Nearly half of GPs manage complex care while patients wait for non-GP specialists, says Avant survey.
Long wait times and navigating referral pathways are key barriers to GP-referred care, according to the first national analysis of GP referral decision-making and patient attitudes towards referrals.
GPs remain the primary decision-makers for referrals, with over 93% of patients trusting their advice. But patients aren’t passive recipients, they’re key collaborators, influencing specialist selection in roughly 40% of consultations, researchers found.
Commissioned by medical insurer Avant, Australia’s largest doctor-owned organisation, the survey found GP satisfaction with private referral pathways was high but plummeted substantially for public pathways, driven largely by lengthy wait times – particularly acute in rural and remote areas.
This strain compounded GP workload. Nearly half of GPs (48%) reported often managing patients’ complex conditions themselves due to access barriers, including being in an underserved area or difficulty securing public hospital outpatient appointments.
One third of patients waited three months or more for specialist care, and more than half identified shorter waiting times as their top priority for referral pathways, echoing a longstanding call to expand workforce capacity and specialist availability.
Avant medical advisor and Adelaide GP Dr Sally Parsons told TMR that general practice acts as “a safety net for the system”, with her and her colleagues often managing conditions themselves due to barriers to non-GP specialist referrals.
“Where there is no other avenue for our patients to seek help, we’re really put in a position where we have to do the best we can,” she said.
Dr Parsons said this research would help Avant advocate for its members and had already been presented at a recent Parliament House roundtable in Canberra, attended by Minister Mark Butler.
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Cost mattered in referral decisions but was secondary to clinical suitability and access.
Of 694 private GP referrals, 87% were influenced by clinical factors, such as previous experience or expertise, and 86% by non-financial considerations.
Financial factors still influenced 64% of private referrals, with GPs citing patients’ provider price preferences, case complexity, or – as one put it – “sometimes it just comes down to who can see them soon enough”.
The calculation shifted, though, when it came to choosing between private and public pathways. Here, financial considerations were the most-cited factor, and GPs initiated these discussions more often than patients.
RACGP president Dr Michael Wright said GPs often face the difficult decision of referring patients to more costly private specialists or wait-listed public services.
“It’s a real burden that gets pushed back on GPs,” he said.
“Given GPs are providing this more complex care, it’s a real reason why you want to have Medicare rebates increase, particularly for longer consults, to save these costs downstream,” he said.
“In the absence of evidence, you can’t really design policy. This is a good example of trying to gather some evidence to understand and ensure that health policy works for patients as well as for GPs, without shifting its administrative burden onto us,” he said.
Specialist quality itself wasn’t a major concern across the board. Rather, a proposed government-sponsored, specialist-quality rating website was – 98% of GPs cited a lack of credibility as the barrier to use.
“I think it’s a terrible idea… that’s something incredibly subjective,” one GP said.
Others warned the site would add limited value to existing referral networks and risk inciting perverse incentives and could see ratings misinterpreted by patients.
Support for the Medical Costs Finder, a tool for comparing specialist fees, was warmer – 63% of GPs backed the concept.
But given the barriers and opposition to mandating its use, the survey suggested it would be better suited as a patient-facing transparency tool than as an integration into GP consultations.
Principal barriers included time pressures during consultations and the additional workload, which GPs felt was ultimately the patients’ and specialists’ responsibility.
“Honestly, my immediate thought is that it’s not our job… that’s extra time, that’s extra effort… we feel incredibly disrespected as a cohort,” one GP said.
Just 16% of GPs felt responsible for discussing costs with patients, compared with 87% who believed the responsibility rested with the specialist or specialist practice – a view Avant said patients largely shared.
RACGP WA chair and Perth GP and practice owner Dr Ramya Raman told TMR the report highlighted a capacity problem, particularly outside metropolitan areas.
“Sometimes, depending on the specialty, it can take up to 12 to 18 months for [patients] to be seen through the public system,” she said.
During the wait, Dr Raman said, GPs continue to monitor patients and liaise with hospital doctors for additional advice – often extending consultations in the process.
In Western Australia, some patients must fly to Perth for non-GP specialist treatment due to the state’s vast geography, she said, underscoring the need for telehealth services and case-conferencing options.
“GPs should be able to escalate care when the complexity is high, or a condition requires a non-GP specialist referral. The referral systems need to support that shared care, timely non-GP specialist advice, and clear clinical accountability,” she said.
The research drew on survey responses from 373 GPs – 256 of them Avant members – and 503 patients who had received a GP referral to a specialist.
Read the full report here.
