When might it be necessary to provide referrals for a client?

A referral is a written request from one health professional to another health professional or health service, asking them to diagnose or treat you for a particular condition.

What does a referral do?

A referral provides information about you and your condition so that:

• the person you are being referred to does not have to ask so many questions
• they are aware of relevant background information
• they know exactly what they are being asked to do

A referral is also used to indicate that the consultation or test you are being referred for is clinically important, and that Medicare should cover at least part of the cost.

When might I need a referral?

Your health professional might refer you to someone else if:

• they believe you need expertise that the other person has
• they believe you need treatment that the other person can give
• they believe you need specialised tests or investigations

For example, someone with pregnancy complications may be referred to an obstetrician, or a person with cancer may be referred to an oncologist and surgeon.

You are likely to need a medical referral or request to:

• see a specialist
• get x-rays or use other diagnostic imaging services
• use pathology services, such as blood tests

The referral should include:

• relevant clinical information
• the date of the referral
• the signature of the referring practitioner

You can choose the individual specialist you want to be referred to or ask your doctor to recommend someone. The doctor can address it to a particular person or make a general referral without using the name of the specialist (for example, addressing it to 'Dear psychiatrist'.)

How long does a referral last?

Most referrals from general practitioners (GPs) to specialists are limited to 12 months. They should cover a single course of treatment for the condition you are being referred for. The referral covers all the visits to the specialist for that condition.

If you need continuing care, such as for a chronic (continuing) health condition, the GP can write a referral beyond 12 months or for an indefinite period. If you develop a new condition, you will need a new referral for that condition.

Referrals from specialists and consultant physicians to other specialists are limited to 3 months unless the patient is admitted to hospital.

Who can make a referral?

Referrals can be made by doctors, dentists and certain allied health professionals — nurse practitioners, midwives, physiotherapists, osteopaths, optometrists and psychologists.

Some services can only be ordered by a particular specialist. For example, you may need a referral by a specialist for certain types of MRI scans.

How do I get a referral?

Make an appointment with your GP or doctor and ask them to write you a referral. You can discuss your needs with them, and they can properly assess you.

This helps to ensure that the referral contains the information the other health practitioner needs.

Getting a second or further opinion

If you are unhappy with a diagnosis or feel there might be better treatment options, do not be afraid to ask your doctor to refer you to another specialist for a second opinion.

What happens if you visit a specialist without a referral?

Many specialists will still see you, although some might not. But Medicare will not cover any costs if you visit a specialist without a referral.

The referring doctor or health professional will provide the specialist with as much information about your condition as they think is needed. Once the specialist has seen you, they will in turn send details of your recommended treatment back to the doctor or health professional who referred you. All your medical information is regarded as private and confidential.

If you are uncomfortable with this, talk to your referring doctor or health professional.

• From Medicare's perspective
• About referrals from a GP's perspective

Last reviewed: April 2021

Feltham and Dryden (1993: 157) define ‘referral’ as ‘directing someone to a counsellor or alternative source of treatment’.

Clients may be referred inwards to a counsellor (by, for example, a GP or another counsellor) or be referred onwards by a counsellor (to another professional helper better suited to helping the client). This article is about onward referrals.

Some services may accept only self-referrals (that is, the client must refer themselves – though may often have been ‘signposted’ (i.e. given information on the service) by a third party.

Making appropriate referrals is part of professional conduct for counsellors in practice. A referral procedure should provide a seamless journey from one professional helper to another.

The Ethical Framework for the Counselling Professions, published by the British Association for Counselling and Psychotherapy (2018: 6), includes in its commitment to clients that counsellors will ‘work to professional standards by … working within our competence’.

Working within your own competence is key, and thus there will be times when making a referral is the ethical decision.

For example, this situation could occur if:

• the client needs help with other issues (such as housing problems, financial difficulties, law-related matters or medical issues) instead of – or before being ready to engage in – counselling
• the client has a mental-health issue that prevents the establishment of psychological contact (e.g. they are delusional or are hearing voices)
• the counselling issue that the client is bringing is not within your area of competence (e.g. if they need specialist counselling for substance misuse or addiction)
• your agency offers a limited number of sessions, and you know this amount will be insufficient to work safely with the client
• your modality is not a good match for the client’s issue (e.g. the client needs help to overcome a fear of flying before an imminent holiday abroad, and you are a person-centred counsellor rather than a cognitive behavioural therapist)
• the client is experiencing difficulties that mirror your own – i.e. there is parallel process (e.g. if a client wishes to work on feelings related to their divorce, and you are currently struggling with this in your own life)
• you feel unsafe with the client (e.g. if lone working in private practice).

It is important that clients are not taken by surprise by your suggestion that referral maybe be needed; this could feel like a rejection, and lead them to believe their problems are particularly complex and therefore difficult to solve.

Preparation for referral should ideally begin during contracting, with the counsellor introducing the idea that this is a process that sometimes happens, simply because different professionals are trained and have strengths in different types of helping and different client issues.

In this way, the client is aware from the very start that referral is not threatening but is instead intended as a genuinely helpful action to support them in getting the right help at the right time.

If you are considering referring a client, it is always important to explore the possibility of referral with your supervisor, who can help you decide whether this is the right course of action.

For example, might you be thinking of referring because you are lacking confidence in your ability to help a certain client? Discussion in supervision may reveal that you are in fact competent to work with the client.

If you do decide with your supervisor that referral is the right course of action, it is important to plan ahead for this. You will already have explained to the client during contracting how referral in general is managed.

Before telling the client about your specific plan to refer them, make sure:

• you know where you will refer to
• you are familiar with the referral pathways and processes (including any documentation needed
• you have ascertained current waiting times for the new provider

If you need to transfer any personal information about the client, ensure that you do this in a way that fits with the Caldicott principles.

For example, unless the situation justifies the breaking of client confidentiality (e.g. if the client is at imminent risk of causing serious harm to themselves or others, or has knowledge of a serious crime), then do ensure that you get the client’s written consent for the information you will transfer before doing so.

Even though you are not able to help [the client] fully with their issue (hence the need to refer), your ability and willingness to accompany them as they wait, offering them the core conditions to support them during this time, could be invaluable to them.

Bear in mind that being referred may lead to the client experiencing difficult emotions: be ready to explain your decision and reasons clearly and calmly, pointing out what you feel the client will gain from the referral. You can also help the client work through their reaction.

Before raising the topic with the client, consider whether this may key into any other issues they have – for example, attachment difficulties, or struggles with loss or rejection – and be ready to link these themes to how they experience being referred.

If there is a waiting list for the service to which you are referring the client, you may wish to offer the client some ‘holding sessions’ during this time, so that they are not left unsupported during this gap.

Even though you are not able to help them fully with their issue (hence the need to refer), your ability and willingness to accompany them as they wait, offering them the core conditions to support them during this time, could be invaluable to them.

It is also important to allow yourself time to reflect on and process your experience of referring the client, ensuring that your professional decision to do so does not lead to feelings of incompetence (sometimes known as ‘imposter syndrome’).

You may also feel emotions in yourself relating to loss, or to how the client reacted when you raised the topic of referral. This is a good opportunity for reflection and personal development, so enhancing your own self-awareness and growth.

BACP (2018) Ethical Framework for the Counselling Professions, BACP: https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/

Feltham C & Dryden W (1993) Dictionary of Counselling, Whurr Publishers