Dear Minister Fitzharris
Over the recent past I have been sending you letters and you have not answered them. I sent those letters as an ACT Taxpayer, a small businessowner and as a General Practioner. One would have assumed that any of those roles would have qualified a well though out response but unfortunately the only response that I, and others who have asked, could get from your office was to advise us to attend an information forum on 31 August at the Gungahlin Health Centre.
The questions I had posed in my letters to you were fairly specific and while I have every intention of attending said information forum I thought is best to pose the questions in order to enable you to have a look at the information that you may need to provide (assuming of course that you will be present at this meeting)
This is of course about the ACT Government funded Walk in Centres.
Some background information is essential for readers to understand the matters being discussed.
The rationale for the establishment of the ACT’s first Nurse-led Walk in Clinic (WiC) in 2010 was to offer an alternative primary healthcare source that was the result of a perceived shortage of General Practitioners in the ACT & to reduce a perceived extra pressure on the Emergency Departments as a result.
Based on 2007-2008 statistics the ACT had 57.1 FWE GPs/ per 100,000 people and it was estimated a further 74 full time GPs were needed to reach the national average of 78.3 GPs per head of population.
Despite significant resistance to the idea from the local GP workforce and various medical organisations the ACT Government proceeded to roll out the first WiC co-located at the Canberra Hospital in 2010.
Given the very significant amount of ACT taxpayer’s money being diverted to prop up a perceived deficiency in the Federally funded Medicare services being provided by GPs one would have thought that there would be an ongoing close scrutiny of the costs and outcomes of this service and we were all therefore expecting ongoing reviews after the first one done by a team from the ANU in 2011.
This initial report had some less than ideal findings:
- The limited services being offered were averaging $ 196 cost per visit
- The WiC resulted in an INCREASE of triage category 4 and 5 presentations at the ED
- Less than 3 patients were seen an hour – presumably with at least two clinicians on-duty – an average of 1, 100 visits a month
- The vast majority of attendees were working folk, seen on Monday mornings
- 1/3 of patients were seen with colds
Looking at this, back in 2011, as one of the taxpayers paying for this and as GP, I compared this to existing average GP services:
- A bulkbilled GP clinic visit costs Medicare less than $ 40 (still does in 2017)
- GP services definitely reduce the workload on Emergency Departments
- A typical GP sees at least 3-5 patients per hour or about 600 patients a month ( or often much more)
- A GP deals comprehensively with a much wider spectrum of conditions
The 2011 survey thus showed that the first WiC:
- Cost the ACT taxpayer FIVE times more to deliver a much more restricted service than what at GP could have offered
- Only saw the equivalent workload of about two extra fulltime GPs
- 1/3 of the attendances were for conditions that normally could be handled by a community pharmacy and did not require the services of a Nurse Practitioner or GP.
From a taxpayer’s perspective this was a DISASTROUS outcome mandating an immediate roll-back and review of what seems to have been a very costly mistake.
This was not to be – instead of scaling the program back your Department chose to expand the program and by 2016 we have:
- A WiC in Belconnen and in Tuggeranong
- An election promise being carried out with the spending of a further $ 13 million on a WiC in Gungahlin
- Scoping studies being done on a further two WiC in the future
This led me to sending the aforementioned letters to your department requesting two simple answers:
- Provide a more current evidence of a scientifically validated needs assessment for an expansion of the program AND
- Provide evidence of ongoing cost assessment and evaluation of the program
When my requests for this information, addressed to yourself and others within ACT Health were studiously ignored I managed to get a response by cornering you when you were standing in on our local ABC for the Chief Minister. This resulted in a few phone calls and a single e-mail by staffers in your department in which I was advised that:
- Presentations to the WiC continued to increase (see below)
- Internal and external stakeholders (including GPs) were continually being consulted
- to attend the Information Forum on 31/08/17
The communication prompted me to have a read of the Quarterly ACT Public Health Services report which showed in 2015-6:
- The ED presentations continued to increase every single year – in fact the Category 4 & 5 presentations were now the highest in Australia when compared to other jurisdictions
- The TWO WiCs saw an average of about 2600 patient combined each month. Their hours of operation are shorter that it was in 2010 and they are still averaging only 3 patients per hour at each site – presumably still at least two clinicians on-duty
- 1/5 of patients were seen with colds. And 1,000 people had their earwax seen to
Crucial information that were discussed in the 2011 survey are now kept hidden from the public view. We have no information regarding current costs and efficiency measures but there is no reason to not believe that these two clinics are every bit as inefficient as the 2011 review showed – and still only sees the equivalent of what 3 to 4 fully qualified GPs could easily do in a normal working day.
This brings us back to the proposed new WiC in Gungahlin – planned to be rolled out within walking distance of some of twelve (soon to be thirteen) existing GP Clinics in the area. Clinics that are mixed billing or fully Bulkbilling and that have daily openings for patients.
What is equally true is:
- The number of GPs all over Australia has significantly increased since 2008 and will continue to do so for the foreseable future – using a perceived GP shortage as the motivation for rolling out the WiCs is simply not based in fact
- Even if the existence of the WiCs can be blamed on a GP shortage replacing them with a less effective yet much more expensive service makes no sense to me as the taxpayer funding this
- The ACT does the same or better than other States & Territories on all major health indicators and there is no health outcome based justification for the expenses associated with the WiC
Minister I cannot write letter like this to you without putting my GP hat on – as a taxpayer I can be forgiving about a perceived mis-spending of my hard-earned taxes but as a GP within the ACT system I cannot.
You are spending millions of dollars from a limited tax resource on an un-proven and un-needed venture while I as a GP:
- Cannot make a call lasting more than 30 seconds to Specialists at the Canberra Hospital (phones have been broken there for months)
- Cannot send basic Urology cases to the public system
- Cannot send basic ENT cases to the public system
- Cannot sent basic eye surgery to the public system
I could go on but you get the point – you are wasting money on what can only cynically be described as a vote buying spending spree while those of us at the coalface are dealing with these very real deficiencies in the system.
If you really feel that there is an actual proven need for ACT Health to augment the existing GP services I would suggested setting up a clinic and employing a few GPs as fulltime employees. They could easily triple the number of patients currently being seen at the WiCs at a fraction of the current costs, see and manage a much broader spectrum of conditions and you could even offset a large part of your expenses against the income being generated by the Medicare billing.
Now THAT would be a sensible use of my taxmoney.
Thinus van Rensburg