Direct referrals from allied health professionals to non-GP specialists could soon become a reality.
An almost-forgotten recommendation from the 2024 scope of practice review has resurfaced, with the Department of Health, Disability and Ageing formally commencing a review of direct referrals from allied health workers to non-GP specialist doctors.
An MBS Review Advisory Committee communique dated last month but published this week confirmed that the work was underway, and that the committee was currently assessing recommendation 12 of the scope of practice review final report against MRAC guiding principles.
Recommendation 12 from the Unleashing the Potential of our Health Workforce – Scope of Practice Review final report was one of the more controversial proposals and drew heat from various medical advocacy bodies upon the report’s release.
Specifically, the report recommended that the government implement new direct referral pathways for consumer access to specified non-GP specialist MBS items so long as the direct referral was written by a health professional working within their scope of practice and that the referral was accompanied by “appropriate, timely notification” to the patient’s usual GP.
Examples given in the report were physiotherapists, chiropractors and osteopaths being able to refer to an orthopaedic surgeon, or audiologists and speech pathologists being able to refer to an ENT surgeon.
Psychologists would be able to refer to psychiatrists, dieticians would be able to refer to gastroenterologists and diabetes educators could refer to endocrinologists.
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Current rules technically allow all of these allied health professionals to write these referrals – but the patient would not be eligible for an MBS rebate for the resulting consultation.
“Outside of referrals provided by specific named professions, these regulations prevent the consumer from being eligible for MBS benefits for the referred service, resulting in out-of-pocket costs by default,” the report said.
“For consumers, this creates both cost and time barriers to accessing primary care because, despite receiving care and referral advice from a health professional of their choice, they are often required to undertake a secondary consultation (typically with a GP) to access the required referral.”
The guiding principles of the MRAC, according to an unrelated recent consultation document, include that the MBS is structured to support coordinated care by recognising the central role of general practice and is designed to provide sustainable, high-value, evidence-based and appropriate care.
When the scope of practice review was first released, GPs like then-RACGP president Dr Nicole Higgins and AMA president Dr Danielle McMullen told The Medical Republic that they were concerned the direct referrals would potentially be for conditions which were treatable by GPs, representing low-value care.
They were also concerned that it would undermine the role of GPs as stewards of the health system.
The Department of Health, Disability and Ageing predicted that the direct referrals review would take approximately 18 months to complete. It will do both targeted and public consultations.
It’s unclear how this would interact with DoHDA’s other ongoing work on modernising referral pathways.
