New Zealand’s Urgent Care and After-Hours Clinics in severe crisis

The Accident and Medical Clinic Association (AMCA) and the General Practice Owners Association of Aotearoa New Zealand (GenPro) are calling on the Government to recognise a life-threatening risk to continuity of services for local communities due to another unsupported and vital primary health care service which has been left hanging by a thread.

Due to fundamental flaws in the Government’s funding framework for such essential health services, many clinics risk being forced to close early and lay off staff, meaning local communities are left without urgent care services or facing impossible journeys to the nearest emergency departments (EDs) which may be several hours away.

A massive drop in the number of patients attending during the pandemic and lockdown period has led many after-hours and urgent care clinics to lay off staff and is threatening their viability. “Urgent care and after-hours clinics and their staff are at the front-line and under significant pressure to continue to deliver acute healthcare in our communities” AMCA chair Neil Beumelburg says.

Urgent care and after hours clinics play a vital role in supporting general practice services and keeping patients with mild to moderate illness and injury out of hospital EDs. As the alert levels scale down, Dr Beumelburg says the AMCA expects to see a huge increase in patient demand.

“If clinics are not supported now they will not be well placed and ready to deliver care to people who need it, including those people most at risk. That will also result in a tsunami of unmanageable demand arriving on the doorsteps of hospitals and their emergency departments.”

AMCA, GenPro and the RNZCUC (Royal NZ College of Urgent Care) had worked with the Ministry of Health to propose a package of support funding for urgent care and after hours clinics in the same way general practices did recently. Having been led by the Ministry to believe the support would be provided, the Associations were not then expecting Cabinet to decline the funding.

GenPro Chair and GP, Dr Tim Malloy [pictured above] had already raised concerns directly with the Minister of Health regarding the withdrawal of previously promised COVID-19 support funding for General Practices and now says “This is another ridiculous situation. Local communities are at risk of being left without vital front-line and life-saving services whilst the country is in the midst of its war against COVID-19”.

Dr Alistair Sullivan, AMCA secretary [pictured above] explained that whilst practices have continued to make themselves available to patients after hours during the current pandemic, but this is not sustainable.

“We are hanging on by a thread. Ultimately this threatens an industry that delivers over 2.5 million face-to-face consultations to patients each year. The current situation is pushing many clinics to the brink of collapse.

“We have been receiving hundreds of e-mails and phone calls from clinics worried about having to lay off staff and potentially reduce opening hours to remain viable.

“To pay their bills, these clinics are relying on patients who walk in. This is just not happening at present for a variety of reasons relating to the current pandemic. People are staying home and remaining in lockdown and are less likely to present to clinics which those clinics rely on to produce up to 80% of their income,” he says.

Dr Sullivan says many of their clinics are not also general practices so cannot fall back on capitation funding to financially sustain the cost of after-hours visits. They are 100% reliant on patients walking in the door to remain afloat.
AMCA surveyed its clinics this week to get an exact picture of the extent of the problem.

“We got a 100% response rate with replies from all 46 clinics nationwide to whom we sent the survey,” says Dr Sullivan. “Data from our member clinics shows there is a drop in ACC visits by between 26% and 90% since the pandemic started, with the average being a 54% drop. Overall patient numbers have also dropped between 33% and 85% with an average drop of 51%.”

Many clinics have needed to reduce their opening hours and have done this mostly at the later (more expensive) end of the day, when patients have few other choices.

For example, a clinic that was open previously 8am to 8pm, 7 days per week is now only opening 9‒4pm weekdays and 9‒3pm on the weekend. This means there is no after-hours service for those patients and the only place they can then be seen is ED.

The survey also asked clinics to identify the likely outcomes for their services if this continued: 43% responded they were very likely to have to close within one month.

If clinics are forced to shut and do so for any prolonged period it is likely many will never recover and will remain closed permanently, Dr Sullivan believes.