Evaluation of the GP Super Clinics Program 2007-2008

6.4 Accessible Primary Health Care

Page last updated: 2012

Access to primary health care is fundamental to a high-performing health system.9 Ability to get appointments and financial costs associated with reduced bulk billing rates have been cited in many studies in Australia as barriers to access to primary care.9

All GP Super Clinic Directors had some arrangements for either extended or after-hours medical care. The format this took depended on perceived demand and other local arrangements, such as advising patients of the GP Super Clinic’s arrangement with an agreed after-hours provider. Where extended and after-hours care was provided, demand was mostly seen as greatest between 6.00 p.m. and 10.00 p.m. Some GP Super Clinics had successfully provided weekend clinics. Some GP Super Clinics provided and others were examining the opportunities for out-of-normal-hours allied health appointments.

Just over half (58%) of clinicians indicated that the provision of after-hours care was important. Some clinicians perceived that demand for after-hours care had decreased because of greater availability of appointments during normal business hours. This aligned with the views of some patients who indicated they could access appointments without having to wait for weeks.

At [previous] clinic I had to wait for about a week to get an appointment. If urgent, you had to try to the local after-hours which wasn’t great. Here I can usually get an appointment within a day.

In the survey, just over half of all patients (52%) reported they had changed from another practice to attend the GP Super Clinics. Results from the survey also indicated that patients rated access issues regarding availability and costs as important determinants of reasons to attend the GP Super Clinics. The majority (67%) of the patients participating in the survey also indicated that they were there on the day to see their usual doctors.

Table 11 describes the reasons patients report attending the GP Super Clinics, defined as the proportion strongly agreeing or agreeing with each statement. These are presented in decreasing order, with the most commonly specified reasons reported first.

Table 11: Percentage of Patients Agreeing with Reasons for Attending GP Super Clinic*

Reason for attendingPercentage Agreeing*95% Confidence Interval&Design Effect
Hours clinic opens suits need8781922.9
Close to home/work8576904.2
See range of health professionals8374905.3
Access to GP of choice79648911.3
Clinic bulk bills75528922.9
Staff understand health needs7258838.5
Staff communicate well with external providers68538010.2
Clinic coordinates all aspects of care6651789.9
Do not wait more than 1 day for appointment6552778.3
Staff understand cultural needs5744708.2
After hours services available5238659.0
Drop in appointments available4230557.8
Can't get appointment at other practice3021415.1

* Percentage agreeing or strongly agreeing with each reason
& Standard error adjusted for correlation of patients within clinics using the jack-knife method for the survey tabulate option in Stata

The three most commonly cited reasons for attendance at the GP Super Clinics were: the suitability of the GP Super Clinics opening hours (87%; 95% CI 81%-92%), although only half of the patients (52%; 95% CI 38%-65%) considered after hours opening as important; the location of the GP Super Clinics, i.e. that is they were close to the patients’ home or work (85%; 95% CI 76%-90%); and that patients could see a range of health professionals within the same location (83%; 95% CI 74%-89%).

The opportunity to see the GP of their choice, the fact that the GP Super Clinics bulk-billed and the fact that the staff understand the patients’ health needs were also rated highly by 79% (95% CI 64%-89%), 75% (95% CI 52%-89%) and 72% (95% CI 58%-83%) of patients respectively.

The least important reasons for attending the GP Super Clinic were that it offered drop-in appointments (42%; 95% CI 30%-55%) or because the patient could not get an appointment at another local GP clinic (30%; 95% CI 21%-41%).

The design effects for reasons for attendance ranged from 2.9 for clinic opening hours to 22.9 for bulk-billing. The high value for bulk-billing is not unexpected given that this is a GP Super Clinic feature, i.e. although the importance of this may vary among patients within the same GP Super Clinic, whether or not patients are bulk-billed is determined at the clinic level.

Many patients made comments in the survey as to the reasons for changing to the GP Super Clinics with most providing multiple reasons. These comments were coded with the top six reasons patients changed from another practice reported in Table 12.

Table 12: Top Six Reasons for Changing to the GP Super Clinic – Survey Comments

Number of Mentions
Access to appointments64
Quality of care62
Convenience of location59
Moved to area52
Followed a GP50
Cost 50
The reasons for changing were made in either a positive or negative sense. For example, reasons such as “easier to get an appointment” or “had to wait weeks to get an appointment at other clinic” were both coded as access to appointments. Similarly, comments such as “heard the doctors here provide good care” and “dissatisfied with quality of care at other clinic” were both coded as quality of care. Availability of appointments was the most common reason for changing practice, with 64 mentions, followed by those about quality of care (62 mentions) and convenience of location (59 mentions). Comments from surveyed patients about reasons for change, such as those outlined below, were common.

Patient Comments – Reasons for Change – Patient Survey

“Quicker access to doctors. Unsatisfied with medical care. Unsatisfied with attitudes of reception staff”

“Doctor more professional and get appointment most of time”

“I lost confidence in the doctor and was too expensive”

“More availability plus all services under one roof”

These results corresponded to common themes in patient interviews, where these were the top reasons for moving to the GP Super Clinics. In particular, during interviews patients reported that wait times of up to two weeks were not uncommon at previous practices and expressed frustration about lack of availability of appointments even when they were sick. Concerns about the quality of care as reasons for changing clinics were also common in patient interviews.

All GP Super Clinics provided bulk-billing for some of their patients. Mostly, this was for children less than 16 years, and pensioners and/or people with health concession cards. In one GP Super Clinic all patients were bulk-billed. While it was acknowledged that bulk-billing was desirable, most espoused the view that financial viability was impossible with total bulk-billing. Allied health disciplines seeing clients under MBS-rebatable items bulk-billed in line with GP Super Clinic arrangements. This had in most instances been negotiated as part of the contract for service engagement.

Cultural appropriateness is also an important element of access. Two of the GP Super Clinics had participated in the national Closing Gap the Gap Primary Care Collaborative. A further two GP Super Clinics had undertaken specific training for staff, including reception staff, with respect to cultural appropriateness for Aboriginal and Torres Strait Islander peoples. The majority of patients (57%) indicated that the GP Super Clinics met their cultural needs. The focus on cultural appropriateness as an important element of access appeared to be related to the commitment of the GP Super Clinic Directors to rate this as important. This was evident in GP Super Clinics which had participated in the Closing the Gap Collaboratives. However, these were in the minority, and greater engagement of Aboriginal people and where relevant, refugee or other Culturally and Linguistically Diverse (CALD) groups could be considered in GP Super Clinics in the future.