Specialists to bypass GPs with direct referrals

Medical politics

By Michael Woodhead

16 Jul 2019

The RACP has thrown its support behind a proposal to allow consultant specialists to refer directly for Medicare-rebated consultations with allied health professionals, bypassing the GP.

In a plan laid out by the MBS Review Taskforce, a direct referral pathway will allow specialists to refer patients with chronic complex morbidities directly to allied health practitioners such as dieticians, nurses, physiotherapists and psychologists.

The proposals released for consultation early this year gave examples such as  gastroenterologists referring to psychologists to treat IBS, or endocrinologists referring patients to a diabetes educator or nurse.

Consultant specialists can already refer to allied health professionals, but the patient will not have access to a Medicare rebate. Currently, patients must be assessed by their GP for eligibility and development of a GP Management Plan (item 721). If granted, the patient can access up to five AHP visits with a rebate.

“This is inconvenient for patients, adds an additional cost of visiting their GP, and increases the likelihood of the intervention not taking place,” the Taskforce noted.

It recommended that direct referrals be introduced “but only after a full review of the evidence and the associated costs and benefits of any suggested pathway.”

In its response to the proposals, the RACP said a poll of members showed that 71% agreed with the introduction of an Allied Health Pathway (after removing the one fifth of ‘don’t know’ respondents).

Supporters of the proposals said direct referrals would make for better team care and also reduce costs for patients.

“As allied health professionals typically have a long-term relationship with their patients that is comparable to the relationship that patients have with GPs, this pathway was seen as a means to enhance opportunities for direct collaboration between allied health and consultant physicians and specialists.,” said the RACP in its submission to the MBS Specialist and Consultant Physician Consultation Clinical Committee.

“This recommendation was also seen more broadly as a means of fostering multidisciplinary team-based care. For instance, by enabling endocrinologists to refer patients back to allied health professionals in a primary health care setting, this would greatly aid transitioning diabetes patients from specialist care back to primary care.”

A direct referral pathway would reduce the cost and inconvenience to patients who would no longer have to return to the GP to obtain a referral, the submission noted.

However respondents said the patients GP should be informed about the referrals and “kept in the loop” to ensure there was genuine team care.

A minority of responders believed the move would undermine the role of the GP as a gatekeeper to healthcare, and that if they were bypassed there could be an increase in unnecessary referrals to allied health referrals .

The MBS Review Taskforce consultation process closed in May 2019, with chairman Professor Bruce Robinson saying that following deliberations by the committee “additional work will be needed to inform how any final recommendations  should be implemented.”

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