When to Refer a Client to Their GP: A Guide for Naturopaths
The short answer
Refer a client back to their GP when a result is outside the laboratory's reference interval, when a pattern suggests disease even though single values are in range, when symptoms are red flags regardless of the results, when results do not fit the case, and whenever you are unsure.
Referral is part of good practice, not a sign of its limits. Deciding your referral lines in advance makes the decision quick and consistent.
The professional basis for referral in Australia
Referral is a legal obligation as well as a clinical one. In New South Wales, the Code of Conduct for non-registered health practitioners is set out in Schedule 3 of the Public Health Regulation 2022. It applies to practitioners such as naturopaths, herbalists and nutritionists.
Under the code, a practitioner must:
- recognise the limitations of the treatment they can provide and refer a client to other competent health practitioners in appropriate circumstances
- not attempt to dissuade a client from seeking or continuing treatment by a registered medical practitioner
- keep appropriate records
The Health Care Complaints Commission can investigate alleged breaches and can make a prohibition order against a practitioner. Other states and territories have their own arrangements, so check the code that applies where you practise, along with your association's code of ethics.
Three levels of urgency
Sorting findings by urgency tells you how to act, not just whether to act.
| Urgency | Examples | What to do |
|---|---|---|
| Same day | Chest pain, breathlessness, fainting, new confusion, jaundice, black or bloody stools, heavy bleeding. Any result the laboratory reports as critical. | Call 000 in an emergency. Otherwise arrange same-day medical care. Do not wait for more tests. |
| Prompt | Any result outside the laboratory's interval. Changes in more than one cell line on the full blood count. Low TSH with raised thyroid hormones. Liver enzymes above the interval. Iron deficiency anaemia. | Contact the client now and send a written referral with the results. |
| Routine | In-range results moving steadily in one direction. Subclinical patterns. Persistently high ferritin. Findings that do not fit the case. | Send a referral letter and agree when to retest. |
Symptoms outrank results. Unexplained weight loss, night sweats, persistent fever, a new lump, a change in bowel habit or any unexplained bleeding needs medical assessment even when the blood tests are unremarkable.
Referral triggers from published guidance
These triggers come from guidelines and reviews, so you can cite them when you write to the GP.
| Finding | What the guidance says | Source |
|---|---|---|
| Iron deficiency anaemia in a man or a postmenopausal woman | Needs gastrointestinal investigation to exclude bleeding, including malignancy | Pasricha et al., 2010; Pasricha et al., 2021 |
| Iron deficiency anaemia in anyone | Assess for coeliac disease, and look for the underlying cause | Pasricha et al., 2010 |
| Haemoglobin below 120 g/L in non-pregnant women or 130 g/L in men | Meets the definition of anaemia | WHO, 2024 |
| ALT above 33 IU/L in men or 25 IU/L in women | Above the healthy normal range described by the American College of Gastroenterology, which says such levels should be assessed. Many laboratory upper limits are higher. | Kwo et al., 2017 |
| Raised TSH with normal free T4 | Subclinical hypothyroidism. Treatment may be indicated at TSH of 10 mU/L or higher, or in younger people with symptoms. | Biondi et al., 2019 |
| Ferritin above 500 µg/L in an adult who is unwell | May indicate risk of iron overload | WHO, 2020 |
For the detail behind each row, see the articles on the full blood count, ferritin and haemoglobin, liver enzymes and thyroid patterns.
How to write the referral
A good referral letter is short, factual and asks one clear question. Get the client's consent before sharing their results.
If you use Beyond Normal. Once a client's bloods are uploaded, Beyond Normal drafts the referral letter for you. You review the draft, edit anything you want to change and confirm your clinical question before it goes to the GP. That saves the time spent writing up results, and the letter stays yours to approve.
A good referral includes the following, whether it is drafted in the platform or written by hand:
- the client's name and date of birth
- the results that concern you, with values, units, the laboratory's interval and the collection date
- earlier results for the same markers, if you have them
- relevant symptoms and how long they have been present
- every medicine, herb and supplement the client takes, including what you have prescribed
- the specific question you are asking
- your name, qualification and contact details
If you are writing by hand, this template can be adapted:
Dear Dr [name],
Re: [client name], date of birth [date]
I am [client name]'s [naturopath / herbalist / nutritionist]. With their consent, I am writing about pathology collected on [date] at [laboratory].
Findings: [marker, value, unit, laboratory interval]. Previous result: [value, date].
Relevant history: [symptoms and duration].
Current medicines, herbs and supplements: [full list, including anything I have prescribed].
I would be grateful for your assessment of [specific question].
I am happy to share my notes and to coordinate ongoing care.
[Name, qualification, association membership number, phone, email]
After the referral. Record what you sent and when. Follow up with the client to confirm they attended. Do not advise any change to prescribed medication. Ask the client to share the outcome so you can adjust your own care.
Where a platform helps. Beyond Normal shows each result against the conventional interval as well as the functional one, so an out-of-range value is not lost among functional flags. It also charts each marker across visits, so earlier results are on hand for the letter. To compare tools, see the best online platforms for practitioners to interpret blood tests.
Frequently asked questions
When should a naturopath refer a client to a GP?
When a blood result is outside the laboratory's reference interval, when a pattern suggests disease, when the client has red flag symptoms, when results do not fit the case, or when the practitioner is unsure.
Can a naturopath write a referral letter to a GP?
Yes. It is a professional letter, not a Medicare referral, and it gives the GP the results, history and question they need to act.
Do I need the client's consent to send results to their GP?
Yes. Ask for consent and record it before sharing health information.
What if the client does not want to see their GP?
Explain why you are recommending it, record your advice and their decision, and raise it again at the next visit. Do not discourage medical care, and consider whether you can safely continue treatment without it.
Do I stop treating a client after referring them?
Not necessarily. You can continue care within your scope while the GP investigates, and adjust once you know the outcome.
Which blood test results need urgent referral?
Any result the laboratory reports as critical, and any result accompanied by symptoms such as chest pain, breathlessness, jaundice, confusion or bleeding. In an emergency in Australia, call 000.
Sources
Journal citations were checked against PubMed on 4 October 2026.
- NSW Health. Code of conduct for unregistered health practitioners and health organisations. Public Health Regulation 2022, Schedule 3.
- Pasricha SR, Flecknoe-Brown SC, Allen KJ, et al. Diagnosis and management of iron deficiency anaemia: a clinical update. Med J Aust. 2010;193(9):525-532. doi:10.5694/j.1326-5377.2010.tb04038.x
- Pasricha SR, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. Lancet. 2021;397(10270):233-248. doi:10.1016/S0140-6736(20)32594-032594-0>)
- Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18-35. doi:10.1038/ajg.2016.517
- Biondi B, Cappola AR, Cooper DS. Subclinical hypothyroidism: a review. JAMA. 2019;322(2):153-160. doi:10.1001/jama.2019.9052
- World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. 2024.
- World Health Organization. Use of ferritin concentrations to assess iron status in individuals and populations. 2020.
