At the beginning of August, Kazakhstan updated the rules governing how outpatient clinics operate. This led to different interpretations of the document. For example, people began saying that it was now possible to see a specialist without a referral from a general practitioner (GP). A Tengri Health correspondent looked into when patients can actually see a specialist without first visiting a GP and when a referral is still required.
When Can You See a Specialist Without a GP Referral?
The Ministry of Health order “On Approval of the Rules for Providing Specialized Medical Care on an Outpatient Basis” was approved back on April 27, 2022. Since then, it has been amended and clarified several times, with the latest changes taking effect on August 3, 2026.
We previously explained in detail how the rules for outpatient clinics were updated in this article. Today, we are focusing exclusively on the rules for seeing specialists.
The order already listed situations in which patients could make an appointment with a specialized doctor without a referral from a general practitioner.
These include:
- injuries, including ophthalmological and ENT injuries;
- acute and planned dental conditions;
- dermatovenereological diseases;
- appointments with obstetricians-gynecologists and psychologists (at the patient’s assigned clinic);
- suspected oncological and hematological diseases, provided there are test results or ultrasound findings indicating a potential risk;
- follow-up appointments within the same medical case;
- ongoing monitoring of a chronic disease;
- patients directly seeking care at youth health centers;
- medical services provided by mobile medical units and medical trains.
This list was adopted several years ago and has not changed.
Gulnara Sarsenbayeva, Director of the Department for the Organization of Medical Care at the Ministry of Health, gives several examples.
ENT injuries, for instance, include mechanical, thermal, or chemical injuries to the ear, throat, nose, and larynx — wounds, cuts, bruises, and fractures.
“You can make a direct appointment with an obstetrician-gynecologist in all cases. The exception is women who are registering for pregnancy care — they must first see a general practitioner, who then refers the patient to the relevant specialists,” the expert explains.
People who are being monitored for chronic diseases can also see a specialist without visiting a GP first. For example, a person with diabetes can go directly to an endocrinologist.
Only in these situations could — and still can — patients make an appointment with a specialist themselves without a referral from their GP.
In all other situations, patients still need to see a general practitioner first and obtain a referral before visiting an endocrinologist, cardiologist, neurologist, or another specialist. In this respect, nothing has changed in the list of exceptions.
“In fact, the list of cases in which a person can make a direct appointment with a specialist is quite broad and covers many situations. Unfortunately, however, there are cases when the patient pathway is violated — in other words, a person cannot make a direct appointment even though the rules allow it. This is the responsibility of the medical organizations,” Sarsenbayeva explains.
Last autumn, Ministry of Health expert Asel Kidyralieva explained to Tengri Health why the authorities decided to clarify the rules:
“Although the order has been in effect since 2022, the number of complaints from patients was not decreasing. People could not make direct appointments with specialists. We hope that the situation will change now.”
Sarsenbayeva explains that, to ensure compliance with the rules, specialists are now making changes to digital medical systems so that violations are prevented and monitoring becomes easier.
Specialists Can Also Refer Patients for Tests: Who and When?
Doctors of specialized fields were already allowed to independently refer patients for additional examinations and consultations with other specialists. This rule was also included in the previous version of the order.
As Asel Khassenova, Director of the Department of the National Scientific Center for Health Development named after Salidat Kairbekova under the Ministry of Health, previously explained to us, this provision had not been considered mandatory and was therefore not always followed. According to her, this has now been clarified and compliance has become mandatory.
For example, suppose a person has problems with blood pressure and is being monitored by a cardiologist for hypertension, visiting the doctor regularly. The disease can affect vision, kidney function, and blood vessels.
The cardiologist can independently refer the patient to doctors in other specialties, such as an ophthalmologist or nephrologist, but no more than three specialists.
If necessary, the specialist can also issue referrals for additional examinations, including ultrasound, CT scans, and laboratory tests.
“Understanding that the rules we are discussing did not always work in practice, we introduced a provision requiring clinics to make appointment schedules for specialists available for up to 60 days. Patients can choose the date themselves and make an appointment through the app,” Gulnara Sarsenbayeva explains.
According to the expert, medical organizations previously published specialist schedules for only two weeks, and they were almost immediately filled. Patients could not see the doctor they needed because there were no available appointments left.
“We are now working with the digital teams so that medical organizations can quickly update their schedules when a patient is unable to attend an appointment for some reason. We know that there are cases where medical organizations fail to do this or even deliberately block appointment slots themselves. Therefore, we are improving transparency in the appointment system and checking whether these rules are being followed,” the speaker adds.
This provision is connected with another change. The concept of a completed medical case and its outcomes is being introduced. Doctors will have to record these outcomes in medical information systems.
The order states:
“If a case is not completed during the provision of specialized medical care, the outcome ‘continues to be ill’ is entered into the medical information systems.”
The doctor marks “continues to be ill” in the system. In this case, the doctor can independently schedule the patient for a follow-up appointment.
Previously, patients generally had to make another appointment with a general practitioner to obtain a referral for a follow-up visit to the specialist.
There is also another addition:
“Within the framework of one completed medical case, when medically indicated, a specialist at the primary, secondary, or tertiary level issues a referral for additional consultative and diagnostic services, including consultations with up to three different specialists, with the mandatory entry of the relevant information into medical information systems,” the order states.
How Can You Make an Appointment With a Specialist Without a GP Referral?
You can make an appointment:
- through the clinic’s registration desk;
- by calling the call center;
- through the medical organization’s mobile application;
- through the electronic government portal, eGov.kz.
Could Patients Eventually Be Allowed to Make Direct Appointments With All Specialists?
Sarsenbayeva says that a general practitioner serves as a kind of filter through which patients should pass. GPs can provide many services without involving specialists, particularly for uncomplicated conditions.
For example, in the case of ordinary conjunctivitis, a GP can provide treatment recommendations instead of unnecessarily burdening an ophthalmologist.
“The local GP should determine whether there is an indication for seeing a specialist. Therefore, we do not plan to abandon the practice whereby most referrals to specialists are issued by general practitioners,” the expert adds.
Therefore, in many cases, patients will still have to see a general practitioner first.
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