Labor spending millions more on urgent care clinics without evidence they work, experts say

<span>Experts have criticised Labor’s 2024 budget for expanding urgent clinic funding in the absence of information on the program’s effectiveness.</span><span>Photograph: Penny Stephens/The Guardian</span>
Experts have criticised Labor’s 2024 budget for expanding urgent clinic funding in the absence of information on the program’s effectiveness.Photograph: Penny Stephens/The Guardian

Doctors and health policy experts have questioned the federal government’s decision to fund an extra 29 urgent care clinics in the absence of strong evidence that they work.

Tuesday’s budget included $227m to fund the additional clinics, which will bring the total number across Australia to 87. The clinics offer bulk-billed walk-in care, seven days a week over extended hours, with the intention of reducing the burden on emergency departments and easing out-of-pocket health costs.

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However, the Australian Medical Association and the Royal Australian College of General Practitioners have questioned the budget announcement, arguing the clinics had not been formally evaluated and that the money was better spent on general practice.

Guardian Australia understands an independent evaluation of the urgent care clinic program is being conducted by the consulting firm Health Policy Analysis, but the government is yet to publish any of its preliminary findings.

The federal health minister, Mark Butler, told Guardian Australia he respectfully disagreed with the college’s criticisms for the clinics, adding: “Since the first Medicare UCC started operations in June 2023, there have been over 400,000 visits to clinics across the country.”

But Dr Lesley Russell, from the University of Sydney’s Menzies Centre for Health Policy and Economics, said the “mere recitation of numbers of services delivered is not an evaluation” and that “the value of urgent care clinics is yet to be established”.

Clinic funding is “not a solution to the burgeoning need for ongoing management and care of chronic illnesses or for the provision of preventive care,” she said.

“The program has expanded in the absence of any information about effectiveness in meeting the desired goal of reducing pressures on emergency departments and the selection of appropriate locations.

“It remains to be seen if workforce shortages will undermine the concept and impact further on general practice and primary care services.”

The CEO of the Consumers Health Forum, Dr Elizabeth Deveny, said patients are generally supportive of the clinics which she said “will make a difference to their local communities”.

“What we have heard anecdotally is that some consumers are having trouble accessing the care they need at these clinics and some clinics are reverting to a bookings system, which does away with the walk-in nature,” she said.

A GP working at one of the clinics in Victoria, who spoke to Guardian Australia on condition of anonymity, said he believed patients felt obliged to tell surveys they otherwise would have attended emergency department because they know that is what the clinics are for.

“More than 50% of patients I see come in for minor stuff that would never have actually gotten them to the hospital’s doors,” he said. “We don’t need new clinics being built, but we need to increase access and availability at the clinics that are already there.”

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Prof Suzanne Robinson, the director of Deakin Health Economics at Deakin University’s Institute for Health Transformation, has recently reviewed academic evidence examining similar models of care overseas and how they are perceived by patients and health care workers.

“They are very positive from a patient perspective, with that view being driven by shorter wait times and having access to free services,” she said. “Nurses are also supportive, saying they enjoy working alongside GPs in a different way than they might in other settings.”

She said while strong evidence and evaluation was critical, “sometimes it’s important to act or you wouldn’t move forward with anything”.

The health program director at the Grattan Institute, Peter Breadon, said it was “understandable that the government wants to move fast to take pressure off hospitals”.

“But before the new clinics are set up, information about how well the current clinics are working should be released,” he said.

“That includes how much they’re costing, how many patients are being seen, whether they are easing pressure on hospitals and any lessons on what isn’t working and needs to change.”

Charles Maskell-Knight, a former senior federal health department official and health policy analyst, said given the initial tranche of clinics were up and running in January “there should by now be four months of data about their workload and the workload of the nearest emergency department”.

“I am disappointed that the government did not wait for at least a preliminary evaluation of urgent care clinics before announcing plans to increase the number by 50% … it is a pity that the government has decided to expand the program in advance of any evidence that it is working”.

The president of the Australian Medical Association, Prof Steve Robson, said on Tuesday that there were “some questions about whether urgent care centres deliver anything at all, and there’s been no evaluation whatsoever of urgent care centres”.

“Investment in general practice is likely to deliver that more than a Band-aid solution, which is what an urgent care centre really is.”

The Royal Australian College of General Practitioners’ president, Dr Nicole Higgins, said the clinics would make some difference but the government “should be boosting investment in general practice care so that no patients anywhere are left behind”.

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