Crippling knee injury? A pilot programme allowing GPs to order MRI scans for patients without referring them to a specialist first has been shown to be effective and fast.

Wait times of three weeks dropped to five days during a “common-sense” pilot programme which allowed GPs to refer ACC patients for MRI scans.

The pilot cut out the middle-person. Often patients with knee, back or shoulder injuries are referred to a specialist by their GP. The specialist then decides if an MRI is needed to help diagnose musculoskeletal conditions. 

Getting a specialist appointment to get a scan referral can take weeks, or months. 

The Auckland-based pilot programme trained 273 GPs on when it was appropriate for MRI scans to be ordered. They were then allowed to directly refer patients with neck, shoulder, back and knee issues for an MRI.

A review of GP referrals showed 86 percent of their referrals were considered appropriate.

After the scan, almost 80 percent of patients were then seen by specialists and received surgery, or non-surgical help. The remainder received help from their GP. 

As well as reducing overall wait times, the pilot increased access to MRIs for Māori and Pacific people. For Pacific people aged 15-34, the improvement was 50 percent over the baseline

The initiative was designed by ACC, primary healthcare provider ProCare, and Mercy Radiology for injury-related scans. ACC funds private providers of MRI scans.

ACC said it’s supportive of the initiative because part of its mandate is to minimise the impact of injuries. Streamlining treatment can reduce the length of treatment and time off work.

Mission Bay Doctors GP Dr Jamie Shepherd is at the coal face of managing patients in pain. He said the faster process has helped patients cope better with the uncertainty of injury.

“If you’re a patient who’s experiencing something which is stopping you from working, is really severe, and you don’t know what it is and a GP can’t order the test to find out, it actually compounds how you feel.”

In his experience, some specialist appointments take longer than three weeks to secure.

“If you’re looking for a back or neck orthopedic surgeon you can wait up to six or eight weeks just in a normal time of year. Over the school holiday period that can be longer.”

He called it a common sense approach to healthcare.

“It’s just not that efficient to go just purely to see a specialist who says ‘You need an MRI, go and do that and then come back to me’.”

He thinks it also removes barriers for patients who are time-poor, or struggle financially, by reducing the overall cost of taking time off work for visits and petrol and parking costs.

He hasn’t seen any backlash from specialists.

“Most of the surgeons I know love it. They get the patients they can and need to operate on, rather than having to deal with, the rehabilitation of those who don’t. It really does work for everybody.”

The programme is now expanding in Auckland and is being introduced in Canterbury. 

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