On 1 October 2019, referrals from general practitioners (GPs) to allied health services changed for DVA clients.
Referrals are valid for up to 12 sessions of treatment or a year, whichever ends first. This new ‘treatment cycle’ aims to improve the quality of your care.
You can be referred by your usual GP to an allied health provider, if you have a clinical need for allied health treatment. Referrals can also be initially made by a specialist doctor or hospital discharge planner. Referral arrangements to specialist doctors (for medical treatment such as psychiatry or surgery) remain unchanged. Dental and optical services are not included as part of the treatment cycle arrangements, as referrals to these services are not required.
At the beginning of the treatment cycle, your allied health provider will prepare a Patient Care Plan and ask you about your health goals. At the end of the treatment cycle the allied health provider will send a report to your usual GP. The report outlines the treatment provided, the progress of the treatment towards meeting agreed goals and recommendations for further treatment, if required.
Your GP will use this report to review the progress of treatment and assess if further allied health treatment is clinically required, or whether other treatment options are needed. Your GP will provide you with a new referral to your allied health provider, if it is needed.
You will continue to have access to the care you need. You can have as many treatment cycles as your GP decides are clinically necessary.
You can have a separate treatment cycle for each allied health service you require. This includes having treatment cycles for different allied health services at the same time. For example, you may have services provided by a dietitian, podiatrist and physiotherapist at the same time.
If you are a DVA client with a Totally and Permanently Incapacitated (TPI) Gold Card, these changes do not apply for physiotherapy and exercise physiology services. When you use other allied health services, for example, occupational therapy, podiatry or psychology, the treatment cycle arrangements will change your referrals for these services.
DVA has produced leaflets that explain how the treatment cycle works:
A letter has also been sent to DVA clients who have accessed allied health services during 2019:
What do I need to do from 1 October 2019?
If you are already receiving allied health treatment, you can continue to see your allied health provider up to 12 more times after 1 October under your existing referral.
If you have an annual referral, you can receive:
- up to 12 sessions of allied health treatment after 1 October 2019, or
- treatment until your annual referral expires
whichever ends first.
If you have an indefinite referral, you can receive:
- up to 12 sessions of allied health treatment after 1 October 2019, or
- treatment until 30 September 2020
whichever ends first.
All new referrals from 1 October onwards will be part of the new treatment cycle arrangements, excluding referrals to exercise physiology and physiotherapy for TPI Gold Card holders.
Why are we introducing the treatment cycle?
The treatment cycle aims to give you better care based on your health needs.
At the beginning of a treatment cycle, you and your allied health provider will decide on your treatment goals. At the end of the cycle they will look at how you are progressing towards your goals and send a report to your GP. This report will help your GP decide on the next steps for your treatment.
You, your GP and your allied health providers will be able to communicate better and work together to achieve your health goals through the treatment cycle.
Are any treatments excluded from the new referral arrangements?
The treatment cycle does not apply to:
- dental and optical services, as GP referrals are not currently required
- hearing services
- Open Arms – Veterans & Families Counselling, which provides free and confidential counselling to anyone who has served at least one day in the Australian Defence Force and the veteran community
- therapies that have other treatment limits. The relevant provider notes and fee schedule will advise which therapies are excluded from the treatment cycle.
Referrals from GPs to specialist doctors (including surgeons and psychiatrists) are not subject to the treatment cycle.
Are any clients excluded from the new referral arrangements?
The treatment cycle does not apply to exercise physiology or physiotherapy services for TPI Gold Card holders.
This means that TPI clients can have as many sessions for exercise physiology or physiotherapy as clinically necessary in the period covered by existing referral arrangements – that is either annual or ongoing referrals.
This exclusion applies to all veterans who hold a DVA Gold Card embossed with the letters ‘TPI’, including clients who receive the Special Rate Disability Pension under the MRCA.
Will I be able to access allied health services outside of the treatment cycle arrangements?
In addition to TPI veterans who are exempt for exercise physiology and physiotherapy services, as part of the treatment cycle arrangements, DVA has developed the At Risk Client Framework for assessing DVA clients who may need tailored arrangements outside of the treatment cycle in exceptional circumstances. The Framework aims to provide tailored referral and care arrangements for the minority of clients for whom the treatment cycle would detrimentally impact upon their health, wellbeing or treatment; and/or place on them an unreasonable burden or imposition.
The Framework will be used by GPs to determine whether a client needs tailored allied health referral arrangements and provide criteria to assist GPs in making this decision. The Framework arrangements are consistent with the role of the GP as care coordinator in Australian health care, responsible for determining the needs of the patient and referring them to clinically necessary health services. DVA anticipates that only a small number of DVA clients will need tailored arrangements.
How long does a referral last?
A referral is valid for one year from the date of issue, or for 12 sessions of allied health treatment, whichever ends first.
Will I need to see my GP more often?
No. We do not expect you will have to see your GP more often.
On average, DVA clients who receive allied health treatments visit their GP 14 times per year. You can request a new referral during one of these visits.
Some clients see their GP more frequently than 14 times per year, and others less. While the treatment cycle may result in more frequent visits to their GP for some DVA clients, please be assured these arrangements are to promote quality clinical care for DVA clients so they have the best possible prospects for living a healthy life.
Will there be any gaps in my treatment because of the new arrangements?
DVA is working closely with allied health providers and GPs to ensure they understand these changes so that there is no disruption to any of your clinically needed treatment.
Will my allied health treatments be limited under the new arrangements?
The treatment cycle does not limit the number of clinically required services you need.
You may have as many treatment cycles as the GP determines are needed for you. A separate referral will be given for each provider. For example, you may need the services of a dietitian, podiatrist and physiotherapist at the same time, and you would receive a separate referral for each.
How many treatment cycles can I have?
You may have as many treatment cycles as your GP thinks you need. At the end of the 12 sessions, when you go back to the GP to review your progress, you can be referred for another 12 sessions if the GP determines further treatment is clinically necessary.
You can also get treatment from different types of allied health providers at the same time. For example, you can have a treatment cycle with an occupational therapist, a speech pathologist and a podiatrist at the same time.
Does the treatment cycle limit access to mental health services?
No. While the treatment cycle applies to mental health services provided by psychologists, mental health occupational therapists and mental health social workers, you may have as many treatment cycles as your GP thinks you need. Under the treatment cycle, your mental health provider will provide regular reports to your GP to ensure you are receiving the most appropriate mental health treatment for your needs.
The treatment cycle does not apply to services provided by a psychiatrist. You may also access mental health treatment from your GP.
Will DVA monitor how the new arrangements are working?
The Government is committed to listening and acting upon the views of the veteran community. The treatment cycle will be evaluated, including the impact on DVA clients, after the first year of operation. DVA will report back to Government on the outcomes of the evaluation in late 2020.
The Queensland University of Technology has been contracted to undertake an independent evaluation of the treatment cycle. Please visit QUT’s webpage to find out how you can participate.
Who can complete the At Risk Client Assessment Form?
DVA clients must be assessed by their usual GP who will determine whether tailored arrangements are required, in reference to the At Risk Clients Framework. The At Risk Client Assessment Form must be completed in full by the GP, including a clinical justification that explains why a tailored referral would better serve the client’s quality of care. This explanation does not need to be exhaustive, however it must be individualised and specific to the client’s circumstances.
Does DVA have to approve the At Risk Client Framework?
No. The client’s usual GP assesses the client against the Framework criteria and makes a clinical decision about whether tailored referral arrangements are required. The GP must lodge the completed assessment with DVA as a record of the arrangement, but DVA does not need to approve the GP’s decision.
How long can a client have a tailored arrangement?
A tailor arrangement can be in place for up to 12 months. Clients’ needs and circumstances change over time, and clients are not expected to maintain their tailored referral and review arrangements indefinitely. They should return to the treatment cycle requirements when appropriate.