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I work in a hybrid family practice and walk in clinic and pretty routinely see patients with advanced diseases that are basically excluded from the family practice based system (as everyone is working at capacity). Currently the only other clinic seeing non attached patients (we both operate hybrid system) in a 150km radius are thinking of closing to non attached patients. If this happens patients will either have to wait a long time to see us, as we will be overwhelmed, or go to ED, which will cause problems for everyone and expense for the system.
While I completely agree that complex attached patients should be funded properly, we have had zero help managing the needs of the unattached. All funding seems to rely on attachment, which is only going to happen for a small proportion of this cohort. Good access to episodic care is very important in a healthcare system and it seems no one is addressing this. Today's untreated diabetic with cystitis is tomorrows ICU-bound case of pyelonephritis and those in power don't seem to understand the benefits of addressing things early.
Competing Interests: None declared.