which is most acute in rural and regional locations,” O’Neill said.
RACGP Victorian deputy chair Dr Aadhil Aziz said strengthening Medicare funding for comprehensive general practice remained the most effective long-term solution.
“General practice is severely underfunded,” he said.
“But if you fund it better we will be able to deliver a better-class healthcare system for everyone, which will reduce the number of people needed going to EDs.”
However, the article prompted a vigorous debate on LinkedIn, where health economist Professor Stephen Duckett shared the report and attracted comments from clinicians, academics, health executives and consumers questioning whether emergency department performance should be the primary measure of success.
“Pretty poor reporting here. There have been two independent reports on urgent care clinics which provide quantitative data,” Professor Duckett wrote.
“This front page story cites neither, mostly relying on gossip and irrelevant data (Declaration of interest: I am a member of the advisory committee to the evaluation).”
Aged care researcher and advocate, UNSW Honorary Professor Kathy Eagar said urgent care clinics were being criticised for failing to achieve an objective they were never intended to deliver.
“Another case of criticising a service for failing to achieve what it was not designed to do,” Eagar wrote.
“Urgent Care Centres were never designed to reduce demand by the 3s and 4s. But we certainly need more effective demand management for this cohort.”
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Former RACGP president Adjunct Professor Karen Price said the debate should focus less on whether urgent care services were needed and more on how they were funded and integrated into primary care.
“The point is not whether the scope of practice is needed. It clearly is and provides a service to the community undeniable,” Price wrote.
“The bone of contention is that these are staffed by GPs who cannot deliver this service in their usual general practice because it is not funded to do so.
“Thereby fragmenting continuous care which has academic evidence which even Steven Duckett cannot deny.
“There are large governance issues and there are large academic issues that this article does address that the subjective one single experience of having access to so-called free care does not understand.”
Professor Price said continuity of care remained a central issue and noted that “the free care is funded at five times the amount of usual general practice care in the after hours slot”.
“The issue is integration of this care into a system that is seamless for the patient and provides the continuous comprehensive coordinated care that supports good patient outcomes,” she wrote.
Flinders University Associate Professor Dylan Mordaunt, who is also locum group director of Medical Services for the Illawarra Hospital Group (ISLHD), said urgent care clinics should not be judged solely on whether they reduce emergency department presentations.
“Urgent Care is often misrepresented as being an alternative to EDs, as its sole value proposition,” he wrote.
“It’s a different model of care. There’s people who could go to Blyth, but there’s issues and reasons people legitimately want to go to urgent care rather than see their GP- sexual health, mental health, urgent musculoskeletal issues, etc.”
Drawing on New Zealand’s experience, Mordaunt said Australia should expand multidisciplinary primary care by removing Medicare restrictions affecting nurse practitioners, paramedics and physiotherapists.
“That way when our hospital patients can’t get into a GP practice, we can work with these other providers to avoid unnecessary time and travel spent coming to hospital,” Professor Mordaunt wrote.
Health services researcher, Monash University Adjunct Professor Peter O’Meara said the patient perspective had largely been overlooked.
“My disappointment with the newspaper article was that while it focused on the impact on EDs and GPs, the perspective of patients was largely absent,” he wrote.
Professor Mordaunt agreed.
“100%. I think that’s where UCCs shine- they fit a patient need and preference,” he wrote.
Dr Pankaj Arora, chairman and CEO of Wise Medical Group and a senior staff emergency specialist at Royal North Shore Hospital also questioned the performance metric being applied.
“I also believe the data should not measure impact on ED as it does not provide substitute to ED care,” Dr Arora wrote, describing urgent care clinics as “an amazing solution to an after hour and in hour affordable GP care”.
Several consumers and health executives also shared positive personal experiences.
Lesley Podesta CEO of consultancy service Red Mitten said she had recently been redirected from an emergency department to an urgent care clinic.
“Incredibly efficient – they are a great addition to care system,” she wrote.
Community leader Miriam Suss OAM said she had received “prompt and high class medical attention” at a clinic on a Sunday when her GP was closed.
“This article does not reflect the experiences of people I know,” she wrote.
Former AMA Tasmania president Michael Lumsden-Steel agreed that patients valued free urgent care but questioned why governments were prepared to fund urgent care clinics at significantly higher rates than equivalent services delivered through general practice.
“We know patients have enjoyed access to urgent free healthcare,” he wrote.
“But you’re missing this point.”
He argued the government should explain “where is return on investment?” given the higher funding provided to urgent care clinics while Medicare rebates for GP services remained comparatively low.
Responding to the discussion, Duckett encouraged readers to examine the available evidence, writing, “My view is government should adopt recos of After Hours report alongside UCC expansion”.
See the 2023-24 Review of After-hours Primary Care Programs and Policy report here.