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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.
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 a timely manner, 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. Details of the designated Queensland Health facilities and authorised providers for the Program are available by contacting your nearest Gastroenterology Nurse (GE) Nurse Coordinator QBCSP. 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.
Participants who receive a positive FOBT in the National Bowel Cancer Screening Program (NBCSP) are able to be referred for an assessment colonoscopy and/or other test, in a private or public facility.
Private Referrals
Your patient's care will be managed by your nominated specialist at a private hospital or other facility. The cost for private patients will depend on their level of private health cover, and any additional fees charged.
To refer your patient to a private facility
Public colonoscopy referrals made to the QBCSP allow access to timely and cost-free colonoscopy services on lists reserved for people who have received a positive FOBT result in the NBCSP. Your patient’s care will be coordinated by the GE Nurse Coordinator QBCSP. The GE Nurse Coordinator QBCSP is able to assist Program participants by ensuring access to follow up care and assisting them through the assessment colonoscopy pathway. You should discuss these options with your patient. For more information about your nearest Queensland Health facility with reserved lists, please call your local GE Nurse Coordinator QBCSP on 1300 766 927 (cost of local call). Please post or fax referral to GE Nurse Coordinator QBCSP.
To refer your patient to a public facility
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). See a full list of the GE Nurse Coordinator QBCSP contact details and facilities with reserved lists.
Health Promotion Officers for the QBCSP are based through the state. The Health Promotion Officers QBCSP are a key information contact for general practitioners and other health care providers about the Program. See a full list of Health Promotion Officer contact details.
