​A list of frequently asked questions for the state-wide referral criteria (SRC) in NSW.

Last updated: 01 November 2024
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General

What is the state-wide referral criteria?

State-wide referral criteria (SRC) is a clinical decision-support tool that communicates the minimum clinical criteria and referral information required for referrals issued to NSW public specialist outpatient services. SRC is intended to support referring health professionals when issuing referrals as well as NSW public specialist outpatient services at the point of screening and triage.

What are the five criteria of state-wide referral criteria?

The five criteria of state-wide referral criteria include:

  • Emergency: Clinical presentations or ‘red flags’ where referring health professionals should consider redirecting the patient to an Emergency Department or urgent care service, or seeking medical advice (for example, phone on-call medical practitioner). These criteria should not be used by referring health professionals to refer to NSW public specialist outpatient services.
  • Out of scope (not routinely provided): Symptoms, conditions, and/or presentations that would not routinely be provided by NSW public specialist outpatient services (i.e. could be optimally and safely managed in primary care). These criteria acknowledge and permit exceptions, where clinically appropriate.
  • Access and prioritisation: Symptoms, conditions, and/or presentations that advise referring health professionals, clinicians, patients and carers suitability for management by NSW public specialist outpatient services. These criteria are classified by expected clinical urgency category and clinically recommended timeframes to be seen for a new outpatient appointment (i.e. Category 1: within 30 days, Category 2: within 90 days, Category 3: within 365 days). These criteria are only applicable where NSW public specialist outpatient services exist and manage the identified presenting condition.
  • Required information: Mandatory information that is to be supplied with referrals to NSW public specialist outpatient services for specific symptoms, conditions and/or presentations. These criteria support the determination of an appropriate clinical urgency categorisation.
  • Additional information (if available): Optional information that can be supplied with referrals to NSW public specialist outpatient services for specific symptoms, conditions and/or presentations. These criteria support with the determination of an appropriate clinical urgency categorisation, however, are not required to continue referral processing.

How are state-wide referral criteria developed?

The development of state-wide referral criteria (SRC) is led through a specialty- and patient cohort-specific Clinical Advisory Group. Each Clinical Advisory Group comprises of NSW Health doctors, nurses, midwives and/or allied health professionals as well as referring health professionals who are appointed to provide clinical advice and expert opinion based on scientific evidence and clinical best practice guidelines.

Once the Clinical Advisory Group reaches a consensus in defining the SRC for identified presenting conditions, the SRC is circulated to a range of stakeholders for consultation. All feedback received from the consultation is considered and, where appropriate, amendments are made to the SRC.

The proposed SRC then undergoes an independent, clinical review in preparation for final endorsement from relevant professional groups.

Why are state-wide referral criteria important?

The availability of state-wide referral criteria (SRC) aims to provide referring health professionals with clearer expectations of clinical and referral requirements when determining whether to issue a referral to NSW public specialist outpatient services.

The application of SRC aims to improve the quality and appropriateness of referrals to NSW public specialist outpatient services, minimise clinical variation with referral acceptance and triaging practices, and reduce the number of patients who wait unnecessarily on NSW public specialist outpatient waitlists.

What is the scope of state-wide referral criteria?

State-wide referral criteria (SRC), where available, is in-scope for NSW local health districts and specialty health networks with existing NSW public specialist outpatient services where new referrals (external and/or internal to NSW Health) are accepted, and presenting conditions with associated SRC are managed. For example, if Service A is available in NSW local health district A, new referrals from General Practitioners are accepted, and Service A manages Condition A, SRC is to be applied.

When will the state-wide referral criteria be made available to referring health professionals, NSW local health districts and specialty health networks?

State-wide Referral Criteria (SRC) for identified presenting conditions within the specialties of Ophthalmology and  Gastroenterology were made available in July 2023. SRC for additional presenting conditions within the specialties of Ophthalmology and Gastroenterology were made available in May 2024. SRC for identified presenting conditions within the specialties of Ear, Nose & Throat (ENT) and Orthopaedics were made available in June 2024.

SRC for identified presenting conditions within the specialties of Diabetes, Endocrinology, General Paediatrics, Obstetrics (preconception, pregnancy and postnatal care), Gynaecology, Cardiology, Nephrology, Respiratory and Sleep Medicine will be progressively developed and made available across 2025-26.

Will all referrals made to an NSW public specialist outpatient service in accordance with the state-wide referral criteria result in patients being seen by a doctor?

No. The state-wide referral criteria (SRC) supports patients to be managed by the most appropriate member(s) of the multidisciplinary care team, involving doctors, nurses, midwives and/or allied health professionals, in the most appropriate setting based on their presenting condition. This may result in patients being seen by a doctor, nurse, midwife and/or allied health professional, or nurse, midwife and/or allied health professional only.

Does the state-wide referral criteria apply to referrals where patients are being referred for multiple reasons to a given NSW public specialist outpatient service and there is not a primary condition for the referral?

State-wide referral criteria (SRC) may not be applicable to referrals where a patient is being referred for multiple reasons to a given NSW public specialist outpatient service and there is not a primary condition for the referral (e.g. complex or rare disease). The decision to apply SRC under these circumstances is to be assessed on a case-by-case basis.

Are there processes in place to regularly review the state-wide referral criteria?

Yes. The relevant Clinical Advisory Group will review the state-wide referral criteria (SRC) every five years, at a minimum, to ensure alignment with contemporary evidence and clinical best practice guidelines. Where urgent changes are required to the SRC, a representative of the SRC project team will convene the relevant Clinical Advisory Group to determine the changes to be made.

What is the process to request a change to the state-wide referral criteria?

Interested stakeholders can issue state-wide referral criteria (SRC) change requests by emailing the SRC project team at NSW Health. All requests submitted will be managed by a representative of the SRC project team. Where SRC change requests are unclear, requesting stakeholders will be invited to meet with an appropriate representative(s) within NSW Health to clarify the request. Where SRC change requests are clear, the request will be circulated to the relevant Clinical Advisory Group to review the SRC change request received and determine the need for change(s) to be made. Where consensus is unable to be reached regarding the SRC change request, the clinical lead of the relevant Clinical Advisory Group will be asked to decide whether the change(s) is deemed necessary.

How can interested stakeholders obtain further information on the state-wide referral criteria?

Interested stakeholders can obtain further information on the state-wide referral criteria (SRC) by emailing the SRC project team at NSW Health.

Referring health professionals

Are referring health professionals expected to reference the state-wide referral criteria upon availability?

Yes. Referring health professionals are expected to reference state-wide referral criteria (SRC), where available, when determining to issue referrals to NSW public specialist outpatient services. By referencing the SRC, referring health professionals will be made aware of thresholds for referral to NSW public specialist outpatient services and the expected clinical urgency category based on clinical need.

What are the implications for referring health professionals who do not reference the state-wide referral criteria?

Referring health professionals who do not reference state-wide referral criteria (SRC), where available, may be unaware of the expectations of clinical and referral requirements when determining to issue referrals to NSW public specialist outpatient services. As a result, patients may be delayed access to care due to NSW public specialist outpatient services seeking additional clinical and/or referral information from referring health professionals to support with referral screening and triage and/or returning the referral to referring health professionals with advice of alternative care options.

What are the key changes for referring health professionals with the availability of state-wide referral criteria?

Present stateDesired stateKey changes
Issue referrals to NSW public specialist outpatient services based on local referral criteria.Issue referrals to NSW public specialist outpatient services based on state-wide referral criteria.
  • Refer to state-wide referral criteria (where available) when determining to issue referrals to NSW public specialist outpatient services.
  • Supply clinical and referral information in line with state-wide referral criteria to NSW public specialist outpatient services.

As a referring health professional, how can I access the state-wide referral criteria?

Referring health professionals can access the state-wide referral criteria (SRC) on the NSW Health website. The SRC will also be progressively accessible on your local HealthPathways portal and NSW Health electronic referral (e-Referral) forms.

As a referring health professional or clinician working in an NSW public specialist outpatient service, what do I do if the state-wide referral criteria is not available for a given specialty or condition?

Where there is no state-wide referral criteria (SRC) available for a given specialty or condition, referring health professionals and clinicians working in NSW public specialist outpatient services are to follow referral criteria determined by NSW local health districts or specialty health networks.

As a referring health professional or clinician working in an NSW public specialist outpatient service, can I override the state-wide referral criteria?

Yes, where appropriate. The state-wide referral criteria (SRC) is intended to be used by referring health professionals and clinicians working in NSW public specialist outpatient services as a clinical decision-support tool. As such, referring health professionals and clinicians working in NSW public specialist outpatient services may override the SRC should it be deemed necessary. Issuing and/or accepting referrals that vary from the SRC are to be documented with clinical reasoning.

Clinicians working in NSW public specialist outpatient services

As a clinician working in an NSW public specialist outpatient service, how can I access the state-wide referral criteria?

Clinicians working in NSW public specialist outpatient services can access the state-wide referral criteria (SRC) on the NSW Health website. Each NSW local health district and specialty health network will also have local processes and systems in place to support the application of SRC.

As a referring health professional or clinician working in an NSW public specialist outpatient service, what do I do if the state-wide referral criteria is not available for a given specialty or condition?

Where there is no state-wide referral criteria (SRC) available for a given specialty or condition, referring health professionals and clinicians working in NSW public specialist outpatient services are to follow referral criteria determined by NSW local health districts or specialty health networks.

As a referring health professional or clinician working in an NSW public specialist outpatient service, can I override the state-wide referral criteria?

Yes, where appropriate. The state-wide referral criteria (SRC) is intended to be used by referring health professionals and clinicians working in NSW public specialist outpatient services as a clinical decision-support tool. As such, referring health professionals and clinicians working in NSW public specialist outpatient services may override the SRC should it be deemed necessary. Issuing and/or accepting referrals that vary from the SRC are to be documented with clinical reasoning.

NSW local health districts and specialty health networks

Are NSW local health districts and specialty health networks expected to apply the state-wide referral criteria upon availability?

Yes. In line with the NSW Health Management of Outpatient (Non-Admitted) Services Guideline, NSW local health districts and specialty health networks are expected to apply state-wide referral criteria (SRC) upon availability.

What are the implications for NSW local health districts and specialty health networks that do not reference the state-wide referral criteria, where available?

NSW local health districts and specialty health networks that do not reference state-wide referral criteria (SRC), where available, may experience inconsistencies in referral acceptance and triage practices. As a result, patients may be delayed access to care due to clinical variation in referral acceptance and triage practices and/or waiting on outpatient waitlists unnecessarily.

What are the key changes for NSW local health districts and specialty health networks with the availability of state-wide referral criteria?

Present stateDesired stateKey changes
Screen referrals based on local referral criteria.Screen referrals based on state-wide referral criteria.
  • Refer to state-wide referral criteria, where available, when screening referrals to identify missing information.
  • Request referring health professionals to supply missing information in line with state-wide referral criteria.
Determine triage outcome and clinical urgency category with reference to local referral criteria.Determine triage outcome and clinical urgency category with reference to state-wide referral criteria.Refer to state-wide referral criteria, where available, when triaging and clinically prioritising referrals.
Referral screening and triage workflows accommodate local referral criteria.Referral screening and triage workflows accommodate state-wide referral criteria.Redesign referral screening and triage workflows to accommodate state-wide referral criteria.

Does the state-wide referral criteria define presenting conditions to be managed by all NSW local health districts and specialty health networks?

No. The state-wide referral criteria (SRC) does not define presenting conditions to be managed by all NSW local health districts and specialty health networks. Rather, the SRC defines the criteria to be applied by existing NSW public specialist outpatient services where new referrals (external and/or internal to NSW Health) are accepted, and presenting conditions with associated SRC are managed.

Patients and carers

As a patient or carer, how can I access the state-wide referral criteria?

Patients and carers can access the state-wide referral criteria (SRC) on the NSW Health website.



Current as at: Friday 1 November 2024
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