How your GP follows up test results — and what you can do

When your GP orders a blood test, a biopsy, or an imaging scan, the conversation does not end at the order. Every investigation opened in your name remains the responsibility of the ordering doctor — and the practice — until the result has been reviewed, acted on, and you have been informed. That duty does not end because a result looks unremarkable, because the GP who ordered it has left the practice, or because results arrived after-hours.

Missed or delayed test results are the most common category of medico-legal claims in Australian general practice. Avant’s analysis of over 2,000 diagnostic-error matters (2019–2024) found that approximately 75% of GP diagnostic-error claims traced back to a failure at one of three points: the initial assessment, a referral that was never followed up, or a pathology, imaging, or histology result that arrived at the practice and was never actioned. A result sitting in a software inbox, never reviewed, never communicated — that is the common thread.

This article explains how AU general practice recall and follow-up systems are structured, what the accreditation standards require, and — most practically — what you as a patient can do to be an active part of the safety net for your own care.

A. Core clinical — the AU general-practice framework

The GP’s legal and professional duty

The RACGP Standards for General Practices 5th Edition Criterion GP2.2 is the binding accreditation framework for results handling. Five indicators define compliance:

• GP2.2 A — Every result is reviewed, notated, acted on, and filed by a named clinician
• GP2.2 B — Clinically significant results trigger a recall through a tracked register
• GP2.2 C — At the time of ordering, the patient is told the practice’s follow-up process
• GP2.2 D — A reminder system manages preventive-care activities (screening intervals, immunisations, GPCCMP reviews)
• GP2.2 E — A documented protocol exists for critical results identified after-hours or outside clinic hours

The complementary ACSQHC National Safety and Quality Primary and Community Healthcare Standards (2021) require documented systems for test ordering, result acknowledgement, communication, and escalation under the Clinical Safety standard.

The ordering GP owns the loop

RACGP and Avant are consistent: the GP who orders a test owns responsibility for the result until it has been reviewed and the patient informed. This does not transfer automatically to a receptionist, a practice manager, or a clinical software “inbox opened” notification. It transfers only when a named clinician has signed off.

For locum-ordered or registrar-ordered tests: MDA National (2023) and coronial findings converge — the highest-risk category in test-result failures is after-hours or locum-ordered tests where the ordering clinician has left the practice before the result was reviewed. Best practice requires that every locum or registrar order is co-signed to a continuing GP at the time of ordering.

The recall register

A properly maintained recall register tracks:

• Patient identifier and contact details
• The investigation and the result or reason for recall
• Urgency tier (critical / urgent / routine)
• Ordering and responsible GP
• Each contact attempt with date, time, modality, and staff initials
• Close-out date and outcome

Three contact attempts using at least two modalities (phone, SMS, and letter) are the standard before a recall can be administratively closed. Critical results — confirmed malignancy, life-threatening blood values, first positive HIV — require at minimum voice contact and registered post as a fail-safe.

A paper recall book is no longer defensible against the RACGP GP2.2 evidence standard. Software-native recall registers with audit trails are expected.

B. Evidence: what the claims data tells us

Where results fall through

Avant’s framework maps the failure modes onto a Swiss-cheese model. The holes that most commonly align to produce a missed result:

Failure point	Common cause
Result delivered but not reviewed	Inbox volume, clinician absence, locum gap
Result reviewed but action unclear	Ambiguous report, competing priorities
Action taken but patient not reached	Three-attempt policy not enforced
Patient unreachable	Phone number outdated; no alternative contact

The most-litigated cancer types in AU missed-diagnosis claims are melanoma, breast, colorectal, and lung — typically a single returned biopsy or imaging report that sat in an inbox with no clinician sign-off.

The “critical result” problem

Not all critical values appear on pathology providers’ critical-result lists. The Domachuk inquest (VIC) established that a low cortisol result not on the laboratory’s standard critical list contributed to a missed adrenal crisis. The implication: practices cannot rely solely on the laboratory to flag urgency. Each practice should define its own critical-result list based on the clinical conditions it manages and verify that it covers values the laboratory does not automatically escalate.

Examples of values warranting same-day or immediate patient contact:

• Potassium below 3.0 or above 6.0 mmol/L
• Haemoglobin below 80 g/L
• Platelets below 50 × 10⁹/L
• INR above 5
• Sodium below 125 or above 155 mmol/L
• Glucose below 3.0 or above 20 mmol/L
• Any histology containing “malignant”, “carcinoma”, “invasion”, “high-grade dysplasia”
• Positive blood culture, CSF abnormality, HIV seroconversion, HBsAg first positive, syphilis RPR rising, positive gonorrhoea
• Imaging reports stamped “urgent” or flagging suspected pulmonary embolism, aortic dissection, or new malignancy

C. What you as a patient can do

The safety-net question

The single most effective thing a patient can do is ask at every test:

“When should I expect to hear from you if something is abnormal? And what should I do if I haven’t heard by then?”

The answer tells you how the practice operates. A practice with a sound recall system will give you a timeframe and actively invite you to call if you don’t hear. That invitation is not a burden on the practice — it is a designed redundancy in the safety net.

Most practices aim to contact you within 1–3 business days for any abnormal result and within 5 business days for routine results. If you haven’t heard within that window, calling the practice is not being difficult — it is being a responsible co-manager of your own care.

Keep your contact details current

The most common reason three contact attempts fail is that the phone number in the practice record is outdated. Every time you visit, confirm that your mobile number and address are current. If you have changed your phone number since your last visit, update it with the practice — one conversation can prevent a missed cancer diagnosis reaching a dead number.

Keep a personal record

When a test is ordered, note:

• What test was ordered, and by whom
• The date ordered
• The timeframe the GP gave you for results
• The practice’s after-hours number for urgent concerns

This is not excessive — it is the patient-held equivalent of the recall register. For patients managing multiple conditions or complex investigations, a simple notes-app entry at the time of ordering prevents the kind of assumption (“I’m sure they would have called me if it was bad”) that contributes to delayed diagnosis.

D. Australian operations

Accreditation and standards

AU general practices seeking accreditation are assessed against RACGP Standards GP2.2 by AGPAL or QPA surveyors. Evidence required includes a written results-handling policy, software configuration showing clinician sign-off is required before a result can be marked actioned, audit results showing recall close-out rates, and de-identified recall register samples. Practices not accredited to the RACGP Standards may operate outside this framework.

MBS billing for results consultations

There is no separate MBS item for the back-office work of tracking, recalling, and following up results. The consultation in which results are reviewed and the patient is contacted attracts standard time-tiered items:

• Face-to-face: 23 (Level B, standard) / 36 (Level C, long) / 44 (Level D, prolonged)
• Telephone: 91890 range — existing-relationship rule (12/24-month MyMedicare) applies
• GP Chronic Condition Management Plan review: GPCCMP 965 / 967 — integrates chronic-disease result review into a structured care plan; cannot be co-claimed with items 3/23/36/44 on the same day

If you receive a phone call from your GP to discuss test results, that call may be billed using a telephone consultation MBS item — this is appropriate and legitimate.

If something goes wrong

If you believe a test result was not followed up appropriately, the first step is to contact the practice and ask directly. Most failures are administrative rather than deliberate, and most practices will respond constructively to a direct question.

If you believe you or a family member suffered harm as a result of a missed or delayed result, contact the practice’s complaints officer. If unresolved, escalate to the relevant state Health Complaints Commissioner or AHPRA for concerns about an individual practitioner’s professional conduct.

For medico-legal questions as a patient, HealthDirect 1800 022 222 can provide guidance on consumer health rights and direct you to the appropriate state body.

E. Special situations

After-hours and urgent care settings. If a GP or after-hours locum orders a test in an after-hours encounter, ask explicitly: “Who will receive this result, and who is responsible for following it up?” A well-run practice links after-hours orders to your usual GP’s inbox for review at the next business day.

Specialist referrals. A referral letter sent is not a referral completed. If you do not receive an appointment within the timeframe your GP described — particularly for urgent referrals — follow up with your GP. The GP who referred you retains a duty to confirm the referral loop was closed.

Tests ordered in hospital. Responsibility for investigations ordered during a hospital admission typically rests with the discharging team. However, if a result returns after your discharge and the hospital does not contact you, your GP should be notified via the discharge summary. If you are unsure whether all discharge results have been reviewed, ask your GP at your first post-discharge appointment.

Rural and remote patients. Geographic distance increases the likelihood of contact-attempt failures due to intermittent phone access. Ensure the practice has a second contact option (a family member’s number, or a community health worker) for critical result communications.

When to escalate

If you are concerned that a test result has not been appropriately followed up:

• First: contact the practice directly and ask for a named GP to review the result
• If your symptoms are worsening: do not wait — seek same-day urgent review with your GP, or attend an emergency department if symptoms are severe
• If the practice is unresponsive: contact the state Health Complaints Commissioner or AHPRA
• If you experience symptoms that may represent an urgent abnormality (chest pain, significant shortness of breath, unexpected weight loss, new lump) — do not wait for a call that may have been missed. Present for review proactively.

What this article is and is not

This article draws on RACGP Standards for General Practices 5th Edition, ACSQHC National Safety and Quality Primary and Community Healthcare Standards, and published guidance from AU medical defence organisations (Avant and MDA National). It is general health information for Australian patients and does not constitute legal advice, medical advice, or a complaint template. For specific legal, medico-legal, or complaints-process guidance, contact the relevant state body or HealthDirect 1800 022 222.

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Sources cited

1. RACGP — Standards for General Practices 5th edition Criterion GP2.2 (Follow-up systems)
2. ACSQHC — National Safety and Quality Primary and Community Healthcare Standards (2021)
3. Avant — Claims and complaints insights: General Practitioners
4. Avant — Missed or delayed diagnosis
5. Avant — Patient follow-up and recalls
6. Avant — Reducing diagnostic error
7. MDA National — Recalls and reminders: closing the loop (2023)
8. AHPRA — Mandatory notifications guidelines
9. Services Australia — MBS billing rules for GP chronic condition management plans
10. HealthDirect
11. Better Health Channel — Tests and treatments