Referrals 101

How do I choose a specialist to refer to?

You and/or the practice should maintain an up-to-date list of practitioners with their subspecialties or special interests. You can also use the online platform HealthPathways available through your Primary Health Network, use directories produced by specialty bodies, or ask colleagues. Involving the patient can help, considering factors such as location, cost or past experience.

Should I write an open or a named referral?

There is no requirement for a specific name of the specialist or physician on a referral. If you or the patient have a specific doctor in mind, then you can enter the relevant details on the referral. A referral can be rejected in limited circumstances, as it’s at the discretion of the specialist’s practice or hospital if they are willing to accept the referral.

How do I write an effective referral letter?

Consider the person who will read it, and what they need to know to provide care. Standardised information, such as that produced by records software, is helpful; but referral letters must be tailored to the individual patient. Current information about medications, comorbidities and allergies is vital (these should be regularly reviewed and updated in the records). Family history, smoking and alcohol consumption, and occupation may be helpful. Do not include sensitive patient health information that is not relevant to the referral. The RACGP provides suggested phrasing and structures for referral letters.¹ In specialist-to-specialist referrals, it’s usually helpful to copy in the patient’s regular GP.

Do referral letters need to be printed and hand-signed?

No. Referrals can be sent electronically if acceptable to the referee, and if reasonable security measures are taken. Depending on the circumstances, this may involve using a secure messaging system, sending referrals as password-protected or encrypted files, double-checking the ‘send’ address, deleting emails from the ‘sent box’, having staff trained in safe email and internet use, and using general IT security measures. Medicare accepts electronic signatures. The referral needs to be generated by sole-usage software and must include the date the referral was created, with a timestamp. Sign off the letter “electronically signed by” with the designation and name of the practitioner.

What do I need to know about provider numbers and Medicare?

You must have your own unique provider number to be able to refer, request and claim MBS items via Medicare. You need a specific provider number for each location you work at. If you work in the reserve of GP respiratory practices or in a Medicare Urgent Care Clinic, you will require additional provider numbers. If you leave a location and close any provider numbers (where the patient hasn’t yet seen the specialist), the Medicare claim will be rejected.

What is a valid referral for Medicare purposes?

To be valid, a referral must include patient contact information, relevant clinical information, previous or current management and/or any investigations. It must include the date the referral was created, and the provider number and signature of the referring health professional.

How long are referrals valid for?

The standard single-course treatment referrals from a GP to a specialist or consultant physician are valid for 12 months, which starts from the patient’s first visit to the specialist.² GPs can refer beyond 12 months or indefinitely if the patient needs ongoing care. However, a new referral is needed if the patient has a new or unrelated condition while on an indefinite referral.

‘Specialist to Specialist’ referrals are valid for three months.³

Can I backdate a referral?

Patients who have let a referral lapse may ask you for a backdated one so they can claim Medicare benefits for seeing a specialist. You should not agree to do this, as it is unlawful under the Health Insurance Act 1973 (Cth). Ensure practice staff know this. Try to prevent such requests by educating patients about valid referrals.

Do I need to check that the patient attends?

At the time of making a referral, a doctor must decide whether the outcome for the patient is likely to be clinically significant and, if so, the patient should be flagged for follow-up.

The system for following up the flagged items should ideally be an agreed practice-wide system which is documented and followed consistently by the whole team. This usually involves use of the recalls function of the practice software. Where there are inadequate practice systems, you can create your own system such as a spreadsheet, using the Tasks function in software, or a paper-based log. See the RACGP’s Standards for general practices, 5th edition:⁴ Criterion GP2.2 for further detail.

A recent Court decision⁵ found that a referring doctor’s duty to follow up referrals does not extend so far as to advocate on behalf of their patients to the referring specialist to ensure the patient is seen in a timely manner.

What should I expect from the practitioner I referred to?

You can expect timely communication about the patient’s condition and planned treatment, any guidance or instructions for you, clarification of responsibility for ongoing scripts, copies of investigations, and updates on management (including if they have discharged the patient).

Further information

• Department of Health & Aged Care: A guide for GPs – referrals to medical specialists
• RACGP: Referring to other medical specialists

Reference

1. https://www.racgp.org.au/running-a-practice/practice-resources/general-practice-guides/referring-to-other-medical-specialists

2. https://www.servicesaustralia.gov.au/referrals-for-specialist-treatment?context=20#accordion3

3. https://www.servicesaustralia.gov.au/referrals-for-specialist-treatment?context=20#accordion4

4. https://www.racgp.org.au/running-a-practice/practice-standards/standards-5th-edition/standards-for-general-practices-5th-ed/table-of-contents

5. https://www.courts.act.gov.au/__data/assets/pdf_file/0005/2179166/Ziaee.pdf

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