Urgent care and after-hours clinics nationwide in crisis

MEDIA RELEASE

Thursday 23April

URGENT CARE AND AFTER-HOURS CLINICS NATIONWIDE IN CRISIS

The Accident and Medical Clinic Association (AMCA) is calling on Government to make a strategic investment in patient care by supporting an industry “hanging on by a thread”.

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 frontline continuing to deliver acute healthcare in our communities,” AMCA chair Neil Beumelburg says.

But in the current situation the risk is that many clinics are being forced to close early and lay off staff, meaning patients needing face to face care will end up in ED.

“This is the last place they should be presenting with minor injuries, for example,” Dr Beumelburg says.

There is research demonstrating the crucial role urgent care and after hours clinics play in supporting general practice out of hours and keeping patients with mild to moderate illness and injury out of hospital EDs.

Furthermore, 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.”

Support package denied
Last week, AMCA with support from the RNZCUC (Royal NZ College of Urgent Care) approached the Ministry of Health to request a package of support funding in the same way general practices (that receive capitation) did recently.

“While the Ministry was sympathetic and agreed we had a good case for support funding, the proposal put through to Cabinet last week was not approved,” says Alistair Sullivan, AMCA secretary.

“We were really surprised. It seems like the Government is not fully aware of the tenuous state of after-hours and urgent care clinics at present.

“We are hanging on by a thread. Ultimately this threatens an industry that delivers over 2.5 million face to consultations to patients each year.

“Our healthcare system cannot afford to see clinics failing during this difficult period. We are asking the Government to invest in our capacity to deliver healthcare to New Zealanders, protect our established healthcare system as a whole and let us play our part in the battle against COVID-19,”says Dr Beumelburg.

Dr Sullivan says practices have continued to make themselves available to patients after hours during the current pandemic, but this is not sustainable.

Some clinics on the brink of collapse

The current situation is pushing many clinics to the brink of collapse.

“We have been receiving hundreds of emails 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 with accidents which clinics rely on to produce up to 80% of their income,” he says.

Dr Sullivan says many of their clinics are not general practices so cannot fall back on capitation 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.

Discussions with the Ministry are ongoing.