“The Minister for Health and Aged Care, Hon Mark Butler, recently said that “Primary care is in its worst shape since Medicare began.”
Specialist general practitioners (GPs) are the medical experts in this field, and we emergency doctors acknowledge their leadership on this issue. But systemic deficits in primary care also significantly impact emergency departments and contribute to hospital pressures. How?
Lack of accessible, affordable, and coordinated primary and community-based care – including GPs, other medical specialists, and allied health professionals – can lead to people’s chronic health conditions worsening significantly over time.
What this means is that emergency departments aren’t, as the myth goes, dangerously overloaded because too many people present who couldn’t see their GP today.
There will always be some overlap between primary care and ED regarding management of acute health problems that need timely care. When people come to ED with relatively simple problems, they usually require only simple treatment, and can go home after receiving care. These low acuity presentations do create some extra workload for EDs, especially for departments that see lots of children, but are not the root cause of the problem.
Instead, EDs are dangerously overloaded because they see too many people who simply couldn’t access or afford the care they need in community settings over longer periods of time.
Without access to appropriate care, people get sicker, their health deteriorates, and their acute conditions become chronic. Often, they also become socially marginalised.
Then, when things get unbearable or unmanageable, and they are suffering immensely, they present to EDs for urgently needed help. EDs are always here to care for people and are staffed by healthcare workers who have dedicated their lives to easing people’s suffering, in an emergency.
So now, the ED assesses and treats the patient. By this stage, their health needs are so complex that they require admission to hospital for high-level care.
But it doesn’t end here.
They are too unwell to go home, and there is simply nowhere for them to go to get the further care they still need. Due to their complex health needs, and the lack of capacity in critically lacking areas of federal responsibly, the NDIS, aged care and mental health services, the patient gets stuck in the ED.

The main hospital is full – as are all the neighbouring hospitals – and there are no beds available or staff to care for them.
So, they get stuck in the ED. For hours, or sometimes days.
This is called access block, or bed block, and it contributes to ED overcrowding and to ambulance ramping, and poorer health outcomes for all patients, that can include death. This is experienced across the whole of Australia but is more of an issue in rural and regional areas.
The worst part is, this could all have been prevented by access to affordable, accessible, integrated primary and community-based care over time.
So, what should we do?
We are now seeing genuine understanding from governments, at all levels, as to the extent of the healthcare crisis. Healthcare workers– GPs, paramedics, nurses, emergency doctors – and other stakeholders are aligned. Everyone knows now that there is a problem. State and territory governments are scrambling to do what they can to make up for healthcare resource deficits in areas of federal responsibility. So where do we go from here?
We talk a lot about the ‘health system.” But the truth is, we don’t have a health system in Australia. We have a collection of health services that try, valiantly, to work together. We need to bring all parts of the healthcare system together to reimagine a better, more equitable way of doing things.
ACEM supported the government’s electoral pledge to strengthen Medicare and advocated for the consultation with, and involvement of, frontline emergency clinicians as part of ongoing government responses to the healthcare emergency. We need to see movement on this issue, as well as further urgent investments and policies to build capacity in NDIS and aged care.
These are complex issues, that will require complex responses, but healthcare in Australia needs a fundamental re-think, and emergency doctors stand ready to work with the federal government, and other health stakeholders, to create a genuine health system that meets the needs of all Australians, now and into the future.”