Involvement of general practitioners is critical to the success of the Program. For your patients in the Program, you can play a key role in:
More information on the role of the GP in the Program is outlined in the Queensland Bowel Cancer Screening Program Screening Pathway.
Each general practitioner will be receiving a letter in July 2008 from the Department of Health and Ageing in regards to the expaned National Bowel Cancer Screening Program. In addition each general practice within Queensland should have received an information kit from the Australian Government as part of Phase 1 of the Program containing all necessary Program information, brochures and forms. Additional kits can be ordered from the National Bowel Cancer Screening Program Information Line on 1800 118 868.
General practice staff can also contact their local Program team on 1300 766 927 (Mon - Fri; 9am - 5pm EST) should they have any questions about the Program.
To support the Program, a National Bowel Cancer Screening Program Register has been established by Medicare Australia. The primary role of the Register is to:
Program participants will be encouraged to nominate their usual general practitioner or medical practice on their participant details form, but this will not be compulsory. The result of the FOBT test will be sent to the participant, and if nominated, to their general practitioner.
In addition, general practitioners are required to complete a Payment Account Details for Service Provider Form for the Register (once only) in order to receive information payments (a $6.60 payment for each completed form about consultations/procedures relating to Program participants who have a positive FOBT). This form is available on the National Bowel Cancer Screening Program website.
Participants showing symptoms of bowel cancer or who have a family history of bowel cancer should be managed in accordance with the National Health and Medical Research Council Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer. A guide for general practitioners has also been developed based on the NHMRC guidelines. Information on familial aspects of bowel cancer is also available in the brochure, Familial aspects of bowel cancer: a guide for health professionals.
Randomised controlled clinical trials at the population level have indicated that screening using FOBTs, in populations selected on the basis of age, can reduce overall mortality from colorectal cancer by 15-33% [1].
During this phase of the National Program, an immunochemical FOBT called 'Detect' will be used. Detect requires the collection of faecal samples from two separate bowel motions and does not require dietary modification prior to the test being completed.
According to NHMRC's Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, immunochemical FOBTs detect 60-90% of cancers and many advanced adenomas under ideal conditions. The NHMRC Guidelines recommend that screening with FOBT be performed at least once every two years [2].
During the pilot program the positive predictive value of the Detect FOBT for suspected cancer or advanced adenoma was 20.1%. For all cancers and adenomas, including small and diminutive adenomas, the positive predictive value was 26.3% [3].
In comparison, the pilot data indicates that the positive predictive value for significant family history and/or symptoms of bowel cancer, in the absence of a positive FOBT, was 0.5 % for cancer, 4.3% for advanced adenoma and 7.5% for cancer or any adenoma [4].
The cumulative effect of FOBT is also important. An article by Yamamoto and Nakama suggests that a two-day collection method for immunochemical FOBT is recommended from the viewpoint of cost-effectiveness as well as diagnostic accuracy [5].
Queensland Health has taken a number of steps to ensure that Program participants with a positive FOBT result have access to high quality and timely assessment colonoscopy services. Additonal funding has been committed to meet the demand for assessment colonoscopies generated by the Program that are referred to the public sector.
The capacity to provide these additional services is not evenly spread across Queensland. To maximise the availability of assessment colonoscopies, an Authorised Provider model has been developed for the Program, which is currently being implemented in the public sector. This model involves the identification of designated Queensland Health facilities which currently have the capacity to provide additional services for the Program within 30 days of referral, and authorised providers (specialists) who will provide these services for the Program. Details of the designated Queensland Health facilities and authorised providers for the Program are available for your reference. In some catchments, public patients will have their procedure at a private facility under the Program.
Any Program participants with a positive FOBT result who choose to have their assessment colonoscopy privately should be managed as per your usual referral arrangements.
The Assessment Form: Referred for colonoscopy / Not referred for colonoscopy following a positive FOBT result is to be used to provide information to the Register about consultations with Program participants who have received a positive FOBT result.
Practices can lodge the Assessment Form with the National Register by:
North East Valley Division of General Practice (Victoria) has also developed the Assessment Form into a template that can be integrated into practice the software suites Medical Director, Best Practice, ZedMed and GP Complete. This form will be accepted by the Register as all the information is included, and it is in the same order as for the official NBCSP stationery. The template and detailed instructions on how to upload it into the various practice software suites can be found on the North East Valley Division of General Practice Ltd website under Information Management resources.
For those general practitioners who do see Program participants, the Department of Health and Ageing has sought legal advice from Clayton Utz regarding duty of care issues resulting from the Program. In summary, Clayton Utz advised that the Program does not impose any additional duty of care upon medical professionals. Practitioners and medical practices will discharge their duty to their patients if they act in accordance with existing professional standards and what is viewed as being best practice in the medical profession. The legal advice has been provided to a number of medical organisations including the Australian Divisions of General Practice, the Australian Medical Association, and the Royal Australian College of General Practitioners.
GE (Gastroenterology) Nurse Coordinators QBCSP
The GE (Gastroenterology) Nurse Coordinators are able to assist Program participants by ensuring access to follow up care and referral and assisting them through the assessment colonoscopy pathway, to the stage of treatment or re-screening.
General practitioners who refer Program participants for colonoscopy in the public sector should send a copy of the GP Assessment Form and a standard referral letter with a green NBCSP sticker attached to their local GE Nurse Coordinator.
The general contact number for the GE Nurse Coordinators is 1300 766 927 (cost of local call).
| Catchment | GE Nurse Coordinator QBCSP | Contacts |
| General Number | Will be diverted to the GE Nurse Coordinator QBCSP in your catchment | Telephone: 1300 766 927 (local call, Mon-Fri, 9am-5pm) |
| Brisbane North | Gillian Schofield | Ph: 07 3139 4106 Mob: 0408 728 777 Fax: 07 3139 4956 |
| Brisbane South - Logan | Charlie Vaughan | Ph: 07 3299 8077 Mob: 0408 727 523 Fax: 07 3299 8129 |
| Brisbane South - PA Hospital | Esther Drommel | Ph: 07 3167 1047 Mob: 0447 798 400 Fax: 07 3167 1295 |
| Bundaberg | Kim West | Ph: 07 4122 8321 Mob: 0447 057 310 Fax: 07 4122 8325 |
| Cairns | Debra Whittaker | Ph: 07 4050 9535 Mob: 0447 718 697 Fax: 07 4050 9539 |
| Gold Coast | Jenny Harvey |
Ph: 07 5519 7644 |
| Mackay | Robyn Nikolsky | Ph: 07 4968 6811 (office phone) Mob: 0428 794 069 Fax: 07 4968 6850 |
| Rockhampton | Fiona Petersen |
Ph: 07 4920 5747 |
| Sunshine Coast | Lea Wiggins | Ph: 07 5470 6213 Mob: 0447 720 129 Fax: 07 5470 5431 |
| Toowoomba | Sandra Lake | Ph: 07 4616 6823 Mob: 0448 618 085 Fax: 07 4616 5696 |
| Townsville | Helen McManimm | Ph: 07 4796 1238 Mob: 0447 182 122 Fax: 07 4796 1261 |
| West Moreton | Kim Williamson |
Ph: 07 3810 1982 |
Queesland Bowel Cancer Screening Program Health Promotion Officers (HPO) are based through the state. The QBCSP Health Promotion Officers are a key information contact for general practitioners and other health care providers about the Program.
| Catchment | Health Promotion Officer QBCSP | Contacts |
| Brisbane North | Michelle Hogan | Ph: 07 3139 4116 Mob: 0448 155 436 |
|
Brisbane South - Logan Brisbane South - PAH |
vacant |
Ph: 07 3167 1046
|
| Bundaberg | Ruth Ward |
Ph: 07 4122 8332
|
| Cairns | Naomi Goldsworthy |
Ph: 07 4050 6385
|
| Gold Coast |
Nicole Brancato | Ph: 07 5519 7644 Mob: 0403 449 226 |
| Mackay | Vacant |
Ph:
|
| Rockhampton | Debra Robson | Ph: 07 4920 5748 Mob: 0418 874 557 |
| Sunshine Coast | Rochelle Coombs | Ph: 07 5470 6213 Mob: 0407 692 996 |
| Toowoomba | Bernie Roberts | Ph: 07 4616 6848 Mob: 0447 155 530 |
| Townsville | Joanne Stewart | Ph: 07 4796 1238 Mob: 0400 063 212 |
| West Moreton | Deborah West | Ph: 07 3810 1531 Mob: 0438 732 593 |
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