St John Ambulance (SJA) has traditionally been associated with ambulance transport and first aid. A few years ago, however, it acquired the Apollo network of practices and transformed this into urgent care centres with co-located general practices. The stated aim was to relieve pressure on EDs by redirecting patients to the urgent care centres. SJA claims these centres have been outstandingly successful, with a very high percentage of patients who would otherwise have attended ED.
This has never been independently verified and local hospitals have reported little or no change in attendance figures following the opening of these centres.
Anecdotally, the GPs working within the centres themselves report that, although a minority comprise acute minor ED-type presentations, a high percentage of patients are “straightforward GP presentations”.
Before the last federal election, SJA successfully lobbied for funding to expand a “trial” of four more urgent care centres – $28 million was granted, with locations determined by Government and seemingly focused on marginal electorates.
There was no consultation with any stakeholders or WA Health, and no detailed local needs analysis undertaken. SJA is the only organisation in Australia awarded this funding, which was announced in the pre-election budget, with half the funding already distributed.
Now that the grant is locked in and the centres are a fait accompli, SJA has belatedly embarked on “consultation” with key stakeholders and finally with local GPs.
The initial model was based on complete bulk billing centres to be subsidised via the grants. Though the centres are labelled a trial, SJA has never hidden its intention to continue them in some form, either via ongoing government subsidy or the allocation of special Medicare “urgent care” item numbers.
The AMA (WA) has always opposed government-subsidised general practices competing unfairly with established local practices and rendering them unviable. Such an approach will never result in stability or improved care. The urgent care centres are largely treating GP-type patients, few of whom could not be managed in surrounding general practices.
Echoing AMA (WA) concerns, the Royal Australian College of General Practitioners (RACGP) has also come out strongly against the concept as promoted by SJA.
We have now held a number of meetings (and plan more) with very worried and upset local GPs, a number of whom have indicated their intention to downsize or even close their practices when these centres open.
Given funds are allocated and the centres will go ahead in some form regardless, the AMA (WA) has been in discussion with SJA to ensure it fully appreciates the damage its policies could inflict on primary healthcare in WA if implemented as originally planned.
We may get fewer minor ED attendances but at the expense of destroying the quality GP care that actually prevents the more serious ED admissions. This may not concern SJA – their “research” on the impact of these centres specifically excludes this – but it should concern everyone else.
I am hopeful that we may be able to negotiate with SJA to reduce the adverse impact of these centres, by ensuring transparency in the funding, no operational subsidies, and a true focus on ED-type presentations. SJA has at least agreed to send every patient who presents at their urgent care centres back to their regular GP with a letter. We would also like to ensure co-located GP clinics are no larger than necessary and are non-subsidised, with billing in line with surrounding GP clinics.
I have challenged SJA to ensure its clinics are not damaging local general practices – you will all be the judge of that – and also to consider ways it can help local practices by using its corporate power to strengthen rather than weaken them.
Rest assured the AMA (WA) will keep up the pressure on this issue, and we are working closely with our colleagues at the RACGP on this. We want to protect the vital fabric of primary healthcare in WA as well as Australia, and for SJA to truly value add and support local GPs, not just keep a handful of minor cases out of ED.
If you have any further insights, queries or concerns, please contact me at: firstname.lastname@example.org