Critical Condition: Urgent care and after hours clinics - how do we keep more Tasmanians out of the ED?

For the period 2009-10 to 2018-19, the total number of emergency department presentations in Tasmania increased by 17.3 per cent. At Launceston General Hospital there was also a 112 per cent increase in the number of hospital admissions for the same period.

RELATED: Critical Condition - Why Launceston needs a new private hospital

More than a third of the state budget already goes to health, but of this, only about $70 million goes to preventative measures. Meanwhile, preventable hospitalisations continue to rise, with 15,848 in 2017-18 alone.

The LGH ED remains the only place that offers 24-hour access to free care in Northern Tasmania. However, many of the people who present here are not having a medical emergency, but rather an "access and affordably" emergency.

With the prospect of a private co-located hospital on the cards, stakeholders are calling for greater integration between the region's acute and primary care sectors. Something they say will take not just additional funding, but a greater focus on prevention.

On March 1, Newstead Medical Centre will open Tasmania's first urgent care centre, aimed at relieving ED pressures by treating those in need, outside of a hospital setting. Urgent care is a category of walk-in medical clinics, for a wide range of non-life-threatening illnesses and injuries in need of immediate treatment.

But it comes with a cost. An initial presentation to the Launceston Urgent Care Centre will cost $150, payable on arrival, and not covered by Medicare or other health funds.

However, Newstead practice partner Toby Gardner said they were confident patients would be willing to pay, with urgent care just one example of how Northern Tasmania could better utilise a private service to help take the pressure off public hospitals.

"There are so many people who would love to use a private service, but it either doesn't exist or it's not easily accessible," he said.

"That's why we are starting an urgent care centre because there are people who will pay an out of pocket fee, to be seen in a timely manner and be seen as they present, but they just don't have that option at the moment.

"Really, the only place you can be seen for urgent presentations is the emergency department. But from the surveys we have done among our patients, we know there is a whole cohort who would happily pay to be seen in an urgent care centre, treated, able to go home and get on with their life, rather than sitting in the ED for eight hours."

Last year the state government released a report exploring the feasibility of establishing UCCs at Mowbray and Glenorchy. Now, as part of its Our Healthcare Our Future document, it's committed to further consulting stakeholders on what comes next.

The same document also recognised improvements made over the past six years in the number of GPs across Tasmania, with a 10 per cent increase since 2014 (from 95.9 FTE GPs per 100,000 Tasmanians in 2014 to 105.4 in 2020).

However, Tasmania remains below the national average, with ongoing challenges regarding GP attraction and retention - particularly in regional areas.

Dr Gardner said timely access to GPs remained a key issue that was contributing to rising, often avoidable hospital presentations.

"We have been down GPs in the North, compared to the South, for a long time now," he said.

"I am fully booked for about five weeks in advance. Fortunately, we have been able to take on a few new doctors, so we do have more capacity then we have ever had at our practice. But lots of places don't."

As it stands, the Launceston Medical Centre provides semi-urgent walk-in clinics 365 days of the year. But it's not enough to meet demand.

Only open for three hours a day, Health Hub director Dr Jerome Muir Wilson said for people who were unable to wait for this window and who couldn't get into their GP, the LGH ED becomes the only available option.

However, Dr Muir Wilson said there was no government support for this service, even though it reduces the pressure on the government-funded ED.

"As general practitioners, we can provide early intervention, diagnosis and treatment to keep patients out of the hospital system," he said. "But we are not seen as an investment even though it can help deliver the laudable target of making Tasmania the healthiest state in the nation.

"I feel GPs either in an urgent care centre or accessible/affordable alternative to the emergency department would be a great option. This requires collaboration amongst the Commonwealth and state governments for a willing general practice community willing to help out that current medicare arrangements make it unsustainable."

Bass Liberal MHR Bridget Archer said she had engaged with several Northern Tasmanian general practices and was aware of their concerns.

"I have been consistently advocating on this precise issue to Canberra colleagues, including directly with the Prime Minister's office last night [Wednesday] and will continue to do so in my fight to ensure our community has greater access to primary care services," she said.

Health Minister Sarah Courtney said the state government was continuing to work closely with GPs.

"While the federal government is predominantly responsible for funding GPs and primary care, and provides a higher rebate level to incentivise the delivery of after-hours care, the Tasmanian government is investing in community-based care to reduce hospitalisation and deliver better care," she said.

"These investments include important services that link in with GP clinics such as the Community Rapid Response Service, and we are progressing a brand new specialist support model in the North and North-West as part of Our Healthcare Future.

"This new model will help to take the pressure off our EDs by supporting better patient management and helping with clinical support."

The Launceston Health Hub plans to build on its after-hours services further as part of expansion plans, due to be completed by 2023. This includes an increase from 48 existing medical practitioners to 73, with the number of medical staff on site at any one time to increase to 25 - including seven GPs and 18 specialists.

The idea of a co-located hospital in Launceston is not new to the region, or the broader health precinct.

Before John Kirwan was chief executive of the Royal Flying Doctor Service Tasmania, he was chief executive of the LGH and Northern Allied Health Services from 2008 to 2014.

In that time, the hospital commissioned a report from health consulting company Banscott to investigate the potential of a co-located hospital. And, he said it found there were many advantages to the development.

"After this report was finalised, the world was hit with the global financial crisis and the next couple of years were focussed on finishing the rebuild and dealing with significant budget challenges, all while maintaining a busy acute hospital," he said.

"The merit of this report and a co-location was not forgotten with several leading doctors, who worked in both the private and public sectors, keeping the issue alive before Calvary lodged an unsolicited proposal three years ago."

Mr Kirwan said all stakeholders should strive to optimise the proposal as an opportunity to create synergies within the health system, that benefits from working together.

"While it may not be obvious, there is an interdependence between the public and private health sectors," he said. "If this was lost, the outcomes would be adverse. A co-located hospital enables patients and their families at the centre of health service delivery."

Similarly, both Dr Gardner and Dr Muir Wilson agreed that Calvary's proposed co-located hospital could help take pressure off the LGH, but only if it's delivered in the right way.

Dr Muir Wilson said there was potential for hospitals and community GPs to work more closely together, while also relieving frustrations often felt by patients.

"Our current private hospital where designed and constructed years ago and is much harder to retrofit, as we have seen at the Royal Hobart Hospital, than to have a purpose-built service," he said.

"Launceston has a great history of attracting practitioners that work across the public and private system, but this is getting harder with older infrastructure, older operating theatres that were designed around older models of care. Being co-located will hopefully lead to better cooperation that all patients will benefit if they have private health insurance or not."

Dr Muir Wilson said GPs often helped patientS navigate the health system and witnesses admission blockages daily.

"Over the last few decades Calvary has stopped offering spinal surgery, post-natal care, private ED and acute admissions," he said.

"Hopefully by being co-located with access to onsite doctors and the back up of intensive care, those patients with private health insurance will have improved access.

"Those without insurance will also benefit as currently a number of unplanned hospital admissions can only access care at the LGH."

Launceston independent MLC Rosemary Armitage, who also heads the LGH Community Support group, said patients needed to have immediate access to intensive care when they needed it.

She said waiting lists, ED waiting times and the availability of services and specialists remained the key concerns raised with her.

"I believe we missed an opportunity by not locating a private hospital on the site of the old LGH with an overpass walkway connecting the two hospitals," she said.

"I would like to see an emergency department in the new co-located hospital as it would take bed pressure off the LGH.

"While the LGH emergency department staff do a wonderful job, they are hampered by large attendances and a lack of space, given the bed block.

"People with private health insurance, with less serious conditions, could then be admitted to the co-located private hospital for their care."

What do you think? Send us a letter to the editor: