The incoming program represents an opportunity to strengthen how primary and non-GP specialist care integrate nationally.
The release of No child left behind, the House of Representatives Standing Committee report into the Thriving Kids initiative, is both timely and welcome.
The inquiry was led by Dr Mike Freelander MP, a practising paediatrician, alongside Deputy Chair Dr Monique Ryan MP, a paediatric neurologist. Their clinical leadership and the report’s findings reflect what clinicians, families, and educators have been experiencing for years. Too many children with mild to moderate developmental needs have fallen into gaps between systems, with the NDIS becoming the default entry point simply because there was nowhere else to go.
The intent of Thriving Kids is sound. Earlier identification, stronger foundational supports, better integration across health and education, and reduced reliance on the NDIS for children with lower needs are necessary reforms. The report also acknowledges a critical truth. When children move off the NDIS, they do not disappear from the system. They land somewhere. And in almost every case, they land back in general practice.
I recall consulting with a family whose daughter, Rachel, was five years old and had experienced multiple challenges since early childhood, including failure to thrive and concerns regarding language and motor development. After a prolonged diagnostic process, she was diagnosed with autism and associated ADHD traits, alongside emerging anxiety. Until recently, she had been receiving NDIS-funded supports that enabled her to function well at home and at school.
Under the proposed Thriving Kids reforms, children like Rachel, with low to moderate support needs, are expected to be supported outside the NDIS.
As GPs, we are already seeing this transition begin. Parents arrive worried about what the changes mean. Schools are unsure who is coordinating care. Funding arrangements may change, but the child’s needs do not. The work returns, quietly and inevitably, to the GP.
Where these children will land
This is not inherently a problem. In many ways, it is exactly right.
GPs see children early, often before diagnoses are clear. We understand family context, school pressures, and the overlap between developmental, physical, and mental health concerns. We are well placed to manage mild to moderate autism and ADHD over time.
But this work is not simple. These children are often complex. Comorbidities are common. Presentations evolve. Diagnostic uncertainty is the norm. Families are anxious, particularly when funding and supports change. Care is frequently complemented by allied health input that can be difficult to access in a timely way.
Without new models of care, this reform risks shifting responsibility without strengthening capability.
Why traditional referrals will not work
Thriving Kids cannot succeed if the solution is simply more referrals into public paediatric and child psychiatry services that are already under extreme pressure.
Across Australia, children with developmental concerns commonly wait 12, 18, 24, or even 36 months for public outpatient appointments. For developmental presentations, these timeframes matter. The evidence is unequivocal. Early intervention delayed is early intervention denied.
As paediatricians, we see this daily, and the inequity is most stark outside metropolitan centres. For many regional and rural families, access to a developmental paediatrician is not limited. It is effectively nonexistent. Public services may be absent, private specialists are rarely available locally, and outreach clinics are infrequent and oversubscribed.
Families call colleagues, friends, and sometimes complete strangers, searching for any available specialist anywhere in the country. Recently, a paediatric colleague in Perth asked whether there were any options at all for a child he was caring for in Melbourne or Sydney who had been placed on a three-year public waitlist for developmental paediatrics, with no private services available. When private care is an option, the costs of specialist assessments are often prohibitive, with families facing thousands of dollars in out-of-pocket expenses. That families are willing to fly interstate, incur significant costs, or both, speaks volumes about the pressure they are under and the absence of viable, affordable local pathways — a situation reflected in national reporting of parents paying thousands and travelling long distances while children wait months or more for specialist appointments.
What already works in practice
This is not an unsolved problem. Other health systems, and increasingly parts of Australia, have already begun to address it by using specialist expertise differently.
In the United Kingdom, the NHS has embedded Advice & Guidance (A&G) as a core outpatient reform. Rather than defaulting to a referral, GPs can seek structured specialist advice through digital platforms and receive specialist A&G within days. This advice often clarifies investigations, management, or thresholds for referral. Many cases are resolved without a hospital appointment, while others are streamlined so that when a child is seen, the referral is more appropriate and the wait shorter.
Related
Importantly, this approach is already in use in Australia. The Sydney Children’s Hospitals Network has for several years supported primary care clinicians through Advice and Guidance style arrangements within its developmental services. When children are placed on outpatient waitlists, or when referrals are returned with specialist advice rather than accepted for clinic review, SCHN paediatricians provide structured A&G back to GPs. This advice focuses on what can be done now: early intervention strategies, allied health prioritisation, guidance on investigations, medication considerations, and thresholds for escalation. In many cases, this allows meaningful support to begin months or even years earlier, without increasing outpatient demand.
Other Australian jurisdictions are scaling similar models. Mater Health has implemented a statewide Queensland eConsultant service that allows GPs to access specialist advice within approximately two business days. Not two years. Two days. This model supports GPs and NPs across Queensland and demonstrates how specialist input can be delivered equitably at scale without increasing outpatient demand.
In Victoria, a complementary model has been established through the Victorian Virtual Specialist Consults (VVSC), led by Northern Health. This service enables GPs to participate in time limited virtual co-consults with specialists. While delivered differently, the principle is the same: timely specialist input to support primary care decision making, clarify management plans, and reduce unnecessary outpatient referrals while care continues locally.
For a GP managing a child with suspected or confirmed developmental delay, this support is transformative. Rather than waiting months for an outpatient appointment, the GP can seek timely specialist advice on next steps. This Advice & Guidance is both supportive and educational. It builds confidence in primary care, reduces unnecessary referrals, and allows interventions to begin quickly. Children receive help when it matters, families feel supported, and care progresses rather than stalls.
For regional and rural communities, these models are not a convenience. They are essential infrastructure.
Thriving Kids is the moment to scale this approach
Thriving Kids creates an opportunity to strengthen how primary and specialist care work together nationally.
The technology to support this already exists. Secure digital platforms enable structured advice, shared information, and clear clinical governance. Models of care have been tested locally. Clinicians are familiar with them.
Supporting GPs with timely access to specialist advice is not an additional layer of care. It is a more efficient use of the system we already have. It preserves specialist capacity, improves equity, and aligns with the goals of early intervention, mainstream care, and sustainability.
Thriving Kids will only succeed if it is built on thriving connections. Connections between GPs and specialists. Between health, education, and community supports. Between families and a system that responds early, not years later.
Advice & Guidance shows what those connections can look like in practice. Timely specialist input. Shared responsibility. Care that moves forward rather than stalls. A system that supports clinicians to act early, with confidence and clarity.
For kids like Rachel, thriving connections are not a policy aspiration. They are the difference between waiting through childhood and being supported while childhood is still unfolding.
Associate Professor Vikram Palit is a paediatrician and the CEO of digital referral platform Consultmed.
Dr Adam Braithwaite is a GP in Victoria.
