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Report questioning value of GP referrals draws RACGP fire
The college has pushed back against claims that many GP referrals to specialists represent ‘opportunistic rather than purposeful clinical engagement’.
GP referrals have been vigorously defended.
The comments formed part of a wider piece in The Conversation Australian Healthcare and Hospitals Association researchers, who questioned the ‘wasted dollars’ in a ‘broken referral system’ and suggested referral terms can be too short.
‘The “gatekeeper” role of GPs in patient care is reinforced by legislation framing the referral system. However, GP engagement through referral expiration is a model that is based on opportunistic rather than purposeful clinical engagement,’ the researchers note in the full report.
‘Improving information sharing among service providers through real-time health information exchange would avoid the need for low-value administratively driven GP consultations, and address any ongoing concerns by GPs regarding the impact of expanded referral pathways and periods of referral validity on continuity and coordination of care.’
RACGP Acting President Associate Professor Ayman Shenouda told newsGP the argument shows a ‘lack of understanding’ of the valuable role GPs played in the health system. He said the core function of general practice is to see patients first – due to the wide range of knowledge possessed by GPs – and only refer if necessary.
‘People in hospitals have little understanding about what actually happens in general practice and the value and function of it,’ he said.
‘General practice does play a facilitation role, but its core function is a lot wider than that. GPs have skills to analyse and deal with the majority of conditions patients are facing.
‘The majority of health needs are addressed by GPs.’
Associate Professor Shenouda said the decision to treat or refer is an important part of general practice.
‘We screen the population for health issues and refer as required depending on severity or rarity,’ he said.
‘In terms of follow-up of patients, GPs are skilled in following up current treatments in all fields of medicine.’
In a response on Twitter, RACGP President-elect Dr Karen Price criticised the piece for a lack of insight into general practice.
‘[GPs] provide the majority of diagnostic skills across all the specialties and a significant amount of ongoing care. GPs are specialists in chronic complex multimorbidity where the patient’s care is not fragmented into disease boxes by multiple referrals,’ she wrote.
‘Extended referrals from specialists are a bad idea. I have many patients attending six or seven different specialists all for very much general practice care that I provide for other patients.
‘No, they do not need to see an endocrinologist subspecialising in bone every six months simply for a Denosumab injection. No, [patients with] chronic kidney disease that is stable [do] not need to see a renal specialist every six months. On and on [goes] the waste of Medicare dollars and patients’ time.’
Dr Price said primary care has many challenges, including a ‘chronically underfunded patient payment system’ that has resulted in some cases in high volume care.
‘The churn and burn … needs to be reviewed if it is the case and type of practice to which the authors unwittingly seem to refer,’ she wrote.
‘There are many better ways to ensure patients are well looked after in our complex health system, but diminishing the role of the specialist general practitioner and diminishing the power of generalism as a healthcare philosophy is a dangerous road to take for both health economics, patient care and population health outcomes.’
Responding to Dr Price on The Conversation website, co-author Samantha Prime said her response highlights important issues such as a lack of inter-professional communication.
‘The article does not advocate undermining the role of the GP – simply using GPs more effectively,’ Ms Prime wrote.
‘Given how important communication is in healthcare, we should really look to a system of enhanced interoperability that does not rely on “referrals” as a mode of keeping GPs informed.’
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