Urgent Care Centres – NSW

The Minister for Health in NSW, Jillian Skinner, in response to Ryan Park, MP for Keira, has indicated that there areproposals to replace the Bulli Hospital Emergency Department with an Urgent Care Centre: The Local Health District is in the early stages of the planning and consultation phase for proposed changes at Bulli Hospital, including the “reconfiguration of the Emergency Department to an Urgent Care Centre. I also refer the Member to my response to his question without notice on Tuesday 18 October 2011 concerning the Bulli Hospital.”

NSW Health – Healthcare Services Plan 2010Referp 38-39 of plan (nb not pdf page no.) – “Bulli Hospital will be supported by and access a full range of sub-speciality services and urgent and complex and tertiary level services by networking with Wollongong and Shellharbour Hospitals. In addition, the hospital will have an Urgent Care Centre and provide integrated primary and community care services in a purpose-built facility”
p 40 – Show cuts of 1 Medical role in Emergency for Bulli – but no changes for Wollongong and Shellharbour – cost cut & difficulty staffing ??
p42 – Summary of change for Southern Hospital Network- Change – # Urgent care centre establishedMajor focus aged care & community health ^ Services transferred to TWH/ SHH
Budget 2011-12 Estimates Questions – Questions from Dr John Kaye MLC (Greens) on Bulli Emergency Department –
89. Is the emergency department at Bulli Hospital currently open?
90. When will funding be allocated for an alternative urgent care centre?
91. Is there a planned start date for construction of the new centre?
92. Will the Bulli emergency department be kept open until the new centre is built?

NSW Health Annual Report 2010-11 –page 14 refers to the ISLHD: The opening chapter of the Illawarra Shoalhaven Local Health Network has been a momentous and exciting time. In the new financial year I look forward to the transition to the new governance framework with the District Board led by Professor Denis King OAM and the Clinical Councils. Under their guidance, the organisation will continue developing an integrated health system, investing in contemporary patientcentred models of care, reconfiguring our capital footprint to meet demand and, of course, building the workforce of the future. – Sue Browbank, Chief Executive

So what is an Urgent Care Centre ? – In fact there are a number of quite differing models for Urgent Care Centres in Australia & Overseas ?

And it is interesting to note that Urgent Care Centres have been identified as taking the pressure off busy Emergency Departments and solving the ED Doctor shortage problem.
However it would appear that there may be challenges in staffing Urgent Care Centres in NSW – refer Locums job advertisement for an UCC 1.5 hours from Sydney.

Public Urgent Care Centre Models :

In NSW in late 2010 it was revealed that NSW Health had prepared a draft document to roll out Urgent Care Centres to take the pressure off struggling ED’s …
” The centres could be : //

  • co-located with an ED,
  • co-located on a hospital campus away from an ED,
  • or freestanding in the community.

The document states that “the Revive nurse clinics are an example of how urgent care centres could work in community settings.
The centres will be able to treat patients for a range of medical conditions, including “acute back or neck pain, acute otitis media, respiratory tract infections, dermatological issues and minor fractures and dislocations… .They could be staffed by either doctors, “senior registrars with ED experience”, nurse practitioners
or other nursing staff.
It was unclear from the News item cited whether these would be fee for service or not.

Health Minister Carmel Tebbutt also cited the UCC in Port Macquarie in 2010 ”
An urgent care centre is separate from the hospital emergency department and it will treat patients who require walk-in episodic care for acute illness or injury. I have seen the urgent care centre at Port Macquarie Hospital….That is why we are piloting this new model at Wyong Hospital, Campbelltown Hospital, Westmead Hospital, Sydney Children’s Hospital and the Children’s Hospital at Westmead.”
1. Wyong UCC – planned – not open yet – co-located with existing ED on Hospital CampusDr Andrew McDonald ALP spoke on National HealthCare Reforms in the NSW Parliament where fellow ALP Member, Mr David Harris MP for Wyong, advocated for the proposed Urgent Care Centre in Wyong- Dec 2010
In late 2010, Wyong Hospital’s Director of Emergency expressed fears that the creation of an Urgent Care Centre could draw medical staff away
from the ED, creating even more pressures on it. Then NSW Health Minister Carmel Tebbutt responded that 5 Urgent Care Centres were being tested
– including Wyong.

Wyong were advertising for a combined role of Emergency Department – Urgent Care Centre nurse earlier this year :
Wyong Emergency has been selected to pilot a new concept in Emergency Nursing. The position will be flexible with rotation through Emergency and Urgent Care Centre.”
Another advertisement for a CMO for Wyong covering Emergency & Urgent Care ?This position is required to deliver direct patient care to patients attending the newly established Urgent Care Centre. This is co-located within theEmergency Department at Wyong Hospital, part of the Central Coast Local Health Network, and the CMO position is to ensure the provision ofon-site experienced medical management to these patients.Wyong Hospital Emergency Department is part of the Central Coast Local Health Network. The Department attracts over 53,000 presentations peryear (25 % paediatric) with a broad range of patients across all age groups. Wyong Hospital is one of five NSW Hospitals to receive federal fundingto assist its emergency services in addressing the large number of lower acuity patients that present to the facility. These centres are designed to improve the long waiting and treatment times often experienced by low acuity patients in the emergency department. Patients will be triaged through the standard emergency department process – low acuity patients who are expected to require little or no pathology testing, no extended observation period, no prolonged procedural intervention and hence a reasonably quick “turn-around” time, will be triaged to the UCC. The UCC will be open 7 days a week from 1200 (Midday) – 10pm when low acuity presentations are at their highest.
However by May 2012 the mooted 8 Chair Urgent Care Centre at Wyong Hospital had not been introduced & pressures in the Emergency Department had continued to grow – it would appear that the proposed Urgent Care Centre would be co-located with the existing Emergency Department on the Wyong Hospital Campus.
More on May 2 – 2012 – news media story mentions plans for Wyong’s Urgent Care Centre

2. Campbelltown UCC – Planned not yet opened ? co-located with existing ED on hospital campusCampbelltown – UCC – 2010The Commonwealth and NSW Governments will also jointly fund a new $1 million Urgent Care Centre at Campbelltown Hospital. This centre will mainly treat patients with minor injuries or illness, such as fevers, upper respiratory tract infections, sprains and strains and simple fractures. This service is separate from the Emergency Department, thus freeing up Emergency Department staff to treat more seriously ill patients that require emergency care.
NSW Health Annual Report 2010-11 – page 51 – South West Sydney Key Achievements 2010-11″Campbelltown Hospital was chosen to pilot an Urgent Care Centre. The purpose of the UCC is to improve access to the Emergency Department for patients presenting with minor injuries or illnesses.
3. Westmead UCC – Planned Upgrade of existing UCC – co-located with existing ED on hospital campus
Westmead’s Urgent Care Centreis to be upgraded to treat its less urgent cases to reduce pressure on its ED in a capital redevelopment to be managed by Kane Constructions – April 2012 – more onWestmead UCC to be upgraded – part of ED facililties – Westmead UCC upgrade tendering
NSW Health Annual Report 2010-11– p 67 Western Sydney – Key Planned Activities and Outcomes 2011-12
Establishment of an Urgent Care Centre at the Westmead Hospital Emergency Department to treat less urgent cases and a Safe-T-Zone (SeniorAssessment Further Evaluation after Triage) Zone where patients are seen by a senior doctor to commence treatment.”
4. Sydney Children’s Hospital UCC – Planned not yet opened? co-located with existing ED on hospital campus“Planning is also underway for an Urgent Care Centre at the Sydney Children’s Hospital – to be jointly funded by the NSW and Commonwealth Governments – according to media story from Peter Garrett in 2010. The Centre will treat patients with minor injuries and illnesses and will reduce pressure on the Children’s Hospital Emergency Department.” – again co-located with an existing Emergency Department on a hospital campus.
5. Children’s Hospital at Westmead

Port Macquarie – UCC is co-located – co-staffed – co-managed with the existing ED on hospital campusAdditionally Port Macquarie by Carmel Tebbutt was cited as already having an Urgent Care Centre :Recently an ad for a Nurse Unit Manager at Port Macquarie UCC : “- Nursing Unit Manager – Emergency Department The NUM Level 3 of the Emergency Departmentis also responsible the the Express Community Care Centre (Urgent Care Centre) that has been operating for a number of years with a Medical Officer and Transitional Nurse Practitioners or Nurse Pracitioners

Mt Druitt UCCMt Druitt UCC announcement was made by the NSW ALP in Feb 2011 during the March 2011 election campaign – Mt Druitt’s upgrade includes:

  • new urgent care centre and mental health safe assessment room;
  • eight additional dental chairs; and
  • expansion of central sterlising services department.

Mt Druitt Urgent Care Centre subsequently announced by Coalition Government 2012 – ” The state government has announced a $20 million upgrade for Mt Druitt Hospital. The news was described by Mt Druitt MP Richard Amery as late but positive for the area. The upgrade will include extra dental chairs, a new urgent care centre, greater sterilising services, extra rehabbeds, more medical imaging and greater capacity for the Elective Surgical Centre…. Ms Skinner couldn’t confirm how much would be allocated for the upgrade in next year’s budget on top of $500,000 allocated this year forplanning. The upgrades are due to be completed by 2016 but the minister wouldn’t confirm if or when the total master plan for the upgrade,worth more than $550 million, would be completed.”

Morriset UCC
In March 2012 Shadow Minister for Health Andrew McDonald spoke supportively of an Urgent Care Centre, Health One Clinic & Health Fund Facility for Morriset – speaking of the proposed Urgent Care Centre : ” There would be the ability to provide an urgent care centre, with imaging diagnostics such as ultrasound, computed tomography and the ability to perform minorprocedures such as endoscopies.
South Lake Macquarie Integrated Health Care Facility plan advocated an Urgent Care Centre – note Urgent Care Centres seen as Sub Acute Care by Morriset report

Rural Regional Urgent Care Centres in NSW
Additionally – NSW Health 2004 document :
Rural & Remote Emergency Departments with no onsite doctors
– Review and Recommendations of the NSWRural Critical Care Committee – ATS Triage system to be used – education in ATS Triage system to be done – All ATS1, ATS2 & ATS3 Patientsto be seen by a doctor. This model would appear to be similar to the Victorian Rural Regional model of Emergency Department – Urgent Care Centreoperations
Upper Murray Urgent Care Centre:appears similar to the Victorian Rural/Regional Urgent Care Centre model :
“The Urgent Care Centre is available 24 hours per day for emergency treatment. A buzzer is located on the left of the door for after hourspresentations. You will be assessed by a Registered Nurse who is able to contact the General Practitioner on call for advice/ treatment. For further information contact the Nurse Unit.”
Coraki residents want an Urgent Care Centre established while their storm damaged hospital is refurbished – has been closed sinceSeptember 2011 – want their hospital restored

After Hours GP Clinics at NSW Hospitals
NSW Health Annual Report 2010-11 page 59 Sydney
An After Hours General Practice Clinic opened on the campus of Canterbury Hospital. The Clinic has improved access for local residents to healthcare services in the evenings and on the weekends. It has also reduced demand on the Hospital’s Emergency Department, by offering people whomight have otherwise attended the Emergency Department an alternative option if they need non-emergency care.”

Private Urgent Care Centre ModelsAlthough Healthscope proposed to operate an Urgent Care Centre in Hobart Private Hospital in 2009, to replace their private Emergency Department, they do not operate any Urgent Care Centres in NSW. However they do operate a 24×7 Private Emergency Department at their Norwest Private Hospital on a fee for service basis.
In 2009 Kareena Private Hospital, part of the Ramsay Group, in the Sutherland Shire, was one of only 3 Private Hospitals then running an Emergency Department in NSW. However the Kareena Private Hospital ED became unsustainable and was closed in March 2011 -refer The Leader article. However the after hours GP service continues after the ED closure – notice 1 / notice 2 – Kareena after hours GP is considered as keeping the pressure off Sutherland Hospital ED. Kareena’s after hours GP service saw 8000 patients in 2009. However there remains concerns that patients with non-emergency conditions are presenting to Sutherland Hospital ED (& also to St George ED) when the after hours GP services are closed. According to one medico there were some concerns as far back as 2001 about Kareena’s ED & the patients it covered when it was part of the Mayne Nickless Group.
Note – In Australia over 500,000 accident & emergency cases were treated at Private Hospital Emergency Departments in 2008-09 – note at Sutherland Hospital ED total emergency attendance was approximately 41,000 in 2010 whilst Wollongong Hospital ED has over 50,000 attendances.
The Sydney Adventist Hospital (Not for Profit) Emergency Care Department operates 24×7 opened in 1996 & is the largest private hospital ED in NSW. It also operates an EMU – Emergency Medical Unit. Cost is $305 & payable prior to the consultation commencing. If you need to be seen by a visiting specialist whilst at the “SAN” you will be charged by them as well

NSW Health Annual Report 2010-11 Page 7 – indicates that Central Coast is going to appoint a new community advisory committee– viz “Finalise the transition from Local Health Network to Local Health District.• Appoint a new Community Engagement Committee to engage and consult with a broad and diverse range of people and groups in the communityand provide feedback to the Chief Executive and CCLHD Board.”


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