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Pathways to Health: General Practitioner Referrals to Nepean Hospital

Nepean Hospital
Project Added:
13 November 2015
Last updated:
6 January 2016

Pathways to Health: General Practitioner Referrals to Nepean Hospital


The project developed a standardised referral process for emergency department (ED) admissions and increased awareness of outpatient clinics and community health services among general practitioners (GPs) in Nepean Blue Mountains Local Health District (NBMLHD).

View a poster from the Centre for Healthcare Redesign graduation,  April 2014.

Pathways to health [poster]


To reduce GP referrals to Nepean Hospital by 10% in 12 months and increase GP referrals to outpatient clinics by 10% in 12 months. 


  • Improves National Emergency Access Target (NEAT) performance, access block and waiting times.
  • Improves communication between GPs and ED staff.
  • Provides patients with access to services in a timely manner.
  • Improves ‘Did Not Attend’ rates at outpatient clinics.

Project status

Key dates

Project start: April 2013 

Project status

Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.


It was found that many local GPs believed the only way a patient could receive affordable specialist care in a timely manner is if they referred patients to the ED. This contributed to access block, increased waiting times and reduced NEAT performance. Patients were also frustrated at outpatient clinics, which were often booked for months in advance due to high ‘Did Not Attend’ rates.

To enhance care and streamline referral processes, Nepean Blue Mountains Medicare Local (NBMML) and NBMLHD worked collaboratively to engage GPs and encourage them to refer patients to outpatient clinics where possible.


  • Define and streamline the current referral process from GPs to Nepean Hospital ED
  • Define current NBMLHD outpatient clinics
  • Enhance communication between NBMML, GPs and Nepean Hospital through the establishment of a contact database for outpatient clinics
  • Decrease ‘Did Not Attend’ appointments by 14% in 12 months
  • Increase GP referrals to outpatient clinics by 20% in 12 months
  • Decrease GP referrals to Nepean Hospital ED by 10% in 12 months.


  • Developed a standardised referral process for outpatient clinics and community health services, including a GP referral form.
  • Created a database directory of outpatient clinics and distributed to all GPs in NBMLHD.
  • Introduced SMS reminders for outpatient clinic appointments.
  • Promoted community health services to GPs and encouraged them to phone the ED staff specialist instead of referring the patient to the ED. The staff specialist was able to advise the most appropriate pathway to the correct care setting.

Implementation sites

  • Nepean Hospital, NBMLHD
  • Nepean Blue Mountains Medicare Local 


  • Nepean Blue Mountains Medicare Local


  • ‘Do Not Attend’ rates in outpatient clinics decreased by 8%, with a decrease of 10% in Women’s Health Outpatient Clinics. With more specialties implementing the SMS service, this rate is expected to decrease further.
  • There was a decrease of 6.8% in GP referrals from 2013 to 2014.
  • The GP database directory was implemented, with positive feedback from both clinicians and GPs.
  • Significant progress has been made with ereferrals.
  • The outpatient referral form for GPs increased the accuracy and legibility of patient information.

Lessons learnt 

  • Correct sponsorship is vitally important to successful implementation.
  • Projects never stop and need to evolve over time.
  • Effective communication and stakeholder consultation is essential to the success of any project.

Further reading


Danielle Xerri Clinical Redesign Project Officer
Nepean Hospital
Nepean Blue Mountains Local Health District
Phone: 02 4734 1604

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