Introduction by Croakey: To date, 67 Urgent Care Clinics (UCCs) have been opened across Australia, with most located in relatively well off areas, according to the analysis below.
While some medical organisations continue to raise concerns about the clinics, they appear to be popular with communities, and there also are hopes the model will be useful for First Nations peoples’ healthcare.
As Jason Staines reports below, the results of an evaluation of the clinics is awaited with great interest.
Jason Staines writes:
At the start of August, Health Minister Mark Butler announced the opening of a Medicare Urgent Care Clinic (UCC) in the Queensland suburb of Morayfield. It was the latest of nearly 70 UCCs that have been opened since June 2023, with a total of 87 planned so far.
Designed to take pressure off hospital emergency departments (EDs) by providing free, walk-in care for urgent conditions that are not life-threatening, UCCs also bridge the gap between EDs and general practitioners, who may not be available at short notice to treat such conditions.
The clinics have proved popular with patients, with Butler saying earlier this year that there had been more than 400,000 visits since they launched. From a patient’s perspective, there is a lot to like – free care often delivered after-hours for urgent conditions.
The locations for the clinics are determined in conjunction with state and territory governments, usually in places near EDs – Morayfield is about a 10-minute drive from Caboolture Hospital, for example.
“Consumers are generally supportive of the idea of the clinics,” Consumers’ Health Forum chief executive, Dr Elizabeth Deveny, told Croakey. “We’re big believers that people vote with their feet, and the patient visit data tells us that the community are using the clinics across the country.”
They are popular with the Government at well, which has been opening them at a cracking pace and allocating hundreds of millions of dollars to fund them.
In the 2024-25 Budget, it set aside $227 million to boost UCC capacity, including the opening of a further 29 clinics. That funding followed on from $358 million in the 2023-24 Budget, and $235 million from the 2022-23 Budget. Throw in $39.5 million from the 2023-24 MYEFO, and that is $859.5 million allocated so far.
Community control
To date the Mparntwe (Alice Springs) UCC is the only Indigenous-operated clinic in Australia. Managed by the Central Australian Aboriginal Congress, it is seen as a positive step toward addressing healthcare disparities and providing immediate, non-life-threatening care in a culturally sensitive environment.
Indigenous leaders and health organisations are advocating for more clinics and services that respect Indigenous cultural contexts and provide equitable access to healthcare. Expressions of interest, such as those in Western Australia, have noted an intention for UCCs to be located in Aboriginal Community Controlled Health Services.
The chief executive of the Aboriginal Medical Services Alliance Northern Territory (AMSANT), Dr John Paterson, told Croakey that UCCs were an “important step forward” to providing more support for First Nations people.
“AMSANT has called for ongoing and increased recognition and support for provision of urgent care by Aboriginal Community-Controlled Health Services (ACCHS) outside the model of medical care provided by mainstream primary healthcare,” he said.
“We have also suggested remote ACCHS clinics with no immediate access to a hospital to be reclassified as ‘multi-purpose centres’ that provide 24-hour emergency and other hospital-level care, to allow them to access hospital activity-based funding from the Australian Government.”
Paterson points to another benefit that UCCs may have on healthcare delivery – particularly for remote communities – beyond reducing the burden on EDs. They may, in fact, help improve primary care outcomes as well.
“If some of the burden of acute urgent care is shifted to staff specialising in that area, it will free up primary healthcare clinicians to provide proactive preventative healthcare such as immunisations, health checks and health education,” he said.
“This may be the most important contribution of the urgent care clinic model to improving primary healthcare outcomes, as it will lead to improvements in PHC delivery, and improved retention.”
A question of continuity
Not everyone thinks UCC funding is money well spent, however, with the Royal College of General Practitioners (RACGP) and the Australian Medical Association (AMA) questioning whether or not UCCs are the best way to spend public money.
The AMA argues that UCCs may fragment healthcare services, as they operate independently of general practices, which could lead to a lack of continuity in patient care. There are also concerns that UCCs are competing unfairly with existing general practices, particularly those that struggle to stay open after hours due to a lack of funding.
In a letter to the Department of Health, the Queensland branch of the AMA raised concerns that UCCs were only opening during standard hours. “We also note Minister Butler’s recent media release stated just one in five visits to UCCs take place from 6pm onwards. This indicates that 80 percent of UCC visits are likely occurring when existing general practices are open, supporting the concerns of our members and other health professionals that UCCs are a direct threat to their businesses,” they wrote.
In its submission to the Review of After Hours Primary Care Policies and Programs, the RACGP acknowledged that UCCs increased access to healthcare after hours, although it was concerned that such services may “fragment care if not well-connected to existing general practices and a patient’s usual GP”. The College called for a renewed focus on comprehensive care through the prioritisation of “timely clinical handovers and efficient communication channels”.
This is an issue the CHF is aware of as well, according to Dr Deveny. “CHF is mindful that the clinics on their own are not the entire solution to consumers having better access to primary care. Best practice primary care is integrated and holistic. The clinics are there for a set purpose and scope, meaning there are things that they can’t provide.”
What does the data say?
Outside the concerns of the AMA and RACGP, others have raised questions about the serious lack of data that is underpinning the roll-out.
While Minister Butler is keen to highlight how many people visited a nearby ED with minor injuries or outside of business hours, the fact remains that there is little evidence pointing to UCCs taking pressure off nearby hospitals.
Conversely, this lack of data also fails to support claims that the UCCs are a waste of money, but until there are hard numbers, it will be anybody’s guess as to the effectiveness of the concept.
The Government has commissioned Health Policy Analysis to carry out a full evaluation of UCCs, with the first interim report due later this year and the final report expected in 2026. In the meantime, data provided by the services shows they are being used widely.
According to North Western Melbourne PHN chief executive, Chris Carter, UCCs in Victoria had seen more than 380,000 patients to April 2024.
“Patient survey data indicates that around half these patients would have visited a hospital emergency department if UCCs weren’t an option,” he told Croakey.
In the absence of extensive local data, studies on similar systems overseas indicate UCCs do impact consumer behaviour by diverting non-emergency cases from EDs.
According to a study published by AcademyHealth in 2021, UCCs in the United States have been shown to reduce the number of ED visits, particularly in areas with long waiting times. It found that the presence of UCCs in an area was associated with a 17 percent reduction in ED visits.
Meanwhile, a report in the Journal of Urgent Care Medicine in 2023 notes that the rapid growth in the US of UCCs, which have doubled in number over the past decade, is largely driven by consumer demand for accessible, efficient, and affordable care.
This growth is being fuelled by the increasing preference for urgent care among patients who are looking for immediate medical attention without the long waiting times often associated with EDs. More than 78 percent of Americans live within a 10-minute drive of an urgent care center, the report says.
Closer to home, Aotearoa/New Zealand is the first country in which urgent care was recognised as a branch, and it has the lowest rate of emergency department attendance per capita in the developed world, according to the Royal New Zealand College of Urgent Care.
In Auckland, where there are more urgent care clinics per capita than elsewhere in NZ, emergency department attendance rates are significantly lower than in the rest of the country. The College says urgent care facilities help to manage demand effectively by offering timely care for ailments that might otherwise burden emergency services.
However, the data on specific reductions in ED pressure due to UCCs remains anecdotal in Australia, underscoring the need for further research.
Workforce issues
With the country already facing a shortage of GPs, opening more clinics that employ GPs – not to mention nurses – will likely put a strain on the already overstretched supply of healthcare professionals.
However, the Government is firm in its belief that clinics will attract the necessary staff since they offer an interesting and varied line of work.
While that may benefit UCCs, there may be a flow-on effects for GP clinics. As Croakey columnist Dr Lesley Russell, from the University of Sydney’s Menzies Centre for Health Policy and Economics, told Guardian Australia earlier this year: “It remains to be seen if workforce shortages will undermine the concept and impact further on general practice and primary care services.”
As recently as this week, the AMA warned that urgent action was needed to address a predicted shortfall of GPs, with the Department of Health and Aged Care’s GP workforce report revealing a shortage of 2,460 full-time equivalent (FTE) GPs, with forecasts that shortage will grow to 5,560 FTE GPs nationally by 2033.
Responding to the report, AMA President Professor Steve Robson said in a statement: “We need to rebuild the GP workforce, which must start with training more GPs and supporting them to work in areas of need.
“This requires a comprehensive policy approach that starts with medical school and expanded access to clinical placements in general practice.”
Location, location, location
While the Government has raced ahead and opened nearly 70 UCCs, there are questions over their distribution.
A look at the locations of the clinics opened so far shows that two-thirds are in the most economically advantaged areas. There is also a skew towards Labor-held seats, according to the graphics below, compiled by Mitchell Ward.
These statistics, however, could do with some unpacking. If the primary reason for the opening of a UCC is to take pressure off a nearby ED, then socioeconomic considerations would take a back seat.
But, as Maskell-Knight points out, urgent care is not necessarily the only reason people choose to visit a UCC.
“When they were first proposed on the basis that they would ‘take pressure off EDs’, a number of commentators, including me, said that UCCs would attract three groups of patients: people who needed more complex care than their GP could provide, but not so complex as to require an ED attendance; people who needed GP care, but who couldn’t get a timely appointment; and people who needed GP care but couldn’t afford a co-payment and couldn’t find a bulkbilling practice,” he said.
With UCCs bridging the gap between EDs and GPs, they may well end up as de facto bulk billing medical centres where patients see them as a more convenient – and cheaper – alternative to a GP practice.
The CHF’s Dr Elizabeth Deveny said: “One of the biggest issues for people accessing healthcare is being able to afford it. With the rising cost-of-living crisis, it has become much harder to afford care. Another longstanding issue for people is being able to access healthcare services close to them. It’s really great to see the Government provide a free primary care service for people to use in their local community, from that perspective it’s a no brainer.”
Meanwhile, the Labor-skewed distribution could be down to the majority of UCCs being in metropolitan areas – where there is higher population density and a greater number of EDs – and this coincides with seats held by Labor, rather than the Coalition. Again, an independent review of the policy should unpack this high-level analysis further.
A wider remit?
While the AMA and RACGP are concerned that UCCs will interrupt patient continuity of care, others are not convinced this is a deal-breaker.
Former senior health bureaucrat Charles Maskell-Knight says the entire point of UCCs is to provide occasional, rather than holistic, care.
“I don’t think UCCs have much to do with substantive health system reform – they are just a different way of paying for an existing model of care – a once-off attendance to provide treatment for an immediate health issue,” he told Croakey.
“I have seen suggestions that UCCs should be employing other health professionals [such as] physiotherapists, psychologists or even dentists to provide a range of better care pathways. Were they to do this, they would evolve into a sort of multidisciplinary primary care service. That’s fine, except to run an effective multidisciplinary primary care service you need continuity of care,” he added.
Could UCCs evolve into something more than just occasional care?
In addressing the Whitlam Institute late last year, Butler spoke fondly of the Whitlam Government’s Community Health Program (CHP), which “aimed to proactively improve the health of the local community, and not just those individuals who sought – or could afford – care”.
“Underpinning the CHP was a comprehensive model of health that looked beyond the narrow medical reasons for episodes of illness, towards a greater understanding of the social determinants of health,” Butler said, adding that the current Labor Government was integrating lessons learned from the CHP into its reforms aimed at strengthening Medicare.
Moving away from the model
While UCCs may or may not evolve into some new form of community care, there are already concerns that they are moving away from their original remit, either through commercial decision or government policy.
Stakeholders have flagged that some UCCs are no longer operating out of hours, and some have started taking bookings. Both developments undermine the very nature of an out-of-hours walk-in clinic that takes pressure off EDs.
“What we have heard anecdotally is that some consumers are having trouble accessing the care they need at these clinics. We hear that some clinics are reverting to a bookings system or closing the appointments early in the evening, which does away with the intended walk-in nature,” said CHF’s Deveny.
The AMA is also concerned that the ACT Government is undermining the concept of UCCs by modifying them to fit its own model of nurse-led care. The AMA’s Robson said in a statement that the consultation process conducted by ACT Health in the lead up to the decision to rebrand existing walk-in clinics as urgent care centres was “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,” Robson said.
“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,” he added.
Fiscal (and political) sustainability
UCCs are popular with the Labor Government, but would they be as popular with a Coalition one?
While nearly a billion dollars over the forward estimates does not represent the same fiscal strain as, say, a nuclear-powered submarine, it is still a significant source of ongoing funding that may not make it past the Expenditure Review Committee of a Coalition Government.
As Maskell-Knight points out: “As far as sustainability goes, UCCs appear to depend on funding through an annual appropriation. As soon as the government changes, I expect that appropriation will be under threat, and some sleight of hand will be deployed to give half as much money to PHNs in return for some woolly commitment about working to enhance access to low acuity emergency services.”
However, the rapid roll-out of UCCs may in part be explained by a political decision to embed them in communities, where anecdotal evidence shows they are quickly becoming popular. As such, killing off a popular service that forces patients back to long waits at hospital EDs or non-bulk-billing GP clinics might end up being considered a “brave” political decision for a newly minted Coalition health minister.
The Opposition’s health spokeswoman, Senator Anne Ruston, has raised the issue in Estimates, and pushed bureaucrats for hard data on the effectiveness of UCCs in reducing pressure on EDs. She has also raised concerns from the AMA and RACGP over “misguided” investments in UCCs.
However, Ruston has also used the fact that clinics are not operating as originally intended to criticise the Government, and called for more efforts to recruit doctors to ensure they can open for the promised hours. Speaking at the Mount Gambier UCC late last year, Ruston said the Government had broken an election promise since none of the UCCs in South Australia were open during the promised hours of 8am to 10pm.
“That is not the fault of the people that are operating that clinic – if they don’t have the staff to be able to do it, then of course they can only be open for the hours they have staff,” she said at the time. “But, once again, I’d call the Government out for making a promise to this community that they were going to have access to an urgent care clinic from 8 o’clock in the morning until 10 o’clock at night, and that is simply just not true.”
North Western Melbourne PHN’s Carter believes that if the data back up their usefulness, UCCs should become a permanent part of the healthcare system.
“UCC-style models are working in places such as Canada and New Zealand, and early indicators suggest they should become a permanent part of our own health system,” he said.
“We are looking forward to seeing the outcomes of an independent evaluation to understand the impact in Australia. If the evidence shows that this is the case, we then need to see a commitment to long-term funding to ensure UCCs remain stable and viable.”
Where to from here?
For now, the model appears to be here to stay, with the real challenge being visibility. According to experts, there is a lack of information for patients on the availability of UCCs and the role they play in the healthcare system.
Deveny says more needs to be done to make sure that the community knows that these clinics are open and understands when an UCC is the best choice for their healthcare.
“If these clinics aim to improve equity of access it is important that Australians know about them, and when to use them. A key success factor is building tailored education about any new service to those groups who experience the most health disadvantage so that they don’t miss out,” she says.
This view is echoed by North Western Melbourne Primary Health Network’s Carter, who points out that “whenever additional services are added to any system, the risk of complexity grows”.
“With the service options now complementing for the former GP/ED binary, explaining the additional options to the public can be challenging. This is particularly so for a diverse region such as the North Western Melbourne Primary Health Network catchment, where many residents speak languages other than English. There is a lot of work going on to ensure treatment options are explained in different languages, and in culturally appropriate ways, but there is always more that could be done,” he says.
“There is no doubt that UCCs are a welcome option for hundreds of thousands of Victorians in need of urgent care. However, market research shows that awareness of urgent care options such as UCCs and the Victorian Virtual Emergency Department remains relatively low.
“The challenge is to ensure that people understand the system and can receive the right care, in the right place and at the right time.”
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