12:23pm, 24 Feb 2010 Dr Phil Rutherford

The concept of the so-called super clinics appears to have been built around two assumptions:

a. That if a patient is attended to by a doctor who feels that care could be enhanced if they are also seen by another specialist, this specialist is available at the time, and

b. the patient doesn't have their own specialist and is happy to see whomever their doctor recommends.

From a business point of view super clinics are a great idea. They save the medicos a lot of money, they can send referrals to each other, and their marketing and advertising bill is almost zero. But from a health care point of view I think they are nothing more than a grinding machine into which people are more and more being forced with no respect for their rights or concerns. They are often in the middle of shopping centres which means those in outlying suburbs must travel a long way to see a doctor who was quite often located close by. The costs will go up because the doctor/patient relationship often found in the community medical centre is lost and people will find themselves having to see the first doctor/specialist available, rather than someone with whom they've built a rapport.

I personally think it is sad that these so-called advances in patient care are more and more driving people to distrust those in whom they should place their utmost faith. I also think that the future will see us having to work harder to regain this trust.

b.

1:25pm, 22 Oct 2009 Haydrin

Community

Based HealthCare isthe way forward in holistic patient care ,having a Community Health Clinic with Gp's,Dieticians,psychological and mental health services,physoitherpaists,pharmacy,dentist,pathology,community nursing,primary health nurses,podiatrist,and onsite health promotions officer would be a terrific resource fro communities and would greatly enhance access to healthcare and make it eaiser and more efficent for patients and practitioners,these centres would assist in the breakdown of many stimgmas and would provide convient and higher level holistic care.

8:48pm, 20 Oct 2009 cmartin

The idea of a "one stop shop" is merely a gimmick and is not materially different to the status quo.

Many GPs have pathology and a practice nurse in houes, radiology, physiotherapy, psychologists and other allied health professionals within a kilometre down the road. How does having them housed under one roof make any difference to any person's health outcome?

Furthermore, in the current environment, GPs and patients are free to choose which allied health / pathology / radiology they would like to used, based on merit. This provides incentive for those professionals to provide efficient and effective service.

Under a "one stop shop model" the majority of referrals are likely to be made in house for convenience, regardless of quality. Worse still, if all the staff become government employees, and not accountable directly to the GP or patient then time efficiency and quality of care will inevitably decline.

3:48pm, 07 Oct 2009 clevergirl

The reason people go to hospital for a GP service is either that they do not have a GP who bulk bills (despite being in a low socioeconomic area), or they don't have a GP at all. No one seriously wants to sit in an ED waiting room if there is another option. My area has a very serious shortage of doctors, both GP's and specialists. This has been the case for the past 30 years. Unless there is some plan to get doctors out to where they are needed, this will not change. A superclinic building that has a shortage of doctors hasn't changed anything.

11:37am, 02 Oct 2009 rotraut123

A one stop health care centre in the community particularly if co-located with public and private hospitals would be resource effective.

Perhaps more importantly it would be a winner with key healthcare consumers such as the elderly or people with disabilities as access would be more convienient rather than the present situation of going from place to place that is often not supported by public accessible transport.

9:51am, 22 Sep 2009 obrienjackd27

This is a wonderful concept. Surely the idea of access would be more equitable, and the collaboration between disciplines and health professionals could increase to tailor to the needs of the patients.

7:10pm, 20 Sep 2009 summerhouse

Yes, yes, yes. This is something my husband and I 'fantasized' about years ago. But where will you find the professionals to staff such a centre? Will this reduce the waiting times? We saw these centres as being adjacent to existing shopping centres so there would be access to an all hours chemist, and would also have existing public transport. We also saw these centres as being sources of information for preventative medicine, e.g. pamphlets, videos, changing manned displays, and links to other sources of reliable, Australian up to date information. Have you sought input from those who don't have access or knowledge of computers? They often seem to be left out of the decision making processes.

7:02pm, 18 Sep 2009 mentalhealthnurse

I live in a community with plans for two superclinics within 25 minutes either way of our home. The idea seems to have some merit, provided there continues to be a system of overall governance. I do not want to see these become new 'private enterprises', particularily if the creation of these leads to a reduction in public hospital services down the track. I would hate to see the shift of healthcare to the community being more fragmented (or costly to the community) than the systems already in place.

If what is envisaged is genuine community healthcare, supporting Nurse Led clinics is most likely one of the most innovative Reforms I have heard about. Using the knowledge and expertise of the nursing profession to deliver health promotion and preventative illness programs, as well as health assessment and nursing care services make sense (not to mention the econmoic benefits). Ensuring that adequate doctors and allied health staff are also within the superclinic, to allow for a multidisciplinary approach will benefit the community.

Adequate infrastructure to support the range of health professionals will be important. Also having a records system that ensures the professionals are able to access relevant records for the consumer they are working with is essential.

I do wonder at times where all the staff will come from to provide the services within the superclinics, and hope they are not taken from the hospitals!

2:15pm, 14 Sep 2009 kle

A one-stop health care centre makes sense - it theoretically supports integrated care, improves efficiencies and ultimately should improve access. However, there needs to be a significant shift in the way in which GPs, nurses, allied health and other health care providers work. This is a greater challenge than any of the infrastructure type issues (even though these tend to be "noisier"). If all you get is a group of professionals co-located in a buliding and referring to each other then you have a marginal improvement on the current state. If, however, those professionals work as a team, sharing ideas, developing a shared plan of care with the patient and using common and agreed clinical guidelines (nationally endorsed), then we start to get real value for our taxpayer investment. One-stop integrated interdisciplinary primary health care? Do it properly? Bring it on!

10:58pm, 10 Sep 2009 millenniumcow

5000 characters isn't nearly enough space to list the litany of disaster that Medicare has become. Sorry, but even the proposed superclinics placing their fingers in the dyke will not be enough to save the weight of healthcare costs inundating the Australian public.

Medicine is a complex art. I don't think bureaucrats can every really fathom just how complicated even a "simple" consultation can be. The art of medicine and the skill of a good GP has been lost in the last 2-3 decades because Medicare is biased towards speed of service, not quality of service. So a good GP will always lose out to a bad one. Good GP's have had to dumb down their services, and have been essentially deskilled by the tick-and-flick approach of one-sentence histories, and useless drugs or unnecessary investigations. As well meaning as it sounds, super clinics, nurse practitioners, and all the other Rudd Government proposals will not sustain the corpse of Medicare any further. Sorry, but if Medicare were a patient wheeled into an ER, the doctors would call it (stop CPR). "Time of death ..."

Rather than adding more layers of suffocating bureaucracy with superclinics, I think that government interference should be scrapped altogether. Doctors, radiology, pathology etc should be allowed to charge whatever they like. Good doctors will build up a following and be financially rewarded. Doctors that tick and flick will be known as such, and the costs they incur through such a poor approach will quickly turn patients off. If a nurse practitioner wants to set up a shingle, good for them. If they're good, they'll get a following. If they are not, they won't survive either. Same with pharmacy, pathology, radiology. People will become savvy with their health spending.

Health insurance should be revamped so that any health related costs should be able to be covered, unlike the system now where visits to a doctor in an outpatient setting is not covered by health insurance. Medicare and the PBS can be revived as a tax-payer funded health insurance scheme, means-tested for those who are genuinely disadvantaged (Annual income less than $30k perhaps). Health insurance should become fully tax deductable, or at least able to be 100% salary sacrificed - health insurance can become part of an employees package as per the US. The Government wins because the huge drain on Medicare is reduced, the health insurance companies win because it actually makes health insurance worth having and will set up a critical mass of the population with insurance, which in the end will benefit the public too by reducing premiums. The public wins because in the end, they will have much more freedom and control over what they end up paying.

I pray that the government carefully considers all of the information that this blog generates, and that wisdom permeates all of their decisions. I'll be fine. I have lots of doctor friends in my network. But my children and their families will be the sufferers of the legacies of incorrect decisions are made in the next few years. Blessings of wisdom Mr Rudd. Blessings of wisdom Ms Roxon. Blessings of wisdom.

11:58pm, 08 Sep 2009 cherieadams

As a nurse who has worked in the emergency and intensive care fields since 1989 I am so dis-illusioned with the health care system as an employee that I am leaving it...I have also been a consumer recently and the current system is bad. Multi-servicing through one spot would work but staff and resource it properly or dont bother at all

12:22pm, 08 Sep 2009 Bettina

The idea of one stop health care is certainly appealing, but first you have to have doctors to man these health centres. In my locality I have not had a regular gp for 2 years now. The doctors who have been here long term need to be booked 3 monhts in advance to get in to see and the other doctors are registrars or gp's who can barely speak english leaving many people with no consistency of care. Something particularly important for those with complex health issues.

Yes, fix the system, make health care more accessible, but for the love of australians everywhere, do something about increasing the numbers of english speaking doctors available in our communities, especially in rural areas.

And some more nurses wouldn't go astray either.

12:06pm, 08 Sep 2009 jvb

This is a bit of a no brainer in so many ways - yes I agree where a community has no community health care centre then it would make sense to create one - often people who own such services are creating these by their own initiative.

What worries me most is that we have enough investment in retaining and training of people to work in the whole medical profession. Also I am concerned that rural and regional communities also need improved access to health services - surely some might be available on the web in terms of education and preventative measures?? I am really interested in what might be done in the area of preventative measures - I am not involved in any part of the industry but as a mum and user of services I wonder if we do enough to prevent health and emotional illnesses. The current economic climate drives home the need for more support in the area of emotional and mental illness support - surely we can do better than the first option being the gp and drugs??

I have joined headspace and can see it's value for information and education but I pay to be part of an online support group which really replicates the much of what we have lost in community support. This service isn't supported by medicare or by my health insurance yet I feel it has provided me with more than it costs me to join. Psychs are great for the regular sessions but on the wonky days in between there is really nothing available in Australia - or am I wrong??

11:20am, 08 Sep 2009 sue

I think perhpas we neeed to look at where these current services are currently being provided. I don't think people mind travelling to get an ALlied Health service, what they do mind is lack of service and long waiting lists because of inadequate staffing and I'm not sure how this this idea will change that.

9:26am, 08 Sep 2009 s1lverdragon

I think that a "one stop shop" is a great idea, as long as it doesn't become a fast-churn, low quality service where the doctors are more focussed on quantity of patients than quality of health care. If this can be overcome and the centres properly resourced, then I think this is an excellent model.

6:43pm, 07 Sep 2009 sallyn

I think the thinking behind this one stop centre is great but there is more to it than just a one stop centre. There needs to be adequate infrastructure put in place to keep it standing up right. If you don't have the right electronic record keeping devices, and enough people staffed. You'll just end up with another giant waste of money, and yet another gatekeeper service that won't help anyone. We need to address things like waiting time and what each particular community needs. How will this hold up in the regional and rural areas?

5:36pm, 07 Sep 2009 harrip

Creating one-stop shops is going to increase health costs considerably. With centralised specialists already in place for services such as imaging, changing to one-stop shops is going to duplicate existing systems and therefore increase costs.

5:23pm, 07 Sep 2009 Jack

Toronto (NSW) was to have a local public hospital. This became a polyclinic. Now it is a community health centre.

We do have a private hospital ~ but no casualty/emergency care. Perhaps the government could subsidise these facilities in private hospitals.

5:21pm, 07 Sep 2009 DavidTangye

"almost one in four Australians visits a doctor in their community in any two-week period" - if correct, would indicate that either Australians are an incredibly sick bunch or the system is being very badly abused. My guess is the latter.

5:20pm, 07 Sep 2009 Jack

A one stop health service is a good idea as long as one does not have to travel any distance to get to it.

In Toronto (NSW) we have great doctors, dentists, optometrists, opticians, and a private specialist medical centre/hospital.

These facilities should be incorporated in any one stop solution.

Duplication is wasteful.

5:17pm, 07 Sep 2009 katypiglet

It's a great idea, as long as the people staffing it are great. Sadly, if these centres get muddled with private companies trying to make a few bob, service goes out the window. We need even more super doctors, nurses and support staff to make these a success. Of course, there are some amazing people out there, but also some not quite up to scratch. I wonder where the plan is at to have late opening GPs in hospitals, as maybe, where possible, these centre could be located close enought to the hospital to share some resources (such as administration) to help keep the money in the services provided. Good luck with it though, what a great idea!

4:53pm, 07 Sep 2009 Mike Fitzsimon

My wife is a GP and we have built a one-stop health care centre in our suburb - dentist, xray, pharmacy, specialist rooms, physiotherapist, 8 GPs, 3 nursing sisters on staff - just like your proposal. But we cannot get enough doctors to work here to share the load. Wooldridge and Howard stopped training enough doctors in 1996. Where are you going to get your doctors from, Mr Rudd/Minister Roxon? Instead of building NEW centres, how about helping staff the existing centres?

My wife sees her first patient at 7am each day and is fully booked three weeks ahead. HELP!

4:43pm, 07 Sep 2009 MikeAllen

I live close to Creswick in Victoria, and while Hepburn Health Services do a great job, all too often a trip to Ballarat is required for anything out of the ordinary. If a one-stop shop would complement our existing services, that would be a good thing. In country areas visiting services can be good for specialty areas such a dermatology and hearing. Anything new would need to integrated with our existing services.

4:42pm, 07 Sep 2009 yvonnert

Our local GP bulk bills and is brilliant. However, having to drive around to various facilities to have the related blood tests etc done is a major inconvenience.

My 88 year old mother felt very faint and tired but has few options for immediate attention. She will not go to an emergency room (terrible long wait) nor will she call an ambulance (costly). Other than one stop centres I'd like to see more visiting medical support services for homebound elderly.

4:40pm, 07 Sep 2009 ellisoconnor

We used to live in the City of Yarra where their North Yarra Community Health combines most of these services, although dentistry was dropped when the Federal Gov't ceased funding it. This is a brilliant and caring service that relieves the stress of those who are unwell or in need of advice. The community health model has helped with management of chronic disease like diabetes and high blood pressure where ongoing medical treatment is necessary. These centres are a brilliant idea and can be a community information hub for improved health and well-being.

4:38pm, 07 Sep 2009 claracmwa

I think a 1-stop shop is a great idea. The challenge is where to put them.

While I'm sure most people would say they'd like to be able to access multiple services in one place, I imagine it'll be impossible to position them so that *everyone* has one close by.

Presumably there aren't enough pathology, imaging or allied health providers for every GP surgery to include them - even if the building could physically accommodate them.

So - I'm a qualified yes. Yes, I'd like the convenience, but not if I have to travel further than I currently do to see my GP because I don't always need those other services.

4:23pm, 07 Sep 2009 biisuto

nobody should get sick or sicker because of their financial situation. Health care is a big rort - by citizens trying to get "value for money" through over-use and medical profession through over-servicing. Community-based universal health centres are a good concept, but let's put some more meat on those bones before the pollies run any further with any new crusades!

4:20pm, 07 Sep 2009 HarlequinBeetle

I live where there is already a one-stop health care centre. Positives: Excellent, If sick, a doctor is always available, and, choice of doctor available when preferred. A bonus: XRay, Psychology, Pathology, Optomistrist, et al all available unter one roof...and the best best best is that the whole clinic Bulk Bills. Negatives: 1. not open on Public holidays; 2. would like the hours extended. However, these are minor considerations. A rival one-stop shop also in the area does have both of these.

4:19pm, 07 Sep 2009 sherod

Our local GP doesn't bulk bill, but we get considerate service from a regular doctor who knows our family.

The local medical centre is a one stop shop with all the services mentioned. It's basically a factory for milking medicare. Every consultation < 5 minutes from a revolving door of doctors. In fact I have spent more time at that medical centre waiting than any of my trips to the emergency ward.

What's the difference between this place and emergency?

Well, emergency at the hospital is open 24x7 and I get seen faster at the hospital.

What stops me from going to the hospital all the time is the moral knowledge that its a waste of resources and Emergency is a lousy place to spend time due to the ... ahem.. folk who hang around it generally.

3:15pm, 07 Sep 2009 shimmmergirl

I think the idea of a one-stop-shop is fantastic. Let's face it, it does make sense. I have a six year old and I work full time. The idea of a centre which includes the gp, the pathologist, the x ray people etc is a great one. I live in suburban Canberra and fortunately, most of the places I need are placed next to each other, but I think that's rare. Really appreciate the chance to have a say on this blog, so thank you.

2:49pm, 07 Sep 2009 chrisabruns

Absolutely. It has always struck me as strange why many outpatient services are done at major hospital sites when they could be more adequately offered at community sites. Combine them with community health centres, mental health, dentistry etc and you have a mix that meets people's needs