Topic: Diabetes

FREE two-hour diabetes education sessions.

Session times: 9-11am or 2.30-4.30pm
Sessions held on Wednesday subject to availability.

 

All you need to do is:

• book a session with SWSPHN
• invite eight to 25 of your patients who are newly diagnosed or with an existing diagnosis of type 2 diabetes
• we can work with you to hold the session at your practice or at a local community health centre
• confirm patient attendance the day before

Download flyer

 

 

Sessions for patients living in South Western Sydney made possible thanks to the partnership between South Western Sydney PHN and South Western Sydney LHD.

Statistics show the rate of type 2 diabetes diagnoses within South Western Sydney has doubled in the past 20 years, putting it well above the NSW average.

While the statistics are alarming, SWSPHN is playing its part to help GPs halt the escalating rate of type 2 diabetes in the region.

Over the last three years SWSPHN and South Western Sydney Local Health District (SWSLHD) have jointly supported 53 practices to hold 157 type 2 diabetes clinics at their practices, with in-person attendance by an endocrinologist and diabetes educator.

The aim of these clinics is to upskill GPs in complex diabetes management, lessening the need for referrals to hospital outpatient clinics. The partnership also delivers rapid access to endocrinology advice through telehealth case conferencing.

SWSPHN and SWSLHD have been partnering, along with general practices in South Western Sydney, to provide access to free diabetes education sessions, held within the practice or at a local community health centre.

SWSPHN has also partnered with exercise physiologists across South Western Sydney to establish small group exercise classes for patients diagnosed with type 2 diabetes. Many of these classes are bulk billed.

To understand the full impact of the problem it helps to go back to the statistics.

In self-reported census data from 2021, there were 61,086 people in South Western Sydney with diabetes (not including gestational diabetes) which translates to a standardised rate of 6.4 per 100 people. This is higher than the self-reported NSW rate of 4.8 people per 100. And that number is expected to increase to 127,481 people by 2036.

Diabetes Australia estimates the National Diabetes Service Scheme (NDSS) covers 80 to 90 per cent of people with diagnosed diabetes. Their figures show almost 1.5 million Australians were living with diabetes (mostly type 2) in March 2024.

In South Western Sydney (SWS) registration data is higher than self-reported but is still likely to underestimate the true number as it only includes people who have been diagnosed and who have registered with the scheme.

In 2021, there were 72,190 people registered – or 6.6 per cent of SWS population, which is higher than the NSW average of 5.1 per cent. Of these, 88.2 per cent have type 2 diabetes, 7.3 per cent have type 1 diabetes and 3.7 per cent have gestational diabetes.

Across local government areas in SWS, Fairfield has the highest proportion of NDSS registrants (8.1 per cent), and postcodes 2164 and 2176 within the Fairfield LGA have even higher proportions at 9 per cent and 8.3 per cent respectively.

Campbelltown has the second highest proportion (7.5 per cent) and contains the postcodes 2564 and 2565 where the registered population proportion is 9 per cent and 8 per cent respectively.

While Liverpool rates the third highest proportion of registrants (6.9 per cent) it contains two of the highest rated postcodes with 2179 registering 14.3 per cent, which is more than double that of SWS, NSW and Australia, and postcode 2555 recording 11 per cent, which is also very high.

The increase in diabetes rates in SWS is thought to be linked to population growth in groups at higher risk of type 2, as well as growth in lower income areas. Socio-economic status is linked to diabetes, with lower incomes areas consistently shown to have a higher proportion of individuals with diabetes and an increased risk level.

This is likely due to dietary impacts, fewer physical activity opportunities, typically lower educational achievement and limited health resources.

Some culturally and linguistically diverse (CALD) groups are also at an increased risk of type 2 diabetes. This includes those born in Polynesia and Melanesia and First Nations people.

There is evidence to suggest the information being provided to patients from CALD backgrounds is being written in a higher reading level than recommended which can lead to a reduced uptake of advice and have an impact on health literacy levels regarding diabetes in the region.

SWS also has a higher rate of gestational diabetes (GDM) at 3.7 per cent compared to national rate of 2.9 per cent. This figure is driven by the increasing proportion of the population who are overweight and obese from a young age.

In 2020-21 both diabetes-related hospitalisations and diabetes related potentially preventable hospitalisations were higher in SWS than the rest of NSW.

In SWS in 2020-21, the age-standardised rate of potentially preventable hospitalisation for diabetes complications was 171 per 100,000 people, higher than the NSW rate of 162 per 100,000.

Within SWS, Campbelltown has the highest rate (242 per 100,000 people) of preventable hospitalisations.

Diabetes-related deaths are those where diabetes is either the underlying cause of death or it is an associated cause of death, where the underlying cause is one of the commonly recognised complications of diabetes. In 2021, the diabetes death rate in SWS was 34.3 per 100,000 population, higher than NSW rate of 28.4 per 100,000 population.

Age-adjusted death rates for diabetes in SWS have been consistently higher than NSW rates between 2011 and 2021 when they were 1.2 times higher than the NSW average.

 

Helpful resources for learning more about type 2 diabetes

Explore a range of information and services available to support the prevention and management of type 2 diabetes in South Western Sydney:

• Current snapshot of type 2 diabetes in SWS: Plans, reports & documents | South Western Sydney PHN
• Telehealth type 2 diabetes case conferencing for GPs
• Type 2 Diabetes Case Conferencing Clinics
• FREE type 2 diabetes education sessions
• Referral guide for GPs: Type 2 diabetes group exercise classes
• Health Resource Directory – diabetes
• Get Healthy NSW
• Healthy Meal Ideas
• Diabetes Australia
• Management and Care

 

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This article appeared in Practice Pulse on Wednesday, 26 November 2025. If you are a GP, practice nurse or practice manager in South Western Sydney and do not get the weekly Practice Pulse email, speak to your Practice Support Officer.

Consultant endocrinologist Dr Shan Jiang has offered advice to GPs regarding safe practices when it comes to driving and diabetes.

Dr Jiang said medicals for driver’s licences should be completed by GPs in much the same way as the requirements for someone who has coronary disease or epilepsy.

“This is a legal document and should be completed by a doctor who has an ongoing therapeutic relationship with the patient and has done all the assessments including comprehensive reviews of the patient’s history and medication as well as an examination,” Dr Jiang said.

A GP who has been trained in the procedure can do all private licence medicals.

Endocrinologists only need to undertake licence medicals for diabetes or two scenarios: a commercial driver’s licence, or if the patient has poor glycaemic control such as too many hypers or hypos, or end stage complications which would compromise driving.

Commercial drivers should see a private endocrinologist at least once a year for licence renewal.

In the case of poor glycaemic control, if a GP does not feel comfortable providing driving clearance, they can instead give a temporary licence to see if their patient improves without compromising their ability to drive. However, if there are real safety concerns a licence medical should not be done, and these patients should see an endocrinologist for ongoing care.

Dr Jiang said the best way to avoid all these issues was to tell your patient from the start what their legal requirement was to keep their licence in the context of having a medical condition like diabetes which could compromise their driving.

“If a GP feels the patient’s driving ability is compromised, they should not complete the licence medical, and should advise the patient not to drive,” she said.

“The GP does not need to inform Services NSW of this themselves. However, if despite the advice, the patient continues to drive, and their doctor feels this is a significant risk, they can then inform Services NSW. They also need to let their patients know they have taken this step.”

 

Want to know more? Here are some useful links.

Austroad medical standards for licensing

Diabetes Australia

National Diabetes Services Scheme

NSW Government – driving with a medical condition

 

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This article appeared in Practice Pulse on Wednesday, 12 November 2025. If you are a GP, practice nurse or practice manager in South Western Sydney and do not get the weekly Practice Pulse email, speak to your Practice Support Officer.

A partnership between SWSPHN and South Western Sydney LHD (SWSLHD) which saw the piloting of mental health-type 2 diabetes case conferencing was among the projects highlighted at the Diabetes Tech n Talk Conference at the Macarthur Clinical School on Saturday, 25 October.  

Tech n Talk focuses on innovation and integration in diabetes clinical care, self-management and prevention.   

SWSPHN Integration and Priority Populations Coordinator, Alyssa Horgan, joined SWSLHD Mental Health Service Physical Health Coordinator, Isabella Sierra (pictured left and right), for the presentation to about 60 GPs, diabetes specialists and academics.  

Physical health conditions such as cardiovascular disease, respiratory conditions and endocrine conditions, including diabetes and thyroid dysfunction, contribute to an increase in morbidity and mortality in people living with severe mental illness.  

“Cognitive challenges impact logistics of regular care, with life expectancy shortened by up to 23 years,” Alyssa told attendees.   

As outlined in the South Western Sydney Diabetes Framework to 2026, improving the care of people who are at risk of diabetes or who have diabetes, and a mental health condition, is a priority for SWSPHN.  

In their presentation, Alyssa and Isabella described the model they used for the pilot project and the positives and challenges from that model. They also talked about the changes to the model based on patient/clinician responses and the expected outcomes of those changes.  

The model initially involved gaining consent from identified inpatients at Mental Health Units (MHU) to be paired with a ‘keystone’ GP to participate in diabetes case conferencing alongside a GP, endocrinologist and mental healthcare coordinator, who acts as a care navigator in the pilot program. 

There was a good uptake to the model by inpatient resident medical officers and improved liaison between medical officers across MHUs and endocrinology services.  

However, challenges included patients not meeting all eligibility and poor documentation of pathways on discharge summaries.  

The model was then refined. This included revising eligibility; involving a diabetes educator; expanding pathways to allow community mental health services to initiate referrals; and allowing patients to see either their own GP or a ‘keystone’ GP.  

The expected outcomes include: a better coordinated approach to providing healthcare; improved care for patients, especially those with complex needs; person-centred care; shared decision-making; and improved GP knowledge and skills.  

The Tech n Talk also heard from: keynote speaker Professor Anthony Russell, co-creator of Diabetes Beacon Practices; Fairfield GP Dr Dong Hua, who spoke about improving diabetes care in general practice; and Rachel Hicks, who spoke about NetHealth and the future of remote monitoring of gestational diabetes mellitus care. 

Visit our diabetes ‘what we do’ page

GPs can refer eligible patients with type 2 diabetes to group exercise classes delivered by accredited exercise physiologists under Medicare Item 81110. This page outlines referral requirements, what patients can expect, how reporting works, and includes a list of local providers delivering the program.

 

How it works

GPs can refer patients with a GP management plan OR a GP chronic condition management plan to type 2 diabetes group exercise classes under Medicare Item 81110.

After referral to a participating exercise physiology practice (listed below), patients will receive a face-to-face consultation to assess their suitability for the program. A copy of the assessment will be sent back to the referring GP.

Patients deemed suitable will be invited to attend eight one-hour group exercise sessions. Once these are complete, the exercise physiologist will provide a report to the GP detailing the patient’s progress.

These eight group sessions are in addition to the five individual allied health visits available to eligible patients each calendar year. Unlike individual services, there is no requirement for a Team Care Arrangement to refer for group allied health services.

Referrals can be made to the organisation rather than a specific clinician, offering greater flexibility in scheduling and clinician availability.

 

Participating providers – Bankstown LGA

Organisation	Address	Cost
Tambakis Physiotherapy	Unit 2, 11 Cahors Rd, Padstow	MBS Gap fee
Activate Clinic	98 Park Road, East Hills	Bulk billed

 

Participating providers – Camden LGA

Organisation	Address	Cost
Brown and Ross Exercise Physiology	368 Welling Drive, Mount Annan (inside Mt Annan Leisure Centre)	Bulk billed
Built2Move Allied Health	Suite 1/18 Porrende St, Narellan	Bulk billed
MEND Narellan	Shop 3 /4 George Hunter Drive, Narellan	Bulk billed

 

Participating providers – Campbelltown LGA

Organisation	Address	Cost
Harmony Specialist Healthcare	4 Chamberlain Street, Campbelltown	MBS gap fee
Move Right EP	Unit 1/10 Blaxland Road, Campbelltown	Bulk billed
South West Health Management	1/27 Mount Erin Rd, Campbelltown	MBS gap fee

 

Participating providers – Fairfield LGA

Organisation	Address	Cost
Fairfield City Leisure Centres – Active Recovery Rehabilitation	Cabravale Leisure Centre: 30 Broomfield St, Cabramatta Prairiewood Leisure Centre: Prairie Vale Rd &, Moonlight Rd, Prairiewood	Bulk billed

 

Participating providers – Liverpool LGA

Organisation	Address	Cost
Kinetix Health Group	Unit 2/46-48 Jedda Rd, Prestons	Bulk billed
Mounties Health and Fitness	101 Meadows Rd, Mount Pritchard	Bulk billed
Sydney Exercise Medicine	Michael Wenden Aquatic Centre, Miller	MBS gap fee
Fit Clinic	15/2 Ash Road, Prestons	Bulk billed
Aspire Physio	Suite 1, 173–179 Bigge St, Liverpool	Bulk billed

 

 

Participating providers – Wingecarribee LGA

Organisation	Address	Cost
Effect Exercise Physiology	242 Argyle Street, Moss Vale	MBS gap fee

 

Referral form

As of 1 July 2025, the use of a prescribed referral form for allied health services will no longer be required. Allied health referrals will now be provided via referral letters, consistent with the arrangements for referrals to medical specialists.

The minimum requirements for a valid referral to an allied health provider will be that the referral:

• includes the name of the referring practitioner
• includes the address of the practice, or the practitioner’s provider number at that practice, of the referring practitioner
• includes the date on which the referring practitioner made the referral
• the validity of the referral (if relevant). NB: for referrals to individual or group allied health services (Group M3 Subgroup 1, Group M9 and Group M11) referrals will be valid for 18 months from the date of the first service provided under the referral, unless otherwise specified by the referring practitioner
• be in writing
• be signed by the referring practitioner (which may be by electronic signature)
• be dated
• explain the reasons for referring the patient, including any information about the patient’s condition that the referring practitioner considered necessary to give the allied health professional.

 

Need help?

If you’d like support extracting a list of eligible patients for referral, please contact:
Alyssa Horgan – alyssa.horgan@swsphn.com.au