GPs have weathered an MBS freeze, crippling bureaucracy and now federally funded urgent care clinics that threaten their viability.
WA general practitioners concerned about the establishment of four new St John Ambulance (SJA) urgent care centres (UCC), being built with $28 million of federal government money, were asked to participate in a survey organised jointly by the RACGP and AMA (WA).
The AMA (WA) and the college have raised their concerns with SJA, with little joy, so it is hoped when a larger number of GPs are made aware of the ambulance operator’s plans in the primary health care space, there may be some traction with politicians.
They said their concerns included the lack of consultation with affected general practices, the lack of transparency around the SJA business and clinical models and the unfair competitive advantage the new UCCs would have, given the operational funding they are receiving from the federal government.
“Unlike the WA Government-funded WA Urgent Care Network Pilot (developed and supported by WAPHA, AMA (WA) and RACGP) which utilises existing general practices, the St John Ambulance UCCs will provide Australian Government subsidised urgent care services, in direct competition with existing general practices,” the joint statement said.
“Of particular concern…are the funding mechanisms behind the SJA UCCs. The Commonwealth grant of $28 million provides both infrastructure and operational funding, which will create an uneven playing field, resulting in higher overall operational funding than Medicare rebates alone would provide for SJA UCCs.
“We have been clear at the research governance meetings, which were not consultative in nature, that the proposed locations of the SJA UCCs do not correspond with unmet need. Our requests that local general practices be consulted have so far been ignored, and there is a concerning lack of transparency around the details of the funding and clinical/business models of the new SJA practices.”
The survey said:
How will this impact you?
SJA will be competing with local general practices with the unfair advantage of Commonwealth government funding subsidising their operational costs.
Nothing will prevent SJA establishing general practices to operate alongside the Commonwealth subsidised SJA UCCs, as they have at their existing centres. This could lead the SJA UCCs being used as a referral source and patients being directed to SJA operated general practices.
No research or evaluation has been planned or conducted to measure how the SJA Urgent Care Centres affect surrounding general practice services.
Without immediate action, the viability of general practices in areas where SJA Urgent Care Centres operate are at risk.
There appears to have been no attempt to integrate the SJA UCCs with existing medical services, including the WA Government and WA Primary Health Alliance operated Urgent Care Network, which utilises local general practices and is actively supported by the AMA (WA) and RACGP.
Both organisations are advocating directly with Department of Health seeking the immediate introduction of governance mechanisms that will eliminate unfair competitive advantages and ensure SJA UCCs only address unmet need, do not compete with local general practices, and offer sustainability and value for money.
By way of history, annual SJA reports from at least several years ago indicate a growing interest in participating in the primary care space, made reality when it bought three Apollo Health Centres – in Joondalup, Cockburn and Armadale. In that purchase, they acquired not only equipped urgent care centres but general practice and dental facilities as well.
Anecdotally, general practices in the vicinity of the centres voiced their disquiet about the impact it would have on their viability. Little was, or could be done, as the not-for-profit SJA had acquired the Apollo Health centres with its own consolidated revenue.
When Medical Forum interviewed SJA’s Urgent Care Director, Dr John O’Toole, published in December 2018, Dr O’Toole stressed the urgent care centres were not a replacement for a person’s own GP.
“We want to facilitate a patient’s relationship with their GP, not interfere with it. If a patient is appropriate for urgent care, send them and we will attempt to fix the problem, but we’ll them send back to you,” he said.
“If a patient presents with a routine problem that would be better managed in an appointment with their regular GP, we will advise them as such. Urgent care does not perform health assessments, management plans, preventative medicine, referrals to specialists (other than acute specialties such as plastics and orthopaedics). This is the remit of the GP and we are careful to reinforce this.”
<subhead>Political play
Then in February 2019, just three months before the May election, the MHR for Moore, Ian Goodenough, told parliament that he supported SJA’s request for funding for a four-year trial for 10 urgent care centres to provide patients alternatives to presenting at EDs for non-life-threatening conditions.
SJA and Mr Goodenough sought $185 million for the initial infrastructure start-up costs, including four years’ operating costs.
“This financial support will ensure that patients can continue to be bulkbilled,” he said. “Assuming that the trial is successful and becomes normalised, the financial support reduces to $15 million per annum operating assistance to support all 10 centres from there on.”
Hansard records Mr Goodenough citing that SJA UCCs had seen about 57,800 patients the previous year (2018), “a third of whom would have otherwise attended an emergency department”.
He did not speculate where the other two thirds would have sought treatment.
There is little transparency as to the nature of the government-funded trial from either the government or SJA, which has declined to comment to Medical Forum, or provide satisfactory responses to AMA (WA) or RACGP presidents.
It is unknown if there are any other elements of primary care being “trialled” or what MBS item numbers will be used, or if new item numbers will be created, or if SJA has partners, commercial or otherwise, in the venture.
It is believed by some GPs that SJA have signed leases for premises in Midland and Cannington with flyers distributed to GPs in these catchments. By the time of going to press, nothing was known of the progress of the Mandurah and Osborne Park centres.
Chair of the WA faculty of the RACGP Dr Sean Stevens said that the college was appalled with any initiative that fragmented patient care and created an uneven playing field for general practice which was already overworked and under resourced.
“There was no consultation with general practice or the state government about the decision to fund these centres, which also cuts across the WA general practice urgent care pilot that predates the Budget announcement by a year,” Dr Stevens said.
He said the college was already particularly concerned about the impact on private general practices of the existing co-located GP clinics at SJA’s UCCs, four new centres would be an added blow.