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Rejected referrals ‘compromising patient care’
Cost-shifting and the used of outdated technology have been identified as the main causes for a trend GPs believe is putting patient safety at risk.
GPs believe issues with referrals to specialists are affecting patient care.
‘I’m really frustrated from a clinical perspective that this is happening.’
So says Melbourne GP Dr Mariam Tokhi, who has raised the vexed issue of rejected referrals again.
She went public with her frustrations last week after referring a patient to see a specialist at Western Health.
The referral was subsequently rejected, with the health provider asking for it be reissued. Dr Tokhi was informed that the referral was ‘non-compliant with Western Health named referral requirements’.
‘In order to enable our patients the choice to be treated as a public or private patient, we request that this referral be addressed to the Head of Service,’ it stated.
For Dr Tokhi, the example is commonplace, and she believes it shows a systemic failing that is compromising patient care.
‘It takes up time,’ she told newsGP.
‘It’s five or 10 or 15 minutes for each patient but if you get multiple rejections every week like I do, it adds up.’
A GP at Utopia Refugee and Asylum Seeker Health Clinic in Hoppers Crossing, Dr Tokhi says her patients are at risk of getting lost in the system if it does not function as it should.
‘I work with a particularly vulnerable group of patients, many of whom don’t speak English,’ she said.
‘They are really dependent on systems to work well, often for quite serious medical issues, so that they don’t get lost to follow up.’
She also highlights the outdated technology in use, with the referral managed by fax machine.
‘It feels really unsafe, it feels like it’s compromising patient care,’ Dr Tokhi said. ‘Faxes go missing all the time. It’s just another opportunity for something to go wrong.’
Dr Joe Garra, another Melbourne-based GP, advised Dr Tokhi to send a templated letter that points out there is no obligation for GPs to provide named referrals for outpatient services under the
National Health Reform Agreement (NHRA).
He says that he has never had an issue with hospitals insisting on named referrals since using the template.
However, Dr Garra does report encountering various other frustrations and barriers when referring patients to hospitals, including requests for blood and urine tests that he believes are often of limited use by the time the patients are seen.
‘It’s almost as if the public hospitals don’t want to see our patients,’ he told
newsGP.
‘They always seem to find a little reason why [not]. It’s frustrating for us as GPs that hospitals unilaterally set these rules.
‘I understand why hospitals are doing it. But they are funded to run outpatient departments.
‘Their issue should be with the state government not funding them properly. If they are not funded enough by the state that’s the problem, don’t make that the GP’s problem.’
One Medicare expert, Dr Margaret Faux, has previously pointed out that without a named referral hospital outpatient services
cannot be funded by MBS rebates.
GPs have been encouraged to report any concerns if they believe hospitals are
wrongly mandating named referrals for access to outpatient services.
Dr Tokhi says she will consider Dr Garra’s templated approach but, in this instance, simply sent back a named referral.
‘I re-referred with the name of the specialist because I just want my patients to be seen,’ she said.
Dr Tokhi emphasises that her frustration is directed at shortcomings across the whole health system.
‘It’s not a particular institution I’m trying to call out,’ she said. ‘All institutions are doing this, every single hospital system I’ve ever interacted with.
‘It speaks to an underlying issue around cost-shifting, and it has huge impacts for patient safety and care.’
A spokesperson for Western Health said that the requirement for named referrals is to allow for MBS billing.
‘Some services at Western Health are registered as MBS-funded clinics,’ they said in a statement provided in response to a
newsGP inquiry.
‘When referring patients to an MBS-funded clinic, GPs must address the referral to the relevant Head of Unit in order to meet MBS funding eligibility requirements.’
They also said more information about the clinics and heads of unit is available on
the Western Health website.
The college, meanwhile, advises that it is acceptable for a specialist to ask for a named referral if a patient has decided to be treated privately.
‘However, the choice to be public or private is for the patient, patient’s carer or other authorised party to make, with informed financial consent,’
RACGP guidance states.
‘GPs are not required to help patients decide, but many do, and it can be helpful for patients to understand the implications above before booking an appointment.’
The college also advises that if it has been discussed, the patient’s preference for public or private care should be included in the referral.
‘Patients can make a decision with you, or when they book the appointment, or when they attend the outpatient clinic,’ the advice states.
‘If the patient is unsure, it may be best to provide a named referral – this will ensure the patient does not have to seek an additional referral before being seen, if they subsequently decide to be private.’
More details on advice for GPs on named referrals are available on the RACGP website.
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