What continuity of care is worth
High-quality general practice care offers coordinated, comprehensive, and continuous care over time. The 2026-27 Budget made Medicare Urgent Care Clinics permanent: $1.8 billion over five years, then $525.6 million a year ongoing from 2030-31. All 137 promised clinics are open, and they have taken more than three million presentations since June 2023. Over the last two decades, analysis published in the Medical Journal of Australia (Chomik, Bates and Wright, 2026) shows general practice losing share of health spending, with funding for the planned, continuous care of complex patients held below 1% of the health budget throughout. Australia is buying more places to be seen once. The evidence question is what is traded away.
The evidence for seeing the same doctor
Barbara Starfield showed us that continuity isn't just about continuity with a service; it's about continuity with an individual provider. Controlling for the extent of morbidity, discontinuity in general practice visits is associated with seeing more specialists, incurring higher costs, undergoing more procedures, and taking more medications. In the US, the savings from having continuity of generalist care would be about $22 billion per year (Journal of Ambulatory Care Management, 2009).
The largest studies ever run on this question are more recent, and none of them can be put down to an artefact of American managed care. Hogne Sandvik and colleagues (British Journal of General Practice, 2022) followed Norway's entire listed population, 4.5 million people. Compared with patients one year into a GP relationship, patients who had seen the same GP for more than 15 years had 25% lower odds of dying that year, 28% lower odds of acute hospital admission and 30% lower odds of needing out-of-hours care. The effect strengthened with every additional year of the relationship, after adjustment for age, sex and morbidity.
The reviews point the same way. Pereira Gray and colleagues (BMJ Open, 2018) found 18 of 22 studies across nine countries linked higher continuity to lower mortality. Engstrom and colleagues (British Journal of General Practice, 2025) reviewed studies involving about 15 million patients (including Australia) and concluded that personal continuity probably reduces premature mortality by 10-15% and cuts emergency department visits by 10-20%.
Two studies address the obvious objection that loyal patients are simply healthier. Sabety (Journal of Public Economics, 2023) studied American patients who lost their doctor through no choice of their own, to retirement or relocation. Their mortality rose 4%, emergency visits rose 4%, and admissions rose 3%, and the harm grew with the length of the relationship that was severed. Prior and colleagues (BMC Medicine, 2023) followed 4.7 million Danish adults and found that patients whose care was most fragmented across providers died at more than twice the rate of those with full continuity, after adjusting for illness.
Australia shows the same signal as anyone who has looked. Moorin and colleagues (BMC Health Services Research, 2020) linked records for 253,500 NSW adults in the 45 and Up Study: those who saw their GP most regularly had 13% lower odds of repeated unplanned hospitalisation in a year and 17% lower odds of an unplanned readmission within 30 days. Yet the ABS Patient Experiences survey, released in November 2025, found that only 67.2% of Australians could consistently see their preferred GP when they needed to. That is the gap that policy should be closing.
What episodic funding buys
I am a strong supporter of urgent access. After more than 35 years in rural practice, I know exactly what it means when patients cannot be seen. The question is what the system gets for $1.8 billion, and the government's own evaluation answers it. The second interim evaluation of the UCC program (Nous Group, December 2025) puts the cost at $206 per presentation, finds a 10% reduction in urgent-care-equivalent presentations at nearby emergency departments, finds no clear evidence of improved emergency waiting times, and reports a net saving of about $36 million a year. Against a $1.8 billion commitment, that is the return.
The fragmentation cost sits in the same document. Direct clinical handover to the patient's usual GP fell from 68% in the first evaluation report to 65% in the second. And quality handover is even lower; handover is not "please chase results". The AMA president told the National Press Club in April 2026 that one in three urgent care interactions involves no communication back to the usual GP and described a cancer diagnosis delayed in exactly that gap. Grant Russell of Monash University notes that only 1.1% of UCC visits occurred in the after-hours window that justified the model. The United States has already run this experiment with retail clinics: Ashwood and colleagues (Health Affairs, 2016) found 58% of visits were new utilisation rather than diverted demand, and total spending rose. The emergency physicians' own college (ACEM, 2023) holds that urgent care centres have little impact on emergency department pressure because crowding is driven by access block rather than low-acuity attendances.
Continuity is workforce policy
Continuity does not only change outcomes. It changes how far the workforce stretches. Kajaria-Montag, Freeman and Scholtes (Management Science, 2024) analysed more than 10 million consultations in English general practice and found that when patients saw their own GP, the interval before their next consultation increased by 18%, with no increase in consultation length. Lifting every practice to the top tenth would cut consultation demand by about 5%, the equivalent of a 5% larger GP workforce. The official supply and demand study projects a shortfall of 5,560 full-time GPs by 2033. A funding system that undermines continuity makes the shortfall worse than it needs to be.
The pipeline itself is the good news story. Around 2,100 doctors commenced GP training in 2026, a third consecutive record intake, up 14% on 2025. Investment signals work; doctors respond to them. The question is which general practice those registrars are joining: one funded to know its patients, or one competing with subsidised episodic care up the road. Marshall and colleagues (British Journal of General Practice, 2025) found GP turnover is higher in larger, lower-continuity practices. Continuity is part of what makes this job worth doing as a career.
"When I worked in my rural Emergency Department, it was obvious which practices delivered comprehensive coordinated care over time. Their patients presented infrequently, they had clear sick day plans, and when they had to come in they could be discharged earlier because I knew they had a safety net built around their care. These days, with all the data links available, it shouldn't be that hard to reward quality general practice care."
The arithmetic
From 1 July 2026, the Medicare rebate for a standard consultation is $45.05. A non-admitted emergency department presentation costs $776 to $802, according to the latest national hospital cost data, roughly 17 times the rebate. An urgent care presentation costs $206, more than four times the rebate. An average acute admission costs $6,239, about 138 standard consultations: a patient could see their GP every month for eleven years for the cost of one admission. General practice remains the least expensive part of the system by an order of magnitude, and the part of the budget that funds its continuous, planned care has sat below 1% for twenty years, and as a proportion of health care spending, it is reducing.
What funding continuity would look like
Three moves, none of them radical.
First, handover and continuity measures are written into the urgent care standards the RACGP has offered to lead, and into PHN commissioning contracts: discharge summaries to the usual GP within 24 hours, measured and published by clinic.
Second, blended funding attached to continuous care through MyMedicare, with the caution warranted by the evidence. Bates and colleagues (Medical Journal of Australia, 2025) reviewed enrolment schemes across 15 countries and found that registration alone does not ensure continuity; funding must follow the relationship, not the form.
Third, a national continuity measure. Bulk billing rates are published quarterly and treated as the vital sign of general practice. Whether patients can see the same doctor is not measured at all.
A GP is a physician who specialises in you. Patients who have one live longer, use hospitals less and cost the system less, and those statements rest on some of the largest datasets in the medical literature. The case for continuity does not depend on nostalgia for an older style of practice. It rests on the government's own evaluation, the ABS's own survey and thirty years of findings that keep replicating. The funding system should follow its own evidence.