Australian Government Doubles Down on Urgent Care Clinics

The Australian government has bet big on Medicare Urgent Care Clinics (UCCs) and is now winning over some previously skeptical general practitioners (GPs). Still, not everyone is convinced that these clinics will relieve the pressure on emergency departments.

Since 2022, the government has spent hundreds of millions of dollars establishing 87 Medicare UCCs around the country. It is now doubling down on this investment, with 50 more clinics planned.

Medicare UCCs offer free or bulk-billed healthcare services for urgent conditions that are not life-threatening. So far, almost 1.5 million people have visited these centers.

“Medicare UCCs have already delivered significant benefits for Australians through high-quality, accessible, walk-in care,” a spokesperson for the Department of Health, Disability and Ageing told Medscape Medical News.

The Royal Australian College of GPs (RACGP) and the National Council of Primary Care Doctors raised serious concerns about the expansion of the Medicare UCCs before the federal election, arguing that it would be more cost-effective to fund general practices.

RACGP’s Stance Softens

Following the Labor Party’s landslide victory, however, it’s clear that these Medicare UCCs are here to stay. Moreover, they are offering some RACGP members high paying and interesting work.

“GPs working in UCCs report a high level of job satisfaction,” Sneha Wadhwani, MBChB, regional clinical director for New South Wales and head of GP Wellbeing at ForHealth, told Medscape Medical News. ForHealth runs 36 Medicare UCCs and is the largest provider of bulk-billed primary care services in Australia.

“The 2 PM to 10 PM shifts really suit me because I’m wanting to work in my other role as associate professor [of urgent care] at the University of the Sunshine Coast,” John Adie, MBChB, PhD, clinical director of the South Brisbane Medicare UCC, told Medscape Medical News. Adie’s clinic is located within a general practice and is staffed by one primary care physician and one nurse 7 days per week.

Just over half (55%) of presentations at the clinic are for minor infections such as bronchitis or tonsillitis. Around 20% relate to minor injuries, including wounds that can be closed with stitches, glue, or Steri-Strips; fractures; or foreign bodies that can be removed from ears with air suction and from eyes with a slit lamp. “If you come to us, there’s a 97% chance that you will not have to go to the emergency department,” said Adie.

As the Medicare UCCs have become more established, the RACGP’s stance seems to have softened. “We value the work that our members are doing in those clinics, and we’re keen to support them,” Michael Wright, MBBS, PhD, president of the RACGP, told Medscape Medical News.

Underlying Problems Remain

An interim evaluation published in March showed that Medicare UCCs were performing well, with median waiting times of 14.5 minutes. About 46% of patients avoid an emergency department visit by attending a UCC. But the evaluation also showed room for improvement. “We’re keen to work with the government to address some of the problems that have been identified,” said Wright.

The Medicare UCCs are substantially cheaper than emergency departments. Each presentation at a UCC costs $246.50 instead of $616 at an emergency department. But this amount is “more than five times what a GP consult rebate is for a 20-minute consultation,” said Wright.

It is difficult to determine the impact of Medicare UCCs on emergency departments without a more rigorous analysis, Henry Cutler, PhD, professor of health economics and director of the Macquarie University Centre for the Health Economy in Sydney, told Medscape Medical News. “It needs more of an academic approach to evaluate these programs,” he said.

Medicare UCCs are a “Band-Aid solution” that does not address the underlying problems that are putting pressure on emergency departments, Charlotte Hespe, MBBS, PhD, the head of General Practice at The University of Notre Dame in Sydney, told Medscape Medical News. The main problem is patients’ decision not to see their GP for preventive care and chronic disease management because it is too expensive, she added.

Bulk-billing rates are declining because government funding has not kept pace with the costs of running a general practice. Relief seems to be on the way, however, with $7.9 billion being allocated toward supporting general practices to bulk bill starting November 1.

Medicare UCCs are offering “massive hourly rates,” making it “hard for us to compete for that workforce,” Toby Gardner, MBBS, director of a private UCC in Launceston, told Medscape Medical News. Gardner’s clinic lost state government funding after the Medicare UCCs were established. “It’s made it harder for us to remain financially viable,” he said.

Despite these setbacks, the private clinic has used its relationships with local pathology and x-ray providers to keep patients out of public hospital emergency departments, which previously had some of the worst waiting times in the country.

Another concern about Medicare UCCs is fragmentation of care. “Only 68% of patient presentations to Medicare UCCs resulted in an electronic discharge summary being sent to the GP,” said Wright. “Better transitions of care are the key to preventing hospital admissions and readmissions and saving costs.”

Wadhwani, Adie, Wright, Cutler, Hespe, and Gardner reported having no relevant financial relationships.

Felicity Nelson is a freelance science journalist based in Sydney.