GPLink Update from the GPs at Royal North Shore
Issue 10 October 2025
An Initiative of the General Practice Liaison GPs at Royal North Shore Hospital This is the 10th issue of GPLink Royal North Shore Hospital’s regular newsletter to GPs to let you know about service changes, new clinics, research and resources available for patients. This is an initiative of the General Practice Liaison team at Royal North Shore Hospital. The team is available to answer questions particularly regarding referral criteria and the transition to e-referrals. Contact NSLHD-GPLO@health.nsw.gov.au
GPLO Role made Permanent at RNSH- What can we do for you?
General Practice Liaison Officers (GPLOs) are General Practitioners (GPs) who work within hospitals to improve integration between primary and secondary care. Royal North Shore Hospital (RNSH) established a GPLO position in October 2021. While well-established GPLO programs exist in other states in Australia, RNSH has the only comparable program in New South Wales. RNSH has recently decided to make the GPLO permanent, which is a huge step forward for practical integrated care within our health system.
In the last three years, the GPLOs at RNSH have focused on better design at the Ambulatory Care Centre (ACC) to improve communication and reduce waitlist length. The role focuses on three overarching goals: • Improved healthcare providers’ awareness of available services across primary and secondary care settings • Established and enhanced communication between medical practitioners across hospital and primary care • Identification of system-based challenges impacting access to and quality of care provided across the region The GPLOs are your direct point of contact with RNSH outpatients’ clinics. If you have any queries about your patient and the outpatient’s clinic, we encourage you to email NSLHD-GPLO@health.nsw.gov.au
Q+A on ‘Named’ versus ‘Unnamed’ referrals in the Outpatients Clinic Named versus unnamed referrals to the Outpatients clinic can be a source of contention for GPs. This article will outline why they are asked to do this, and more importantly, whether it can be beneficial for patients. What is the National Health Reform Agreement?
What is a Named vs Unnamed vs No Preference Referral? • Named referral : Directed to a specific specialist, enabling private practice billing via Medicare. • Unnamed referral : No specific specialist; patient is seen by the first available doctor and treated as a public patient, using state funding. • No preference : Defaults to the Head of Department and therefore becomes a named referral. All referral types incur no out-of-pocket costs for patients.
The NHRA is an agreement between federal and state governments outlining how public hospital services are funded—either via state funding or Medicare rebates. If a referral meets NHRA criteria and is named, the patient may be treated privately with Medicare rebates applying. The terminology of “private patient” can be confusing as private versus public patients means something very different to clinicians in the community. In this instance, “private” does not refer to a patient using private health insurance, rather it refers to a patient referred to a specialist exercising their right to private practice and able to bill Medicare for their service.
Named Referral
Unnamed referral
No preference
Can see another neurologist if the one who had planned to see them is sick Can see a relevant neurologist if you inadvertently refer to one who only works in the headache clinic
Can choose to have an MRI done at a private imaging provider
Can choose to have a Holter done with a pathology company
Can have their coagulation screen done at their choice of location
May have out of pocket costs to the patient for consultations/tests that could attract Medicare rebate
Can be prescribed a medication via the neurologist
Requires financial consent to be taken by the hospital prior to billing Medicare
*
*All patients have the right to change their mind and confirmation of their pathway is completed with financial election prior to their first appointment. Please note that if a patient with an unnamed referral decides to change their election to “private”, an updated ereferral is required from their GP which may hold up their first appointment.
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GPLink | October 2025
What Difference Does This Make for My Patient? Named referrals allow access to Medicare-rebated investigations and PBS-listed medications-including critical treatments such as some types of chemotherapy. Unnamed referrals require all investigations to be arranged in-hospital and may limit access to some medications. As a result, the care pathway may be less efficient and more limited for your patients. As an example, if a patient is seen in the Neurology clinic after a suspected Transient Ischaemic Attack, the MRI/MRA brain, heart bug, carotid dopplers, pathology for coagulation screen etc all must be arranged within the hospital. If a patient can access fully-Medicare rebated services for these investigations, they may be able to be arranged in a more timely and efficient manner. Will a Named Referral Delay My Patient Being Seen? No. Triage is based on urgency, not referral type. If the named specialist is unavailable in the required timeframe, then the patient will be advised that another doctor is available sooner than the doctor named on their referral and with the patient’s consent, they can elect to change doctors, and the named referral is still valid. What If I Don’t Know Which Specialist is Best? It is not always easily apparent in the community to identify which specialists work in the outpatient clinics or what their subspeciality or area of interest may be. E-referrals (mandatory in NSLHD) list all
specialists, easing selection. NSLHD also has a service directory which may be helpful. If unsure, use the “No preference” option—this still counts as a named referral and lets the department allocate the best-fit clinician. Is it ‘Double Dipping’? No. Funding streams (public vs private) are separate. Hospital policies and NHRA rules prevent misuse of referrals for financial gain. Do We Have a Choice? Yes. GPs choose how to refer. Once again, there are Hospital policies and NHRA clauses that clearly state that named referrals should not be required. Understanding the benefits of named referrals—like improved patient access and efficient care, and sustainable use of hospital resources—may support their use when appropriate. How Can I Easily Change a Referral? If a patient elects private treatment but has an unnamed referral, you may be asked to resend a named one. The use of the e-referral system aims to make this more convenient by allowing ability to add information directly from the patient’s clinical record. What Do My Patients Know? Before their first appointment, all patients must sign an Informed Financial Consent Election Form to confirm whether they wish to be treated as public or private—regardless of the referral type. There is a form for no out-of-pocket expenses and explains the charge is to Medicare Australia not using their private health insurance.
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GPLink | October 2025
Vascular Surgery Trial
Dear Colleague, I am an investigator for the BG003 TRIVIA study. This study is evaluating the safety and efficacy of TR-987® 0.1% gel in conjunction with Standard of Care versus Standard of Care alone in healing Venous Leg Ulcers (VLUs). In this study Standard of Care is wound cleansing with saline and removal of necrotic tissue and compression bandaging. The study is currently enrolling, and we are looking for participant referrals. Research into the mechanism of action indicates that the active ingredient in TR987® 0.1% gel activates an immune response that leads to accelerated wound closure. To qualify for the TRIVIA study participants must meet the following criteria: Key Inclusion/Exclusion Criteria: 1. Male or female aged 18 or older. 2. Has a clinical diagnosis of Venous Insufficiency. 3. Has a venous stasis leg ulcer with an ulcer area a minimum of 2 cm2. 4. Does not have Peripheral Artery Disease with an arterial flow ≥ 0.8 or similar 5. Less than 50% of the ulcer extends below the malleolus. 6. BMI ≤ 42 kg/m2 7. HbA1C ≤12% Endocrinology trials For patients with obesity or diabetes who are at their treatment threshold or unable to access/afford current therapies, considering a clinical trial may be a good option. Please follow this link Active Clinical Trials Information or use the below QR code to see whether your patient is interested and don’t hesitate to reach out to clinical trial coordinators.
Additional criteria apply. Approximately 312 people will take part in this study. Participants will be in the study up to 30 weeks and visit the study site up to 26 times. Participants will be randomised 1 to 1 to receive either TR-987® 0.1% gel with Standard of Care or Standard of Care alone. Please be assured that participants will be returned to your care at the conclusion of the study. Likewise, our team can keep you informed of your patient’s status during the study (with permission). I appreciate your consideration and welcome the chance to discuss the TRIVIA study with you. To learn more about this study, or to refer a patient, please contact me at NSLHD-vascularsurgeryresearch@ health.nsw.gov.au or (02) 9463 1767. Sincerely, Dr Vikram Puttaswamy HoD RNSH
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GPLink | October 2025
Support Your Patients to Quit Smoking or Vaping: New Video Resource Now Available
Northern Sydney Local Health District (NSLHD) has produced a new resource to assist health professionals in guiding patients through smoking and vaping cessation..
• First thing in the morning • Watching TV & sport • Alcohol and smoking or vaping • After meals • Disrupting the triggers
The Prep to Quit video series is presented by NSW Health’s Statewide Smoking and Vaping Cessation Trainer, Tracey Greenberg. Included is a set of nine concise, evidence-informed videos (each under 1 minute) designed to help people prepare for a successful quit attempt. These videos are ideal for use in: • Brief interventions during consultations • Waiting room displays • Follow-up communications or patient education resources • General advice and referral for viewing Each video addresses a common trigger or challenge associated with quitting and offers practical, patient- friendly strategies to manage them. Topics include: • Preparing to Quit
“Prep to Quit is designed to complement the advice health professionals already provide. These short videos are a simple, effective way to help patients feel more confident and prepared for their quit journey,” said Melissa Palermo, Manager of the Alcohol and Tobacco Program at NSLHD. “We encourage clinicians to use them as part of routine care—every small step counts.” Access the videos: • nshp.com.au/preptoquit • YouTube Download the Flyer or email: NSLHD-AlcoholTobaccoTeam@health.nsw.gov.au for more information. Let’s make every patient interaction an opportunity to support quitting.
• Coffee and smoking or vaping • Driving and smoking or vaping • Friends who smoke or vape
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GPLink | October 2025
Shoulder team Recently there has been an increased number of patients with frozen shoulder referred to the shoulder clinic. Although these patients will be seen, it may aid their management for intervention to occur earlier. The triage team has identified the following symptoms and risk factors which could increase the likelihood of frozen shoulder as a differential diagnosis: • Age 40-60 • Metabolic risk factors (obesity, diabetes, and/or thyroid conditions) • Presence of severe pain +/-night disturbance • Presence of stiffness or reduced movement • Imaging findings associated with frozen shoulder (e.g. long head of biceps effusion, capsular hyperaemia, rotator interval thickening, etc) While patients are on the waiting list, we thank you for continuing to monitor your patient for signs of frozen shoulder, including: • Progressive loss of both active and passive glenohumeral joint external rotation ROM by at least 50% compared to the contralateral side. • No other significant pathology to explain the above stiffness on shoulder XR. If you believe your patient is developing a frozen shoulder, please arrange in primary care: 1. An intra-articular corticosteroid injection (NOT a bursal injection) as early as possible while pain remains a significant issue. 2. Referral to a local physiotherapist or physiotherapy service . Please note we discourage stretching exercises in the early, painful phase of this condition. In this phase, please encourage patients to use the arm within a comfortable range of motion, modify activities accordingly, and use simple analgesia and heat packs. As pain improves, structured stretching exercises can help to regain range of motion. Reference: Rupani N, Gwilym SE; BESS Frozen Shoulder Working Group. British Elbow and Shoulder Society patient care pathway: Frozen shoulder. Shoulder Elbow. 2025 Apr 23:17585732251335955. doi: 10.1177/17585732251335955. Epub ahead of print. PMID: 40291049;
Hospital In the Home HITH is a safe alternative to hospitalisation that is intensive, short-term & multidisciplinary. Clinical conditions include: • Cellulitis Community Acquired Pneumonia • COPD / Bronchiectasis • Urinary Tract Infections • Pyelonephritis Bridging anticoagulation e.g. DVT Subcutaneous fluid rehydration (RACF) • Hyperemesis gravidarum • Exacerbation of chronic Heart Failure • Other conditions appropriate for hospital substitution. Our HITH and Virtual Care Service will continue to provide acute hospital level care in the home for appropriate patients, including: • IV antibiotic therapy and antimicrobial stewardship • Management of chronic complex conditions requiring acute intervention • Complex wound management with IV therapy Referrals to HITH can be made via an a-referral (Health link) or by calling the centralised intake line at 1300 790 790. Available 8am-10pm We wish to advise that from 31st October 2025, the NSLHD Hospital in the Home (HITH) service will no longer be able to provide intravenous iron infusion therapy. The decision was made following a review of our clinical service priorities to ensure we continue to deliver safe, sustainable care for patients in the home. What this means for your patients: • HITH will not be accepting new referrals for iron infusions after October 31st, 2025. • Patients currently receiving iron infusions via HITH will be supported to transition to alternative service providers before the cessation date. We encourage you to refer patients requiring iron infusions to general practices, outpatient clinics, community infusion centres, or mobile infusion services (further information available on the PHN website (General Practices offering Iron Infusion Service). We acknowledge that this change may require adjustments in referral patterns and appreciate your support in ensuring a smooth transition for patients. Our team will collaborate with you to minimise disruption to care. For further information or to discuss patient transition arrangements, please contact Shelley Somi, HITH Nurse Manager-9462 9460/ Shelley.Somi@health.nsw.gov.au
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GPLink | October 2025
General Practices Eligible to Apply for Chronic Wound Consumables Scheme from July 2025
In the case of chronic foot wounds, it is not only the wound management plan and consumables used that need to be optimised. Multidisciplinary review, vascular and neurological foot assessment, appropriate offloading, pressure relief strategies, footwear prescription and escalation to medical specialty teams remain the most effective way to achieve the best outcomes for our patients. High Risk Foot Services play a key role in the coordination and facilitation of complex care planning for patients with hard to heal wounds. If you are concerned about prolonged wound healing time for patients with chronic wounds under your care, place an eReferral via HealthLink or contact the below services directly to discuss your case: The Royal North Shore Hospital (RNSH) High Risk Foot Service Phone: 02 9463 1242 NSLHD-RNSH-HighRiskFoot@health.nsw.gov.au Hornby Hospital High Risk Foot Service Phone: 02 9485 6777 NSLHD-HKH-PodiatryReferrals@health.nsw.gov.au
The Chronic Wound Consumables Scheme (CWCS) was announced in the 2023-2024 Federal Budget with the aim of improving the management of patients living with chronic wounds. From July 2025 the CWCS will allow GPs (alongside nurses, podiatrists and Aboriginal health practitioners) to order approved dressings, bandages and related supplies for eligible patients via an online portal, with the commonwealth covering the full cost. To use the portal you will need to complete a short training program being developed by Monash University (available from March 2025). The CWCS is limited to people with diabetes who have a chronic wounds and are ≥65 years old (or ≥50 years for First Nations patients) and does not apply to wounds already treated in hospitals, state-run community services, the NDIS or DVA programs. In practice, the CWCS gives GPs a funded, streamlined pathway to supply evidence-based consumables and removes the out-of-pocket costs that often cause patients to delay care. A stepped approach to managing chronic wounds should still be undertaken with timely escalation to appropriate hospital outpatient services when wounds stagnate or don’t heal as expected.
Feedback
We aim to improve communication between the hospital and primary care; improve patient experience of outpatients and ensure patients arrive back at their GP with adequate information to plan their ongoing care. We welcome your feedback on this information about the clinics at Royal North Shore. Please let us know if the format or content can be adjusted to better communicate the services available at the hospital. Email: NSLHD-GPLO@health.nsw.gov.au
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GP Link | October 2025
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