Colonoscopy in NSW: Information for primary health care providers

There are three main pathways for a patient to access a colonoscopy in NSW. The pathway they take will affect: 

• how they are assessed prior to the procedure (in person or over the phone) 
• the out-of-pocket costs associated with the pre-colonoscopy assessment and the colonoscopy itself 
• the time they will need to wait to have their colonoscopy.

Following a positive bowel screening result, a patient will be referred to: 

1. The Direct Access Colonoscopy (DAC) service of a public hospital: Most patients will be assessed over the phone prior to the day of the colonoscopy. There will be no out-of-pocket costs to the patient for either the pre-colonoscopy consultation or the procedure itself. More details below. 
2. The outpatient gastroenterology clinic of a public hospital: The patient will need to attend the hospital in person to be assessed prior to the day of the colonoscopy. There will be no out-of-pocket costs to the patient for the pre-colonoscopy consultation or the procedure itself if the colonoscopy is then done in a public hospital. 
3. A private specialist’s (gastroenterologist or colorectal surgeon) rooms: The patient will typically need to be seen in person to be assessed prior to the colonoscopy which often incurs an out-of-pocket cost.

Refer4Scope, co-designed by the University of Sydney and the Daffodil Centre, is a decision tool for primary health care providers to support clinical assessment and referral of patients requiring a colonoscopy based on a colorectal cancer screening result, bowel-related symptoms and/or family history of colorectal cancer. 

During a patient consult, primary health care providers can follow the quick and easy prompts to input their patient’s information and receive clinically-accurate recommendations in moments. 

Refer4Scope was developed by leading experts and co-designed with clinicians. It draws from the 2023 update to the 'Clinical Practice Guidelines for the prevention, early detection and management of colorectal cancer'. 

View a short video tutorial on how to use the Refer4Scope tool (1.45 mins) below.

The following short videos are from the ‘Colonoscopy referral education for primary care webinar’, presented in June 2025. 

This webinar was aimed at supporting primary health care providers with guideline appropriate assessment, triage and referral for colonoscopy services in NSW. 

The webinar was presented by: 

• A/Prof Eleonora Feletto, Cancer Elimination Centre, Sydney School of Public Health, University of Sydney
• Dr Cameron Bell AM, Director of Endoscopy and Senior Staff Specialist at Royal North Shore Hospital
• Mr Christopher Horn, Head of the NSW Bowel Screening Program at Cancer Institute NSW

This webinar was accredited by the Royal College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). 

Educational videos 

Patient case study videos

In these videos, patient case studies are used to demonstrate the: 

• Triage process – using the clinical guidelines and Refer4Scope decision tool to support clinical decision-making 
• Referral process – available colonoscopy referral options in NSW and other factors to consider in making a referral

For all colonoscopy referrals, it is crucial that primary health care providers include sufficient information for the receiving clinician to assess the appropriateness, risk and urgency of consultation. Comprehensive referrals prevent delays and allow accurate assessment of the patient’s suitability for colonoscopy and for DAC. 

“Referral documentation greases the wheels of the whole process and can hinder or help streamlined access to colonoscopy and streamlined decision making about whether a colonoscopy is indicated”. Gastroenterologist in NSW 

While each DAC service has their own clinical criteria specific to their local circumstances (see HealthPathways links in the table below), in general, colonoscopy referrals should include the following information: 

• Indication for the referral including bowel symptoms, iFOBT results and/or family history of colorectal cancer (including age of diagnosis of first-degree relatives). 
• Relevant medical history, including cardiorespiratory disease, diabetes, abdominal and pelvic surgery. 
• Current medicines including anti-coagulants, diabetic and weight loss medications. 
• Results of previous investigations, including iFOBT (indicating whether this was through the NBCSP), colonoscopies, histopathology and other recent pathology. Note: Recent blood testing results should be limited to what's relevant to the decision about colonoscopy (FBC, EUC, LFT, iron studies).

• Refer4Scope – Colonoscopy Referral Decision Tool 
• Colonoscopy Referral Education Videos for Primary Care 
• National Bowel Cancer Screening Program Colonoscopy referral checklist (PDF)
• Clinical practice guidelines for the prevention, early detection and management of colorectal cancer
• Colonoscopy Clinical Care Standard | Australian Commission on Safety and Quality in Health Care
• NSW colonoscopy categorisation I Agency for Clinical Innovation

DAC is a NSW Health value based health care initiative that focuses on helping people gain access to public colonoscopy services after a positive bowel cancer screening test. 

A key advantage of DAC is that it allows otherwise healthy patients who have a positive iFOBT and meet the inclusion criteria, to be assessed and triaged during a free telephone appointment with a specially trained nurse. 

This is an alternative to having a face-to-face appointment with a specialist prior to the day of the colonoscopy. A nurse-led telephone triage assessment enables patients to be referred directly to a DAC service. 

If patients are suitable for telephone assessment, they will only need to come to the hospital once on the day of their procedure.

  

  

The DAC model of care outlines the mandatory and recommended inclusions for implementation and should be read in conjunction with the following: 

• the Australian Commission on Safety and Quality in Health Care Colonoscopy Clinical Care Standard 2025 
• the National Safety and Quality Health Service Standards 
• the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for Surveillance Colonoscopy 
• Local Health District (LHD) and Speciality Hospital Networks (SHN) policies and procedures.

In 2024, the model of care was revised to ensure accuracy and to incorporate any changes to practice since the model was first published in 2020.