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Could indefinite referrals become default for GPs?

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GP referral pathways could be in for an overhaul, including an extension of default referral validity periods, as the Federal Government looks to address several ‘potential issues’ with current rules.
 
A consultation paper has sought advice on whether current Medicare referral arrangements effectively support access to specialist care.
 
But a new RACGP submission responding to the paper has cautioned against reform that puts access and convenience ahead of quality and safety.
 
One issue raised in the Government consultation is 12-month validity periods for referrals, which it says may not reflect modern healthcare.
 
‘While GPs can issue referrals for any length of time under the regulations, the default period is 12 months, and non-GP specialist to non-GP specialist referrals expire after three months,’ it said.
 
‘These validity periods have been criticised for not aligning with contemporary healthcare needs.
 
‘Effective treatment of chronic conditions may require ongoing non-GP specialist care. However, patients with 12-month referrals must return to their GP for renewals even when their condition is unchanged, causing inconvenience and potentially extra costs.’
 
This ‘costly and inflexible’ referral system was frustrating for consumers, the paper noted.
 
‘For the GP, this renewal process can help keep them informed and involved but can also add administrative burden and additional service provision where there may not be a need.’
 
In the RACGP’s submission, President Dr Michael Wright said in most cases, a 12-month validity period provides ‘an appropriate balance between continuity, oversight and flexibility in GP to non-GP specialist referrals’.
 
‘Indefinite referrals have the potential to enhance convenience and reduce administrative burden; but also risk private non-GP specialist over-servicing patients, placing additional burden on non-GP specialist availability and increasing costs to the Medicare Benefits Schedule,’ he said.
 
‘Regular patient checkpoints provide the GP with oversight of their condition, reducing the risk of fragmentation of care and maintains the GP-patient relationship for routine care.
 
‘The RACGP could support longer referrals with additional safeguards such as structured and timely information exchange and improved digital interoperability through enhanced digital systems.’
 
The Federal Government also raised concerns that patients can be unfamiliar with the rules around referral and their rights.
 
‘GPs often lack access to real-time data on non-GP specialist availability, fees and quality indicators. This means that at the point of referral, patients are often missing vital information to support informed decision-making around their care,’ the consultation paper said.
 
‘Medicare allows patients to claim MBS referred attendance items from any non-GP specialist in the same discipline as the practitioner named on the referral, regardless of whether the referral is made out to a specific named practitioner, or just to the name of a specialty.
 
‘Many patients are not aware of this flexibility, resulting in the misconception that a patient who is unhappy with the practitioner named on their referral must go back to their GP to get a new referral.’
 
Problems were also identified with care coordination following a specialist visit, with some GPs reporting they often receive little or inadequate feedback from non-GP specialists on the treatment their patients receive, the paper stated.
 
Several reform suggestions were raised for consultation, including:

• extending referral validity periods
• mandating all referrals contain standard information about how referrals operate and where consumers can obtain more details, including information about fees
• mandating patients are provided with a copy of their referral and non-GP specialist reports on their condition as a hard copy or via email, shared with the patient’s My Health Record.

Dr Wright added that exploring ways to modernise referral pathways is an ‘important opportunity to enhance patient access, reduce unnecessary administrative burden, and strengthen integration across the health system’.
 
But he emphasises that it must be done with care.
 
‘The RACGP cautions against reforms that prioritise access, convenience, or cost at the expense of quality and safety,’ Dr Wright said.
 
He also urged the Government to ensure any technological or process reforms be co-designed with general practice to ensure they align with GP workflows, reduce duplication, and deliver meaningful value to health professionals and patients.
 
The college said it would support reform that:
 

• is guided by the aim of better patient and population outcomes and experience, improved clinician experience, greater health equity, and lower overall system costs
• maintains quality and safety while strengthening the delivery of high-quality person-centred care
• builds and supports GP-led multidisciplinary teams
• reduces unnecessary administrative burden for specialist GPs and other health professionals
• improves communication between specialist GPs, non-GP specialists and other health professionals
• mandates clear, timely feedback to specialist GPs on changes to diagnosis, medications or patient deterioration.

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healthcare referrals reform

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