Super clinics won't ease emergency overload

The revelation that most of the Rudd Government's GP super clinics will not be operating for at least another two years has brought opponents of this expensive program out into the open.

The centrepiece of the government's health and hospital reform agenda is facing renewed criticism just as Tony Abbott has flagged Coalition support for a national referendum on a commonwealth takeover of hospital funding.

It is worth remembering that then newly minted opposition leader Kevin Rudd made the same promise in the days of Kevin 07 and has backed away from it since. Abbott's support for a referendum, however, could prove a policy game changer.

The opposition is targeting the systemic problems that plague public hospitals run by giant state government bureaucracies.

Direct federal funding of hospitals run by local boards is far superior to throwing taxpayers' dollars at so-called solutions to the hospital crisis, such as super clinics, that are more ideologically driven than evidence-based.

Under the $275 million super clinics program, the Rudd government is funding the start-up costs involved in bringing together general practitioners and allied health professionals, such as physiotherapists and podiatrists, who want to amalgamate their practices into one-stop shops. An initial 38 clinics have been announced in the past 18 months.

General practitioners fear super clinics, generously subsidised by taxpayers, will compete unfairly and put established private practices out of business.

This follows the direct action taken by suburban GPs associated with the Doctors Action Group who in early November closed their surgeries in protest against the threat super clinics posed to the traditional family GP. GPs are legitimately worried about the long-term effect of large-scale and centralised super clinics on private general practice.

The concern is that young doctors will not buy into an established practice, into which retiring doctors have invested large amounts of capital and years of service, when the alternative is to join a government-controlled super clinic for free with the capital costs paid for by taxpayers.

If private surgeries are crowded out and it becomes too costly and difficult to establish one from scratch, it is conceivable that a future federal government may force doctors to work in super clinics on a salaried basis. Super clinics are therefore a slippery slope that potentially could lead to the nationalisation of Australian general practice.

For the ideologues in the federal health bureaucracy opposed to private medicine, the end of fee-for-service GP care is a time-honoured objective.

In fact, super clinics are a throwback to the Whitlam government's polyclinic model of the 1970s.

Publicly, at least, the Rudd government has consistently claimed that federally funded super clinics are designed to boost the provision of GP services and take the pressure off dangerously overcrowded public hospitals.

The idea is that emergency departments will no longer be swamped by so-called GP-style patients with minor illnesses once a super clinic offering extended-hours services is established at a nearby location. Hence, Health Minister Nicola Roxon recently claimed the program already was helping to solve the hospital crisis, with a super clinic in Tasmania reportedly reducing by 13 per cent the number of people turning up at the nearby emergency department with minor illness.

This sounds impressive. But in reality this confirms how flawed the super clinics program is and how little pressure on hospitals they will relieve.

Several studies have found patients with a cold or sore toe constitute only 10 per cent to 15 per cent of total emergency presentations. But because GP-style patients suffer uncomplicated conditions, they are in fact quick, easy and cheap to treat in emergency departments. They account for a mere fraction, 2 per cent to 3 per cent, of the total workload and for about just 7 per cent of total costs.

Locating extended-hours GP clinics near emergency departments has been found to produce, at best, "an average reduction in attendances of one patient every two hours while the clinics are open". Not surprisingly, studies have also shown it is far cheaper to treat the few GP-style patients in emergency rather than incur the huge capital overheads of establishing stand-alone GP facilities.

The plan to divert GP-style patients into super clinics will therefore impose a huge cost on the federal budget, a cost that is difficult to justify given the insignificant effect super clinics will have on emergency workloads and costs.

But this isn't the half of it. Every credible study shows the critical national shortage of acute beds, not a lack of alternative GP services, is the real cause of the hospital crisis.

Lack of beds - public beds have been cut by two-thirds since 1983 - is the reason more than one-third of emergency patients requiring unplanned admission are forced to queue on trolleys in hospital corridors for more than eight hours before being admitted to a bed.

Regardless of the facts, the government seems hell-bent on proceeding with a planned roll-out of a 300-strong national network of super clinics.

Such waste of taxpayers' dollars on a non-solution for the hospital crisis is anything but an efficient and effective investment in sustainable and evidence-based health reform.

We are right, therefore, to suspect the ideological motives behind the super clinics program.

As the health debate heats up ahead of next year's federal election, super clinics will look increasingly like the anachronism they are.

Next year is shaping up as the year we finally get serious about structural reform of our public hospital system.