A resident who went to his local walk-in centre with a skin infection was turned away because staff said he needed complex care.
The centre, known to treat skin conditions, instructed the elderly man to visit an after-hours GP the same day. Even so, the man's health deteriorated in the following days and he was eventually rushed to the emergency department.
His regular GP, Dr Emily Rushton, was on leave when he had the infection and said her patient struggled with memory loss and confusion.
"It was deemed that this patient was too complex to be managed ... he has a cognitive impairment, didn't really understand instruction, and didn't follow up with a GP," she said.
"It wasn't until I was back ... I was able to follow up with that patient, but by that stage, the infection had spread significantly. He ended up needing hospitalisation for [intravenous] antibiotic treatment."
The doctor said this almost happened again, with another patient.
She said man with severe liver disease also went to a walk-in centre with a skin infection and he was prescribed antibiotics "inappropriate" for someone with the chronic illness.
"I followed up with that patient when I got the discharge summary to change them to something that was safer," Dr Rushton said.
She said the nurse did not have access to man's primary health record and the patient didn't mention the illness because he didn't think it was related.
Unfair expectations
In both examples, Dr Rushton said nurses were depending on patients to tell them about medical problems and to know which details were important.
The latest census showed 52.3 per cent of Canberrans had at least one chronic health condition.
"Patients are being relied upon to firstly, understand their health condition and secondly, be able to advocate for themselves. It's not a fair expectation with complex things like prescribing, to expect the patient to know what's safe for them" she said.
Dr Rushton said numerous local doctors had patients with similar experiences.
"Speak to any GP in Canberra, it's a really widespread problem," she said.
"And it's nothing to do with the nurses, they are an incredibly skilled set of nurses ... they're just being put into a model where they're not supported."
Do walk-in centres need doctors?
Canberra's walk-in centres are part of a national network of Medicare-funded urgent care clinics across Australia. But ACT's clinics are unique because none have doctors.
"[Nurses] don't have backup from a medical practitioner if things are outside their scope. They're being forced to work with incomplete information from the patient, it's just not a fair model," Dr Rushton said.
She believed if both her patients had been seen at walk-in centres with GPs, they could have received appropriate treatment in time and spared one patient hospitalisation.
While walk-in centre services are free, they cost the taxpayer close to $200 per presentation.
"I'm still bulk-billing 50 per cent of my patients, and that's costing $43 to manage the same problem," Dr Rushton said.
She said GP care came with the added bonus of "being able to do preventative care, chronic disease management, and build a lifelong relationship with a patient."
A 'waste' of Medicare money?
The ACT health directorate has been in hot water before when officials shared lower estimated costs, inconsistent presentations data, and did not disclose why they had stopped publishing quarterly walk-in centre performance reports.
How many people are ending up in hospital or at the GP's office after they could not be treated at a walk-in centre? Data has not been available since November 2022.
Internal emails between ACT public servants revealed this was because there was no methodology to calculate these redirections after the Digital Health Record came into effect.
Dr Rushton said these numbers were important because it showed if ACT's walk-in centres - introduced to reduce people going to the hospital - were a successful model of care.
The doctor also said there was no evidence behind the government's move to lower the age of patients, who could be treated at a walk-in centre, to 12 months old.
Peak body 'frustrated'
The NSW/ACT chair of the Royal Australian College of General Practitioners, Dr Rebekah Hoffman, said Canberra's walk-in centres needed to be reviewed by an independent body.
She said the lack of publicly available information was "frustrating".
"We need to have clear outcomes," Dr Hoffman said.
"[The ACT government] is putting money into healthcare without actually having a clear understanding of the outcome of that spend - the Medicare budget. If they're wasting money potentially ... then that's a problem."
The RACGP's local arm called on all 15 political parties and independent candidates to promise an external review of the walk-in centres if elected.
What some political parties said
An ACT Labor spokesperson did not promise such a review, but said the average presentation at walk-in centres cost much less than at emergency departments (about $1000 in 2022).
They said a re-elected Labor government would "continue to ensure transparent performance reporting" across the public health system.
"Robust processes are in place within Canberra Health Services to support treatment protocols and service expansion based on appropriate data and evidence, such as enabling the treatment of children between one to two years," the spokesperson said.
The ACT Greens spokesperson said calls for a review were politically-driven and added public services already had regular evaluations and accreditations.
"Canberrans just want to see things get done and services delivered, not politically-motivated inquiries," she said.
The Independents for Canberra party was vocal in promising a review, if elected.
"As a registered nurse, I know too many people aren't getting the care they need when they need it," IFC's Yerrabi candidate, Sneha KC said.
"People are triaged out of the emergency department or turned away from walk-in centres when they present with issues that are outside of nursing's scope of practice."
Thomas Emerson, IFC leader and Kurrajong candidate, said an independent review could "take the politics out of the conversation" and reveal if funding was being used in the best way.
