Diabetes in South Western Sydney

Type 2 Diabetes is a significant health burden within South Western Sydney (SWS). Diabetes has increased in SWS by over 158 per cent since 2000. 12.6 per cent of the SWS population have Diabetes compared to 8.7 per cent for the state. Fairfield LGA has the highest rates followed by Campbelltown and Liverpool. Six of the top ten postcodes ranked by Gestational Diabetes Mellitus (GDM) occurrence in NSW are in SWS, with Liverpool and Campbelltown LGAs in the top three.

Supporting Diabetes Care in South Western Sydney

HealthPathways is an online portal documents that local referral pathways and recommended management guidelines for health conditions. This tool aims to support a consistent standard of care across region. There are currently 27 Diabetes specific health pathways available, with a further four Diabetes in pregnancy specific pathways. For more information see the HealthPathways website: https://sws.healthpathways.org.au/

Quality improvement initiatives within General Practice can support the improvement in patient care, from prevention and screening through to chronic disease management. South Western Sydney PHN is expanding its successful 5As preventative health clinical audits to allow greater focus on Chronic Disease management. PENCS software is utilised to support General practice to monitor and optimise the aspects of quality care, ie Diabetes Cycles of Care. If you would like to find out more about quality improvement of clinical audits see http://www.swsphn.com.au/qipc.


Diabetes Contraception and Pre-pregnancy Program (DCAPP)

DCAPP is new to South Western Sydney. The initiative has been designed to offer an integrated approach to managing the high rates of congenital malformations that exist in the area. For more inforamation see the Diabetes Obesity and Metabolism Translational Research Unit (DOMTRU) website.


Integrated Diabetes Project

South Western Sydney Primary Health Network and South Western Sydney Local Health District are working together to enhance diabetes care in the area.  A range of measures are planned, which commenced with Health Pathways.

Case Conferencing

Local diabetes specialists are available for in-practice case conferencing to support GPs managing more complex patients and allow the patient to receive care in the primary health setting. The benefits:

  • Access to billing for MBS chronic disease items for case conferencing, GP management plans, Team Care Arrangements and items of Diabetes Cycles of Care, as eligible
  • Diabetes Specialist service without extra cost to the patient
  • Reduce waiting time for patients to access specialist care
  • Increased patient satisfaction with a comprehensive, integrated and interdisciplinary management approach in the one location.

Who can I refer? Any of the following patients will be prioritised first:

  • HbA1c≥9% (8-8.9% included once those ≥9% have been discussed)
  • Significant and frequent hypoglycaemia
  • Recent hospitalisation/CVD/Foot event in past 12 months
  • Nephropathy/↑ACR
  • Blood pressure over 160/100 mmHg
  • Triglycerides 10+mmol/l
  • Women planning/at risk of pregnancy
  • Other (Any other patient with diabetes you would like to discuss).

For more information see the attached flyer. Referral forms can be found on our Forms and Templates page.

How to refer for a case conference session:

Point of contact: DOMTRU administration

Contact Number: (02) 4634 3192

Email: SWSLHD-CampbelltownDOMTRU@health.nsw.gov.au

Fax number for referral: (02)4634 3215



South Western Sydney PHN has made available to 1000 health practitioners working in SWS general practice the Australian version of the Cambridge Diabetes Education Program (AusCDEP). 

‘Bite-size’, clinically, contextually relevant

Assessment then content

Saves sitting or working through areas people already know

Screens competency  

Progress quickly to next level if you know the answers



AusCDEP is based on national diabetes competency frameworks that have been translated into a non-traditional online learning program through Cambridge University Health Partners.  It supports health professionals to assess and demonstrate their ‘knowledge’ and ‘know how’ in diabetes management and quickly assesses gaps in knowledge. Information and learning is provided to help fill the gaps in knowledge.

Please see AusCDEP flyer for further information or to get your free access code contact Delena Bailey Delena.Bailey@swsphn.com.au  or phone 4632 3006.

Western Sydney University foot clinic

Western Sydney University currently runs a high-risk foot clinic that will provide free foot assessments to patients with Diabetes. This service will be provided in addition to the Medicare based services, allow for greater service access for the patients.

To refer your diabetes patients for their free foot assessment send your referral to: Jodie Wilson

Fax (02)4634 3810. Phone (02) 4634 3192 or email SWSLHD-CampbelltownDOMTRU@health.nsw.gov.au 

For more information see the foot clinic flyer.

Training in Foot assessments and screening

GPs and practice nurses are also welcome to consider the opportunity to further their knowledge in skills foot screening and interpretation through attending workshops at the university foot clinic.

By attending this clinic, you will attain competency in the following areas:

  • Vascular Assessment (including, pedal pulses, Doppler waveforms, ankle and toe brachial pressure indices)
  • Neurological Assessment (including small and large sensory, nerve fibre assessment, motor and autonomic assessment, assessment of cutaneous innervations)
  • Structural assessment (including muscle or joint problems e.g. hammer toes, claw toes, wasting of lesser muscles etc. and their implications on footwear selection)

Importantly you will learn how to interpret this information to assign risk status to your patient and ensure an appropriate level of preventative care.

For more information, contact DOMTRU administration phone 4634 3192 or email: SWSLHD-CampbelltownDOMTRU@health.nsw.gov.au