The promise of Urgent and Primary Care Centres (UPCCs) was to attach large volumes of patients without a family doctor to longitudinal primary care, while also providing better access to urgent episodic care.
While the idea was sound, they have failed to live up to their promise. A tiny fraction of patients have been attached. Most same-day spots are filled within minutes of opening.
They have proven to be extremely expensive and inefficient walk-in clinics, but the government continues to double down on UPCCs as the solution to the primary care crisis.
Here is a high-level overview of the most important facts.
This Facebook post, with comments by many family physicians intimately familiar with UPCCs, will let you dive deeper into the details.
It's not the money, which is quite good for family practice. UPCCs are designed and managed by health authorities, who run large hospitals providing acute episodic care. They have no idea what real world family practice providing longitudinal care looks like. Doctors are frustrated working in a bureaucratic environment that prevents rather than enables them to treat patients effectively. Their knowledge and expertise is devalued. There is tremendous waste and inefficiency.
Nurses, nurse practitioners, and other allied health professionals have valuable and unique roles to play as part of an integrated primary care system. But they do not replace the education, training, knowledge, skills, and expertise of physicians. Physicians diagnose and treat many problems that others cannot. Nurse practitioners are not cheaper than physicians, after factoring in salary, overhead, employment expenses, and benefits. And they deserve every penny of that. Their salary structure allows them to be paid more to spend longer time with patients, unlike independent physicians who are penalized for doing so.
UPCCs are built and operated like mini emergency rooms. They have tremendous overhead (facilities, staffing). For the vast majority of patients, they provide care no different than an independent walk-in clinic. The volume of patients seen is a fraction of that seen at any independent clinic. And they provide far less quality care than longitudinal family practice. UPCCs are delivering a fraction of the care at many times the cost of independent clinics.
Comprehensive data on how many patients have actually been attached to physicians, how many patients are seen (and not seen) per day, the number of physicians available, the cost per patient, and other important metrics are not being shared. Staff are not allowed to speak out or advocate for patients. We know the numbers are bad and show that UPCCs are a poor use of taxpayer funds compared with independent clinics. Politicians continue to deliver promises, cherry pick isolated and irrelevant facts, and spew outright lies rather than treat the public with respect.
UPCCs pay physicians well, compensating them for overhead and work that would go unpaid in independent clinics. Others (i.e., telehealth platforms) are also compensating physicians better for relatively lower-value episodic care. This has fractured and distorted the job market for physicians. Independent clinics cannot compete for regular staff or temporary locum coverage. The most productive independent clinics are being driven out of business. Options for longitudinal primary care are vanishing.