Thank you for the opportunity to comment on the Consultation Paper: Modernising Referral Pathways.
NAPP makes the following recommendations and observations:
Improving fee transparency
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- NAPP supports reforms that improve patients’ awareness of likely specialist consultation costs. This is an informed financial consent process.
- Including standard information and links (e.g. to a government-run fee information site) on referrals would be helpful.
- In addition, NAPP supports publication of typical fees charged by specialists for common consultation types, to support informed financial consent and realistic expectations.
- Alongside, specialist consultation fee examples, patients should be provided information regarding the Medicare rebate they will receive from the Government towards common consultation items.
- Patients should also be provided clear examples of how reaching the Medicare Safety Net threshold(s) will impact their out-of-pocket (gap) fee.
- Extending referral validity periods
- NAPP supports extending GP-to-specialist referral validity to at least three years.
- NAPP supports extending specialist-to-specialist referral validity to at least one year.
- These changes would better reflect the needs of patients with chronic and complex conditions and reduce unnecessary GP attendances for purely administrative referral renewals.
- Clarifying patient choice of specialist
- Patients should be clearly informed that, provided they see a specialist within the same specialty, they can use their existing GP referral for a different named specialist: they do not need to get another referral to the new specialist.
- NAPP notes many patients do not understand this flexibility and believe they must obtain a new referral whenever they change specialists.
- Clarifying when referral validity starts
- It should be clearly communicated to both patients and practices that referral validity starts on the date of the first specialist consultation, not the date the referral is written.
- This point is often poorly understood by patients and some administrative staff, and clearer education and guidance would reduce confusion and disputes.
- Information sharing between GPs, specialists and patients
- NAPPs supports an expectation that specialists notify GPs when there is a significant change in diagnosis, treatment or the patient’s condition.
- Providing patients with copies of referrals and reports
- Patients should routinely receive a copy of the referral to the specialist, as this helps them understand the reason for referral and prepare relevant information for their consultation.
- NAPP also supports patients receiving copies of specialist reports to the GP, as this enhances transparency, engagement, and self-management.
- Managing sensitive or potentially harmful information
- NAPP supports the general principle of clinicians sharing reports with patients but notes that there are rare situations where disclosure of certain information could be harmful to the patient or others receiving this information.
- Any reform that promotes sharing reports with patients should include a clear caveat allowing the specialist, in relevant circumstances, to send information confidentially to the GP where direct disclosure to the patient would be clinically inappropriate or potentially damaging.
These are NAPP’s recommendations on how the referral system could be improved while supporting patient autonomy, continuity of care, and effective communication between clinicians.
Yours sincerely,
Philip Morris
Prof Philip Morris AM (President, NAPP) and Executive Committee (Dr Melinda Hill, Dr Viv Elton OAM, Dr Arjun Khaira)
