Recently Gold Coast Health has forwarded correspondence to local general practices requesting review of expired referrals for particular patients. As a result, there has been quite a bit of discussion and some requests for clarification from local general practices.
Referrals to specialists are governed by at least three different policies:
- Medical specialists working in private or public health care facilities in Australia require a ‘named’ referral addressed to them to claim reimbursement from Medicare (bulk billing) for the clinical services they deliver.
- It is a requirement of the Queensland Specialist Outpatient Services Implementation Standards (SOSIS) that patients who attend public hospitals for review appointments must have ‘in-date’ referrals. All referrals requesting specialist outpatient services expire after a given period that commences at the first consultation:
- referrals by hospital clinicians last for just 3 months,
- GP referrals last 12 months
- Queensland Health requires that every hospital and health service collect data of all service events they provide. Mandatory information includes date and source of referrals. For more information click here. This data from public hospitals is not currently linked to HHS funding or access to services.
Hospitals do not lose funding if patient referrals ‘expire’ and they may continue to deliver clinical services deemed necessary to patients. While some have suggested that in future Queensland Health may link funding to such things as “in date” referrals, there is currently no known intention or time line for this approach.
Sometimes a request may be sent to a GP where the patient is not currently attending. Unfortunately, GCH data is dependent upon patients advising of correct information and advising of any changes to care providers. Should you find that an inappropriate referral has been sent to your practice, we request that you simply return to the hospital.
The rationale for implementing a referral continuation procedure to improve the number of ‘in-date’ referrals is therefore clinical, rather than financial. It is underpinned by two key principles.
- The first is that the health care needs of many patients vary considerably over time.
- The second principle is that GPs provide holistic, continuous care to patients and are therefore ideally placed to assess and meet the healthcare needs of their patients.
Although a referral may originally come from an internal GCH specialist, it is noted that it is vital to the care of the patient that their usual GP be contacted for any referral continuations. This process provides formal opportunities for GPs to assess the current and future health care needs of patients and agree the roles of every team member to deliver efficient and effective health care.
We apologise for any confusion and trust this clarifies matters for you.