6 June 2023

Referral red tape ‘wastes GP time’

Interoperability MBS Political

The RACGP wants the new National Health Reform Agreement to put the hard word on hospitals, and pay GPs for the paperwork.

The RACGP wants GPs remunerated by new MBS items that compensate them for time spent outside patient consultations navigating referral pathways, as well as an end to named referrals and hospital-specific referral pathways that do nothing but “waste time”.

In its submission to the National Health Reform Agreement addendum 2020-2025 mid-term review, currently under way, the college has gone in hard on one of the biggest bugbears for GPs interacting with the hospital system.

“GPs should be spending time with their patients, not on navigating long forms and frustrating processes that can be unique to each hospital,” said RACGP president Dr Nicole Higgins.

“It’s not facilitating quality healthcare, it’s just exporting hospital bureaucracy into general practice. Hospitals know their staff and systems, GPs know the patients they are referring. Standardised digital forms that allow a GP to provide details of their patient and that patient’s case to a hospital will help ensure GPs are able to move quickly to get patients the care they need.

“This is a waste of time that we could be spending with patients and on more appointments.

“General practices have moved past the era of paper, PDF forms, and faxes, yet too often, hospitals are using not just unique forms, but archaic systems. This is an opportunity to make the system both more effective, and more efficient.

“The same goes for named referrals. Named referrals allow public hospital outpatients to be treated as a private patient, with payment from Medicare rather than the hospital’s state-funded healthcare budget,” she said.

“This is an option where someone wants to be seen as a private patient, not a requirement. That choice is for the patient, not a hospital.

“Yet some hospitals still imply GPs must make a named referral, or even reject non-named referrals, even though patients with a named referral may be treated by another doctor at the service.

“This is just using a loophole to shift costs away from public hospitals and onto Medicare.

“For a GP, this can mean reviewing pages of named specialists, which is especially frustrating given this is not about delivering quality healthcare.

“GPs are reluctant to make a complaint or debate regulations with hospitals as this could further delay patient care. Many GPs provide a named referral to ensure the patient is seen as soon as possible.

“The Department of Health has encouraged GPs to report this practice, and this review is an opportunity to make the rules crystal clear.”

It its submission, the college asked the NHRA to do the following in terms of referrals:

  • “Use stronger language and regulations to prevent public hospital outpatient clinics from controlling referral pathways by requiring named referrals for access and working towards a reduction in the number of MBS items claimed by hospitals. General practice needs to be involved in these reforms to ensure referral pathways have GP input and remain a collaborative action; and,
  • “Require hospitals and other health services to use standardised, secure, interoperable digital systems for referral and discharge between general practices and hospitals that are compatible with existing general practice management systems.”

“Ultimately the practice of named referrals uses money that has been allocated for primary health to pay for the hospital sector,” the RACGP says in its submission.

“Hospitals need to be accountable for using the funding set aside for them effectively and not seek to use funds that have been established for other parts of the system.

“The NHRA must work towards reducing the volume of MBS items claimed by hospitals to ensure the financial sustainability of Medicare and the health system overall.”

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Patient advocate
Patient advocate
6 months 1 day ago

Interestingly, it is the person seeking the referral and carer/s who also are at the inconvenience of this process.
This also occurs with the GP Management Plan when a Team Care Arrangement with a specific Allied Healthcare Professional has capacity issues and/or unavailable, or additional visits require adjusting the person is required to revisit or Telehealth the GP to adjust the named referral.
This subsequently delays time to treatment.
Is this admin referral process really providing the best ‘person-centric care’ model?

antony Sara
antony Sara
6 months 1 day ago
Cate thank you the RACGP seems to be asking for some sort of generic “standardised” referral to hospital specialist clinics. In my position working for an LHD, and being involved with the referral forms that the specialists have developed, they are often very specific and detailed from their speciality in terms of the clinical information requested to allow for a more efficient and effective referral and consultation. A GP would not necessarily know the level of detail or tests requested. Thus the request to use some sort of generic referral as proposed would be hard to support as not being… Read more »
Heather Reid
Heather Reid
6 months 1 day ago

Hi Sara
It seems odd then that GPs get it right for the same specialists in the private sector….