Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
Develop and implement a Nurse-led Walk-in Clinic (NLWIC) to address limited access to same day health care in regional Queensland.
Dates: Aug 2024 - ongoing
Implementation sites: Central Queensland Hospital and Health Service
Aim
The model of care is aimed at developing independent nursing clinicians with an extended scope of practice to provide same day care for patients who present with minor injury and illness.
Outcomes
- Significant adoption from the community for the service for the provision of care for minor injury and illness. Total number of patients seen in 2025 = 14,258
- Reduction in low acuity emergency department presentations. 27% reduction in Category 4 presentations from 2024 compared to 2025
- Improved access to limited health care services in the areas of women's health, wound care and primary health care
Background
Gladstone is regional city within central Queensland with a catchment of around 63,000 people. The Gladstone region population is slowly growing, recent data collected from a local area needs assessment indicates that there is a higher incidence of risk factors across the population that lead to poor health outcomes (Service 2022). Like many regional acute care services, Gladstone hospital faces challenges to provide care with increasing demand on the service. In-patient capacity, local specialty services and wait list for outpatient services are often limited. The centralization of services through the hub and spoke model offers an opportunity to extend within an outreach/ satellite model for services such as renal, orthopaedics and oncology. However, demand for specialist services continue to grow placing pressure in acute services and dis-satisfaction within the community. Targeted early intervention and treatment in the primary health care space and community-based services can avoid unnecessary hospitalizations (McGeoch, Shand et al. 2019). Addressing health care needs of regional Queensland's needs to approached from an integrated acute service and primary health care service perspective to improve access and health status of the community.
Gladstone, like many other regional areas of Australia, has seen a reduction in the most basic of health care services, from GP to dentists to in-patient services (Attwooll 2023). Patients are frequently required to travel for specialist care to attend appointments for services that were historically offered within their region exacerbating negative perceptions. A recent study demonstrated that Australians perceptions of healthcare has generally improved over the last 10 years. However, Australians are being advised that regularly engaging with a primary health care clinician is key to improving health outcomes, but Australians are displaying a reduction in confidence in access to primary health care when required (Ellis, Pomare et al. 2021).
The development of the Gladstone NLWIC was targeted to improve community access to free urgent and primary healthcare services by leading an innovative model of care that is nursing led. Previous nursing led modes of care have demonstrated the capacity to address healthcare demands, shortages and costs (Randall, Crawford et al. 2017). The NLWIC recognizes the skill and knowledge of nurses and allows them to work to the full scope of their practice. Historically, nurses have displayed the capacity to work safely and effectively within scope of practice frameworks (Pursio, Kankkunen et al. 2021). The recognition of scope enables clinicians to practice autonomously and independently as primary care providers, as well as interdependently with others within the border healthcare system. This professional self-awareness of scope of practice provides protective mechanisms to ensure clinical governance is upheld.
Furthermore, the intrinsic wholistic approach to the provision of care enables nurses to met key areas within clinical governance frameworks. By nature, nurses have an understanding of the wider local social determinants of health and have the ability to provide culturally appropriate and relevant health care (Wood, Brown et al. 2024). Nurses are able to provide targeted care and interventions that empower patients to take ownership over their health care (Htay and Whitehead 2021). The sound development model of care for the NLWIC's provides a framework from which clinicals can provide evidence-based same day care for patients in the Central Queensland region.
Methods
The Gladstone NLWIC utilises the Primary Clinical Care Manual (PCCM) was implemented as the backbone for the theoretical framework, outlining a patient centered approached to a practical method of delivery of care. The PCCM adapts state, national and international clinical guidelines to address health care needs of Queenslanders in regional and remote areas (Queensland Government 2025). Use of an existing framework that is endorsed and rigorously revised ensures that the content is suitable for the application of a NLWIC to provide evidenced-based care. The PCCM utilizes Health Management Protocols to equip clinicians with practical framework for the provision of care.
Furthermore, endorsements for clinicians with an extended authority to use medicines enables them to use Queensland's medicines and poisons act - extended authority practice part a to administer and supply a treatment dose of medication to a patient who presents with a condition outlined in a health management protocol (Queensland Government 2025). Acting within this clinical framework enables clinicians to truly work at the full scope of their practice as well as provide the community with accessible high-quality care.
The implementation of the Queensland NLWIC aligned with state health priorities outlined in The Women's and Girls Strategy (Government 2024). The clinics area aimed at gaps in healthcare in the ability to access same-day appointment for medicare and non medicare patients over the age of two with non-life medical conditions. This includes but not limited to; minor injury and illness, sexual health and contraceptive advice (ref MOC). Whilst Gladstone NLWIC was launched in conjunction with the state initiative, variances in the model of care have allowed each site to tailor care delivery to suit community needs. A focused MOC allows for improved adherence to clinical governance guidelines, i.e. knowing what is appropriate and inappropriate for the NLWIC scope of practice. These variances include how the Gladstone NLWIC integrates within the local HHS organization and interfaces with other health care services. For example, access to public sexual health services is limited with clinics being held once a fortnight.
A collaborative approach with the use of the PCCM, Australian STI guidelines and existing HHS services have allowed the Gladstone NLWIC to provide routine screening, treatment and follow up care as required. The implementation of NLWIC is aimed at strengthening relationships between acute care services and primary health care. It also directly addresses the health care needs of regional Queensland.
Discussion
The successful implementation of the Gladstone NLWIC was founded on the adaptation of the service model of care for the local health care needs of the community. This allowed the Gladstone NLWIC to address key clinical needs within the community as assist and an emergency department (ED) avoidance model of care. The addition of pathology, medical imaging and onsite full time Nurse Practitioner at the time of commencement of the Gladstone NLIWC allowed the clinic to adapt to clinical needs. Then Gladstone NLWIC works closely with the ED to assist with reducing patient wait times. This has been reflected through a reduction in the low acute presentations to the emergency department since the opening of the clinic (see Figure 1), with a 27% reduction in Category 4 presentations.
Nurse-led Models of care places nurses in key leadership roles with clinical governance to provide evidence based, patient centered, high quality individual care to meet the needs of both the community and the over-burdened healthcare system. Throughout the establishment and initiation phases of the clinic development, discussion around governance was eagerly debated. Studies have found that many Nurse Practitioners build trust and respect within their clinical decision making, however often feel under-supported when compared to their medical colleges. This place NP's in a unique position to provide clinical leadership, governance and professional engagements as service leads within the greater inter-disciplinary health system.
The NLWIC requires nurse to work to their full scope of practice as independent clinicians. Supporting nurses to transition to traditional practice to independent practice has been key to the success of the clinic. The original education guidelines developed by the office of the Chief Nurse (OCNO) included a mandatory education book including case studies utilizing the PCCM, self-directed learning as well as several days of clinical immersions across several specialties. While trying to facilitate this education, it was clear that there would be challenges in implementing this in the local context. Clinicians had a range of differing clinical backgrounds, FTE and start dates therefore the decision was made with ensure adequate and relevant education was provided through in house clinical workshops targeted clinical immersions with key specialist services focusing on the identification of red flags and scope of practice. Pre and post education confidence surveys were done to identify targeted learning needs and needs met (See Figure 2.) From the data collected from clinicians within the clinic, there is a clear trend of increased competence and confidence in numerous areas, therefore supporting the education adaptation of the PCCM to the local context.
his implementation of the Gladstone NLWIC within regional Queensland has demonstrated tremendous success in improving access to health care. Since opening, the clinic has received positive feedback through several channels including formal feedback through the HHS and anecdotal on social media. Common themes identified from this feedback are the holistic approach to care, prompt service, consumers choosing the clinic rather than ED for minor injury and illness, and the high level of care received. This is evidenced through low 'Did not wait numbers and high levels of returned consumers.
The extension of this MoC to outreach model / hub and spoke will address challenges faced within these regions. The NP workforce is continuing to grow within Queensland, however, there are barriers in regional areas with the lack of understanding of the role of NP and succession planning
References
Government, Q. (2024). Queensland Women and Girls' Health Strategy 2032. Brisbane.
Queensland Government, R. F. D. S. Q. S. (2025). Primary Clinical Care Manual 12th Edition Cairns, Office of Rural and Remote Health
Htay, M. and D. Whitehead (2021). "The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review." Int J Nurs Stud Adv 3: 100034.
McGeoch, G., et al. (2019). "Hospital avoidance: an integrated community system to reduce acute hospital demand." Prim Health Care Res Dev 20: e144.
Pursio, K., et al. (2021). "Professional autonomy in nursing: An integrative review." J Nurs Manag 29(6): 1565-1577.
Randall, S., et al. (2017). "Impact of community-based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review." Int J Nurs Stud 73: 24-33.
Wood, E. B., et al. (2024). "Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health." Journal of Emergency Nursing 50(1): 145-152.
Service, C. Q. H. a. H. (2022). CQHHS Local Area Needs Assessment Queensland Government
Attwooll, J. (2023) Hugh disadvantages for rural patients exposed GP news
Ellis, L. A., et al. (2021). "Changes in public perceptions and experiences of the Australian health-care system: A decade of change." Health Expectations 24(1): 95-110.
Key contact
Dale Reading
Nurse Practitioner, Nurse Led Walk In Clinic
Gladstone Hospital