A Sense of Urgency: what is Urgent Care and why is it here?

Just over two years ago, Albanese made a pre-election promise to build 50 Urgent Care Clinics providing fully funded, aka ‘free’ care, to any Australian possessing a Medicare card in need of urgent medical care. 58 Urgent Care Clinics later, and we see yesterday’s Federal budget announcement include funding for 29 more Urgent Care Centres.

The number of UCCs in Australia are steadily growing, as is the number of people who are attending them. They are a newly evolving sector of Australia’s healthcare system, providing people with non imminently life threatening medical conditions timely medical care.

I have worked in Urgent Care in Australia since 2015, and for as long as I have worked in Urgent Care, I have been asked, ‘What is Urgent Care?’

Urgent Care is an area of medical practice providing care to people who have health issues needing to be addressed now, that are not immediately life threatening.

Urgent Care is not a particularly new phenomenon. It has been an integral part of the health systems of the USA, Canada, the United Kingdom, and New Zealand since as early as the 1970s. Amongst the world’s healthcare systems most akin to our own, we are a relative outlier. America and New Zealand each have their own specialist fellowship pathways in Urgent Care. With the rapid growth of Urgent Care Clinics in our healthcare landscape, Australia’s own specialist training pathway will be the next foreseeable development, further integrating this model of care into our healthcare system.

There is a great deal of overlap between Urgent Care and General Practice, and between Urgent Care and Emergency Medicine. This is because up until now, patients have typically received care for urgent medical issues from either their GP or the Emergency Department.

With pervasive gross underfunding, undervaluing, and underinvestment in General Practice spanning decades, a record low of medical graduates are choosing to become General Practitioners. Whereas we previously expected up to 60% of all medical graduates would opt to become a GP, we now anticipate as few as 10% of all medical graduates will choose this area of expertise. By 2031, it is projected Australia with have a 30% shortfall of General Practitioners. There is currently an increasing number of Australians who do not have access to or are unable to afford their own GP. There are currently no signs of this trend being averted.

Without adequate access to General Practice, disease prevention is no longer possible. This results in more people needing medical care for diseases and conditions which might have been treated earlier or prevented altogether. The high cholesterol that wasn’t detected, treated, then monitored, will not have prevented a massive cardiac arrest requiring the technical skills of Emergency physicians, Intensive care physicians, and Interventional Cardiologists with all of their attendants. Without enough GPs, more people are seeking medical care elsewhere.

In tandem with the decline of General Practice Specialty medicine, Emergency Medicine is beset by increasing numbers of patients with increasingly complex health conditions. Our Emergency Departments now run at or over capacity most of the time. In spite of projections in 2017 that there would be twice as ED Specialists as needed, the Covid-19 pandemic proved how untenable the working conditions were in our Emergency Departments; so untenable, that on average across Australia last year Emergency Department medical positions were said to be understaffed by roughly 30%. Being a highly trained health professional working within a system which is unable to provide working conditions fit for purpose is a recipe for burnout and workforce attrition.

The most recent data show that the number of beds per 1000 Australians aged over 65 has again fallen to the lowest number on record, down to 14.3. Without immediate investment into the capacity of our public health system, this long-term decline will continue, impacting the ability of both young and old Australians to access the public hospital care they deserve. Reference: 2024 Public Hospital Report Card

The AMA’s latest 2024 Hospital Report Card provides clear insights as to why Australians are increasingly unable to receive timely care from highly trained healthcare providers in our public hospitals. We now have less than half as many public hospital beds available to provide care to sick people as there was 30 years ago.

When the hospital does not have enough beds, the Emergency Physician cannot admit sick patients. This is called ‘bed block’. Those sick patients stay in the Emergency Department, creating additional work and taking up a bed which might have been occupied by the patient forced to continue waiting ever longer to be seen.

If you happen to be a patient unfortunate enough to have a massive cardiac arrest, you can expect to receive timely care in an Emergency Department. If you happen to be a patient with a laceration to your finger, or even severe abdominal pain, you probably already know you can expect to wait a long time to be seen in the Emergency Department. In numerous Emergency Departments in Australia, a person with a non-life threatening medical problem might expect to wait eight to ten hours to receive medical care.

Fewer emergency department patients are being seen on time. This is particularly true
in Category 2 (emergency – under 10 minutes) and Category 3 (urgent – under 30 minutes). Reference: 2024 Public Hospital Report Card

Often people with minor injuries and illnesses needing medical care simply give up and go home, however, if you need to wait six weeks for an appointment with your GP, an eight hour wait in an Emergency Department for an urgent health concern is relatively convenient.

People with urgent but relatively minor health issues are often underserved by Emergency Departments increasingly swamped by sicker people needing emergency and critical care. They are also often underserved by General Practices, booked weeks in advance, if they haven’t closed their books altogether.

Urgent Care is an area of medical practice which provides health care to people who need same day treatment for relatively minor illnesses and injuries.