Govt and doctors bicker over move to unclog emergency departments

The Health Minister has disputed doctors’ claims that the State Government didn’t properly consult them before rolling out a strategy to divert patients from public hospitals as ambulance ramping reached record highs.

Oct 14, 2019, updated Oct 29, 2019
Health Minister Stephen Wade. Photo: Kelly Barnes / AAP

Health Minister Stephen Wade. Photo: Kelly Barnes / AAP

In August, the government announced the opening of four “priority care centres” – spaces within GP clinics around Adelaide, to which patients could be diverted if they arrive in hospital emergency departments with non-life-threatening conditions.

The Royal Australian College of General Practitioners (RACGP) claims the Government did not adequately consult GPs about the proposal.

Dr Zakaria Baig, SA chair of the College, told a parliamentary committee earlier this month that few patients are being diverted to the centres because they operate during the same hours as normal GP clinics.

“The government didn’t consult us – they actually just debriefed us, (saying) ‘okay, we are rolling this out from that day.’

“When they were establishing this at the grassroots level, they didn’t talk to us about how can it be done, so there are some concerns.

“The (key) concern is the service only runs between 10am until 6pm, so the service runs when all the surgeries are open.”

Health Minister Stephen Wade wrote to Baig on Friday last week, “disappointed” with his interpretation of the government’s consultation efforts.

“I was disappointed in regards to your comments on consultation and the priority care centres,” the letter reads.

“The Marshall Liberal Government is committed to consultation with clinicians and the co-design process is a good example of the benefits of cooperation.”

The letter cites telephone and email contact, and a meeting between Wellbeing SA CEO Lyn Dean and the College in July this year, and another meeting last Wednesday.

“I would appreciate a clarification as to why the RACGP did not reference this consultation with the committee, and why the RACGP has not raised your concerns with SA Health,” it reads.

“It is vitally important to the government to have ongoing constructive dialogue with groups like the RACGP as we look to build a better health system for all South Australians.”

According to an uncorrected transcript of Baig’s testimony to the committee obtained by InDaily, he did in fact refer to two meetings with Dean.

But he complained that the communication from the government had been more like a notification that the priority care centres proposal was going ahead, rather than a consultation on how it would work.

“You would think that the government, in the development phase, would reach out to tell us that ‘this is what we are planning. What do you think? What are the suggestions?’ considering the project would be run by the GP,” he told the committee.

“But we were not consulted in that phase.

“It was more to tell us that, ‘this is going to kick-start from this day and we are just letting you know.”

Baig added during his testimony that said he had spent a day on a shift at one of the priority care centres – and only two patients came in.

One of them, he said, was assessed at the Lyell McEwin Hospital and misdiagnosed, deemed to be a “low priority patient” with groin pain, and sent to the priority care centre.

“When I examined, I just made my conclusion: no, he actually had deep vein thrombosis,” Baig recalled.

“So I said, ‘we’re going to do a blood test – if the test comes back positive, it means it’s a clot and then you go to the hospital.’

“The blood test came back positive for a clot, and we asked the patient to go now to the ED, Lyell McEwin Hospital.”

He added: “If you put yourself in the patient’s shoes, they will say, ‘I went to Lyell Mac, and they sent me there, and they had correctly diagnosed and sent me back to them.”

The centres were established as a 16-week pilot project, aimed at easing pressure on emergency departments, and therefore reducing ramping, by sending patients who do not need emergency treatment to GPs.

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Data released to InDaily earlier this month showed that ramping hit a record high in September, with ambulances parked for 2303 hours outside public hospitals, holding patients waiting to be examined or treated.

But in a press release the following week, Wade argued that the government’s efforts to solve the problem were showing “green shoots”, including the performance of the priority care centres.

“Ramping is unacceptable, and it is heartening to see such promising results,” he said.

“We are starting to see some green shoots from these programs which are easing the pressure on our emergency departments.”

Wade lauded the success of the priority care centres, saying that more than 500 patients had been sent to them over the past two months.

But Opposition Health spokesperson Chris Picton said that on those figures, each of the four priority care centres was seeing just 2.2 patients each day on average – compared to the more than 1300 patients presenting to the state’s emergency departments daily.

“At a time when ambulance ramping has doubled to new record levels – the Government is paying for clinics that are only seeing one patient every few hours,” he told InDaily.

“Something is out of whack here – our hospital emergency departments see thousands every day, a GP usually sees up to 30 patients, but Stephen Wade’s centres are only seeing a tiny number of three patients per day.

“Having these services close at 5pm or 6pm misses the peak demand on hospitals when services are not available.”

Picton described Baig’s evidence to the committee as “damning”.

“Clearly the rollout of these centres (has) been rushed and there is potential for clinical harm to patients as the College has outlined,” he said.

“It appears totally ham-fisted that the Government is paying to open GP clinics when they are already open.”

“Instead of cutting doctors and nurses in hospitals and moving funds to clinics with no patients, Stephen Wade should reverse the cuts in hospitals that are leading to record ramping.”

The Government has announced voluntary separation packages for SA Health staff in central and northern Adelaide and closing 60 public hospital beds.

SA Health justified the latter measure by saying that demand for hospital services was forecast to decrease as the winter peak period subsided.

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