Tasmania's health workers union fears new bulk-billing urgent care centres could put more pressure on the state's paramedics, unless the federal government ensures the community is fully aware of when to access those new clinics.
The Health and Community Service Union (HACSU) is concerned that its workforce — which comprises ambulance workers and doctors — had not been consulted about the new model.
On Monday, the federal government announced that Tasmania would get four such centres, two in Hobart and one each in Launceston and Devonport.
The centres — to be based at existing GP clinics — are designed to fill a sub-acute gap between GPs and emergency departments, where non-life-threatening care can be provided to ease pressure on hospitals.
They would also have ambulance bays.
HACSU Tasmania assistant secretary Robbie Moore said the union had been contacted by Ambulance Tasmania staff who were concerned that the model would further increase their workloads.
"We're worried that this announcement — that hasn't been consulted with Ambulance Tasmania staff and other health professionals — will lead to confusion in the community that ambulance services can be provided for an expanded range of services," he said.
"If the government does not get it right in relation to this — and in relation to what they're communicating to the community — then we will see more and more people calling triple-0 for non-urgent and non-emergency cases."
The centres will be established later this year, with the Tasmanian Government locating existing GP clinics that would be suitable.
Tasmania will be among the first jurisdictions to adopt the model, which will be jointly funded by the Commonwealth.
Federal Health Minister Mark Butler said the selected GP clinics would retain their existing practice and patient list, and the urgent care centre would be in addition to these services.
He said the centres would not replace the functions of GPs, but were specifically for non-life-threatening emergencies, such as sprains and lacerations.
"We want to be very clear that this is not a place to go because you can't get into your local GP with a relatively routine matter that is not urgent," Mr Butler said.
"The scope of practice for these centres is clearly focused on non-life-threatening emergencies. You can't just go there to get a routine script or to do the sorts of things you want to do with your GP.
"The second thing we've been negotiating with the states is to make sure these centres have very clear operational guidelines to work with local hospitals, and to work with local ambulance services."
Guidelines would be established regarding what kinds of health issues are sent to hospital emergency departments, or to urgent care centres.
Questions over staffing
Tasmania already has a significant skills shortage with GPs, particularly in regional areas, with more than 70 vacancies across the state.
The kind of work to be carried out in the urgent care centres falls within general practice.
Dr Lester Pepingco — who practises at the Derwent Valley Medical Centre in New Norfolk — said any additional health services should be welcomed, particularly in a sub-acute setting.
He said it could have benefits beyond treating minor trauma injuries.
"It's much cheaper and more efficient to treat the cholesterol and the blood pressure, than it is to treat the heart attack with the surgery and the stent 10 years down the track," Dr Pepingco said.
"Those urgent presentations that might have otherwise been funnelled to the emergency department, the sub-acute segment … why have they been funnelled there? Because of an inability to access that initial primary healthcare."
However, he said, it was unclear how the urgent care centres would be staffed.
"That's what I'm puzzled about. The idea works in theory — it's a great idea — but who the bloody hell is going to staff it?" Dr Pepingco said.
"The chronic GP shortage, it's not even just GPs, it's every specialty throughout the state."
'Chronic illness' behind blockages
Emergency doctors — the workforce that the government intends to help the most with its announcement — were also concerned that the centres would not achieve their intended outcome.
Australasian College for Emergency Medicine president Dr Clare Skinner said hospitals were overcrowded for a range of reasons, and not just because of minor injuries being taken to emergency departments.
"There will be a small number of people who can avoid an emergency department visit because they're able to receive care for a minor issue, like a sprained ankle or a small cut," she said.
"It's not the people with minor problems that are causing blockages in the acute hospital system.
"It's the large numbers of people who have chronic, complex illness, who require admission to a hospital bed, who are not able to access that bed, who are causing a backlog in an emergency department."
Dr Skinner was also concerned that the centres might cause confusion in the public, by adding another option in an "already complex" health system, and disrupting patient relationships with their GPs.
Bulk billing rates 'worst in country'
Mr Butler said the model had been developed in close consultation with state and territory governments, to start to address some recurring issues in the health system.
Among those, was reintroducing bulk-billing services to Tasmania.
"Tasmania is a real standout for some reason. Bulk-billing rates are some of the worst in the country … the gap fees are some of the highest, in Tasmania," Mr Butler said.
"Given that GPs get the same rebate in Sydney as they do in Hobart or Adelaide or Melbourne, why is there such variance in the bulk-billing rates and the gap fees in different parts of the country?
"The trend in bulk-billing is deeply disturbing."
