The Role of GPs in the Specialist Referral

The notion of eliminating GP referrals to allow patients direct access non-GP specialists via allied health professionals raises important questions about the future of healthcare and the role of general practitioners (GPs) in Australia. Traditionally, GPs have served not just as gatekeepers for specialist referrals but also as coordinators of care through a team-based approach. They utilise medications to treat a broad range of health issues and initiate minimally-invasive procedures, such as interventional radiology, before considering specialist referrals. All the while providing the patient with counselling, easy to understand explanations, empathy and an overview of the various treatments. This approach ensures a comprehensive understanding of patients with complex health conditions.

Take mental health care in the community, for instance. GPs are typically the first point of contact and are well-equipped to manage many mental health issues. All general practitioners have mental health training during the registrar years, and are extensively examined on mental health skills and treatment with both medication and counselling. They refer patients to psychiatrists only in particularly challenging cases or when treatment are needed that GPs cannot prescribe due to state prescribing regulations, or inpatient services. Given the current shortage of psychiatrists and the high costs associated with specialist visits, removing the GP's role in coordinating care could impose a significant financial burden on patients, especially when a GP's care might suffice.

It's also crucial to distinguish between various allied health professionals who have special skillsets and general practitioners. Allied health professionals, such as eligible midwives and optometrists, possess specific expertise in their fields. For example, midwives provide care during pregnancy, labour, and the postpartum period and have established referral pathways to obstetricians for more complex situations in both the antenatal and postpartum period. Similarly, optometrists specialise in eye care and vision health and can refer patients to ophthalmologists for advanced medical or surgical interventions. It is important to highlight that communication with the patients regular GP is paramount and key to these successful models of care.

Allied health professionals, however, lack the comprehensive training in areas such as pharmacology, adverse reactions, antibiotic resistance, pathology, infectious diseases, radiology, acute and chronic pain management, mental health, paediatrics, geriatrics, and many other key medical areas. While they may have specialised training in certain fields, they cannot delve into the foundational knowledge and clinical experiences GPs use to assess, diagnose, treat, reassure, and follow up with patients. Unless the allied health professional is able to instigate investigations and non-surgical, non-specialist care, above their core allied health training, a GP review is essential to prevent unnecessary referrals.

General practitioners, by definition, cover a wide breadth of medical knowledge, which is extensive, expansive, and continually growing. Often, GP's undergo 5-7 years of university education, internship, and 2-3 years of hospital-based training before entering GP training and passing rigorous clinical and written exams. The pathway to becoming a General Practitioner doesn't stop there, Fellowship is merely recognition of the competence for lifelong learning as technology evolves, new treatments are discovered and protocols and policies change. Most GPs do an average of 150 hours per year reading, researching, attending conferences and lectures, consolidating their years of clinical experience.

GPs serve as the first point of contact for most health concerns, providing comprehensive and ongoing care. In most instances, allied health professionals communicate with the patient’s regular GP to ensure up-to-date medication lists and accurate documentation and coordination of medical interventions. This collaboration is crucial for maintaining a holistic approach to healthcare, ensuring all aspects of a patient's health are effectively managed.

Keeping GPs involved when allied health professionals are part of the care team ensures treatment remains consistent and cohesive. This cohesion could be compromised if allied health professionals begin referring without a GP review. The healthcare system must recognise the pivotal role of GPs as coordinators who understand the broader picture of patient care. Reducing their role to merely referral agents could jeopardise patient outcomes and potentially lead to increased healthcare costs.