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The staffing models of Medicare-funded urgent care clinics (UCCs) in Australia are currently being scrutinised, after researchers have warned the ‘one doctor, one nurse’ structure is being stressed by growing patient volumes.
Professor John Adie of ForHealth Group says his research – published today in the AJGP – shows that some UCCs see everyone who comes through the door, but for many this method is unsustainable.
“When working in UCCs, things can get busy quickly. You could go from having one or two people in the waiting room, to ten plus. So, what do we do when that happens? If three really sick patients come in at once, and there is only one doctor, and one nurse staffing the UCC, the service can quickly become stressed,” Adie said.
The concern comes as Australia’s ageing population sees climbing rates of acute illnesses, such as COVID, flu, pneumonia and bronchitis. Acute illnesses make up 63 percent of urgent care presentations and in older people, they are more likely to escalate, requiring GP attention. This could put Australia’s current UCC staffing model under strain during periods of peak transmission.
Overseas comparisons
Exactly how the clinics should be staffed is, however, an ongoing debate. Internationally, there are major variations in staffing models between UCCs, and as yet no consensus on best practice.
In the US, while their more than 15,400 UCCs are supervised by licenced physicians, many are staffed by nurse practitioners and physician assistants. New Zealand UCCs must ensure at least one doctor and a registered nurse are onsite during the clinic hours of operation.
Prof Adie says each of these countries are meeting regularly with Australia to share intelligence.
“We routinely attend international conferences in Europe, US, and NZ, and it is great to hear from people who have ‘been there, done that’,” he said. “It’s a real learning curve, because there are so many different ways to structure an UCC.
“For example, I recently met a provider from the USA with 450 UCCs. Within these 20 percent of the workforce was made up of medical doctors – 55 percent of which were family physicians and GPs and 45 percent were emergency physicians. This is a big contrast from Australia, where you typically have at least one medical doctor on site the whole time.”
Generally, there is recognition that nurse practitioners could play a greater role in improving urgent care in Australia, mirroring the US system. But for this to become a reality, a discussion on remuneration would be needed, Adie said.
“Nurse practitioners in a UCC don’t get paid anywhere near what they get paid in a hospital. So, they’re going to choose the hospital because of that. And if there was some way to allow the nurse practitioners to come work in urgent care, to pay parity, potentially you could, more easily, have a more second or third practitioner on.”
Ahpra’s Advanced Care Paramedic Expert Reference Committee is also exploring the potential of paramedic practitioners in Australia’s urgent care system – a development Adie supports.
“It would be fantastic if we could have paramedic practitioners who, as in other countries, have done a Master’s degree, with a focus on urgent care.
“Obviously, there needs to be changes in legislation and funding for that to happen. But the fact that Ahpra is looking into it is exciting.”
Balancing resources
While there is recognition that more diverse and senior teams lead to better patient outcomes, this must be balanced against available resources. In many sites these are constrained.
However, Adie is hopeful that improvements elsewhere in the UCC model could boost profitability and enable better staffing models.
In particular, he supports the introduction of dedicated item numbers for UCC procedures – a model currently used in New Zealand to incentivise hospital avoidance.
“For example, if I was to rehydrate somebody over two hours or so, there’s an item number for that, and I can claim it. If I was to watch a patient for four hours after they’ve used their EpiPen, for anaphylaxis, there’s an item number for that, too. There’s an item number for iron infusions.
“If there were item numbers for UCC procedures, it would greatly help the sector. It would boost profitability and help it take on more cases that prevent people attending hospital emergency departments.”
Surge policies are essential
While optimal staffing models are still being worked out, Adie recommends that Medicare-funded UCCs have an adequate surge policy for when UCC demand outpaces supply.
“You need a plan in place for when a bus turns up and there’s a one doctor, one nurse model. One option is a surge policy, where everyone still gets triaged, but they might get triaged to the emergency department, to their family doctor, or to come back another time.
“Our research in press with the AJGP shows that some UCCs just close the door in this scenario. Other clinics might cold call a doctor if they have one on backup to come for busy times. Whichever option you choose, there needs to be a robust plan, because if you’ve got twenty to thirty people waiting and only one doctor, it can get challenging” pretty dangerous.”
Continuing the conversation
Prof John Adie is UCC Training & Education Lead at ForHealth Group.
Sharing more thoughts on urgent care, he will join a stellar line up of speakers at the upcoming Urgent Care Conference, hosted by Informa Connect.
This year’s event will be held 16-17 June 2026.
Learn more and register your tickets here.
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