GP clinics at hospitals: an interview with Dr Sharma, Monash University

Interview conducted by April Cashin-Garbutt, MA (Editor)Apr 11 2013

How many hospitals in Australia have general practice (GP) clinics on site?

Around 13 per cent of hospitals have a primary care unit within the emergency department and 6 per cent have a free standing primary care unit.

How does this percentage compare to other countries?

There is no explicit data available for co-located GP clinics across countries. However estimates are available for after-hours primary care arrangements.

In the US 40 per cent of GP practices have after hours arrangement in contrast to five other countries (Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom) where between 76 per cent and 95 per cent of doctors provide such after-hours care.

What is the purpose of GP clinics at hospitals?

The main characteristics of GP clinics are:

• they provide acute, episodic primary care services on a walk-in basis
• are located within a public hospital, near or adjacent to but physically separate from the hospital ED
• only operate in the out-of-hours period including evenings, weekends and public holidays
• have the character of a community-based general practice
• are private practices with distinct business, management and administrative structures to the hospital in which they are located.

The range of services provided by GP clinics include medical consultation, fracture management, minor procedures, electrocardiogram (ECG), management of minor injury and trauma, referral and notification and referral to on-site radiology and/or pathology.

Are the on-site GP clinics open 24/7?

No. Co-located AHGP clinics provide services outside usual business hours. Generally, after-hours is considered to include services provided on a public holiday, a Sunday, before 8am or after 12pm on a Saturday, or anytime other than between 8am and 6pm on a weekday.

Your recent research looked at the relationship between GP clinics at hospitals and waiting times in emergency departments. Please can you outline what your research involved?

Emergency department overcrowding is a critical issue in the Australian Health care system. There is an increasing number of non-urgent patients (which can be treated by GPs) turning up at the EDs thereby increasing the waiting times for urgent patients.

There are two types of potential ED patient demand management strategies to tackle this issue:

1. opening up new EDs or physical expansion of current EDs which offers more choice of EDs to patients and
2. opening co-located GP clinics adjacent to EDs where non-urgent patients can be diverted for treatment.

Our research compares these two strategies to find the more effective strategy in reducing waiting times for urgent patients. We apply survival regression techniques on patient level administrative data to model the effect of these two strategies on waiting time.

Our main findings are that having more EDs in a region (greater degree of choice) leads to higher waiting times for urgent patients.

On the other hand urgent patients in EDs with a co-located GP clinic have 20 per cent lower waiting times compared to patients in other EDs. Thus opening up a co-located GP clinic is more effective strategy in reducing waiting times for urgent patients.

Why do you think more choice of emergency departments in a region actually increased waiting times?

More choice of emergency departments in a region might lead to relatively higher number of presentations from non-urgent patients (especially after-hours), also called a supply-induced demand effect, where greater supply of services generates demand.

This increased demand from non-urgent patients might lead to ED overcrowding and longer waiting times. EDs are preferred by non-urgent patients during after-hours as the treatment is free of charge and EDs are easily accessible.

By how much did co-located GP clinics reduce the waiting time for patients in emergency departments?

Urgent patients in EDs with a co-located GP clinic have 19 per cent lower waiting times. This amounts to 1.5 minutes less waiting time where average wait is 10 minutes for an urgent patient.

How many people in emergency departments actually don’t require emergency care?

For 2011–12, potentially avoidable GP-type presentations accounted for about 38 per cent of all presentations to emergency departments in principal referral specialist hospitals and large hospitals.

In general, the proportion of presentations to emergency departments that may have been potentially avoidable was higher for large hospitals (48 per cent) than for principal referral and specialist hospitals (36 per cent).

Are there plans in place to increase the number of hospitals with co-located GP clinics?

All the state governments in Australia have announced plans to open co-located GP clinics.

The New South Wales government allotted 8 million AUD for ten GP clinics in 2006/07 budget.

Victorian government has already increased number of GP clinics to six.

The Commonwealth government announced $10 million General Practice After-Hours Grants Program in December 2010.

Where can readers find more information?

Copy of the paper can be found at: http://emj.bmj.com/content/28/8/658.long

More information on co-located GP clinics in Victoria is available at: https://www.health.vic.gov.au/

About Dr Sharma

Dr Anurag Sharma is a senior research fellow at the Centre for Health Economics, Monash University, Melbourne.

Before joining Centre for Health Economics Sharma’s previous appointments were at the Australian National University, Canberra and University of New South Wales @ ADFA, Canberra as part-time Research Fellow.

He has worked on several research projects, most prominent being “Modelling the economics of the Australian health care system for policy analysis” funded by NHMRC and “ Poverty Traps, Nutrition, Health Status and Anti-Poverty Interventions in Rural India ” funded by DFID, UK.

He is currently primary chief investigator of ARC Discovery Project titled “The role of taxes and subsidies in promoting healthy lifestyles: An economic analysis”.

He has written papers as first author with prominent health economists Jeff Richardson, Anthony Harris, Bruce Hollingsworth and Luigi Siciliani. He has written papers with prominent development economists Raghbendra Jha and Pushkar Maitra focussing on the issues of poverty, malnutrition and gender bias in education in India.

Sharma’s current research projects include investigating the impact of taxes on sugar sweetened beverages on obesity, comparing several alcohol taxation strategies and modelling patient choice between public and private hospitals.

Dr Sharma was awarded PhD in Economics from Australian National University in December 2005.