Mandated clinical summary exchanges and improved digital interoperability would be enough to get the royal college to back indefinite referrals.
The RACGP has erred on the side of caution when it comes to the issue of indefinite referrals, warning the government against prioritising convenience and cost over patient safety.
However, it also said that it would be willing to lend its support to the indefinite referral cause if the Department of Health, Disability and Ageing agreed to certain safeguards.
GP to hospital-based specialist referrals have been the talk of the (proverbial) town this year, after the DoHDA somewhat unexpectedly opened a consultation on modernising the referral ecosystem in February.
Two of the major changes under consideration include forcing referring doctors to include information about the Medical Costs Finder, extending referral validity to let patients take referrals to multiple practitioners and allowing GPs to write longer or indefinite referrals (i.e., referrals without a 12-month validity period).
Indefinite referrals, which theoretically benefit patients by reducing the number of times they have to visit their GP, have proven divisive.
The AMA argues that such a policy could disrupt continuity of care and signalled a “move to transactional healthcare interactions”.
In the opposite corner, the Medical Software Industry Association believes that technology is now advanced enough for GPs to be kept in the loop by their non-GP specialist peers, especially given the new rules mandating test results be uploaded to My Health Record.
In its submission, the RACGP ultimately sided with the AMA.
“In most cases, a 12-month validity period continues to provide an appropriate balance between continuity, oversight and flexibility in GP to non-GP specialist referrals,” it wrote.
“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.
“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.”
It did provide a caveat, though; the college said it would support longer referrals if there were to be additional safeguards in place.
Suggested safeguards included a “structured and timely information exchange” and “improved digital interoperability”.
According to the RACGP’s vision, periodic clinical summary exchanges between GPs and non-GP specialists would be mandated at “key points” in the care pathway, such as after the initial consultation or when there is a change in medicine or a deterioration.
“Annual referral renewal currently prompts this reciprocity; without intentional mechanisms … extending referral periods risks weakening communication pathways that are vital for safe, integrated care,” the college wrote.
It also envisioned a digital environment where GPs had access to consistent referral templates with compatible formats and universal minimum data requirements.
This would require standardised structures and national data principles, at a minimum.
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While it acknowledged the DoHDA’s interest in improving efficiency, the college was against the proposal to allow patients to take a referral to more than one specialist.
“Trust and professional understanding between clinicians develop gradually and are essential for efficient communication, appropriate escalation and safe care transitions between providers,” the RACGP said.
“A GP’s referral choices reflect not only clinical expertise but also specialist communication styles, responsiveness, shared-care approaches and experience supporting similar patient needs.
“Policies that allow referrals to be freely redirected to less familiar and/or a larger pool of clinicians may unintentionally weaken these established networks, encourage low value care, increase the risk of fragmented care and create duplication and greater complexity for clinicians and patients.”
The RACGP also hit back at what it said was an incorrect framing of referrals in the consultation itself.
“Several questions appear to present referrals as administrative transactions designed to facilitate access, convenience or consumer preference,” the RACGP wrote.
“This perspective does not fully reflect the clinical judgement and coordinated care that specialist GPs provide when assessing need, managing risk and supporting ongoing care.
“It overlooks the fact that referrals are embedded in a longitudinal, relationship-based model of care, not a one-off consumer ‘request’ to be fulfilled.”
