Care Partnership – Diabetes (CP-D) services in Far West NSW help support improved patient access to clinical care, professional development for health practitioners, and health system improvements.
There are a range of services supported by CP-D available for people living with type 2 diabetes and the health practitioners who support them to access.
The Far West Diabetes Service is integrated with the existing Planned Care for Better Health Model of Care within Far West Local Health District (FWLHD) Integrated Care.
Planned Care for Better Health
Planned Care for Better Health (PCBH) aims to improve the patient’s experience of care and keep patients healthier over the long term. It is focused on the needs of people who are at risk of hospitalisation or who would benefit from early intervention. The services provide care coordination, care navigation and health coaching to improve their experience and outcomes.
The program promotes self-management of health conditions and supports consumers in achieving their goals by providing education into their conditions and health, assistance coordinating their healthcare, and assistance in navigating the healthcare system in their community.
Diabetes services
The FWLHD Diabetes service integrates with Planned Care for Better Health within Integrated Care to provide the above listed service, as well as providing access to specific services for diabetes care in Western NSW.
The service offers access to a diabetes educator and Aboriginal health practitioner with multidisciplinary team access as required.
To refer a patient to the service:
Early identification and community engagement
Due to the vast distances and remoteness of FWLHD, Community Engagement is a core part of our model of care. It is important to connect with our communities in a meaningful way to ensure we are delivering place appropriate healthcare.
The Far West Diabetes Service will be visiting each of our communities regularly for early identification, community awareness and education, and to ensure we are meeting the needs of each individual community.
To find out where we will be next or get involved, please keep an eye on FWLHD’s social media.
Patient Reported Measures
Far West Diabetes Service will use Patient Reported Measures (PRMs) as part of the approach to patient centred care, evaluation and monitoring of the program.
PRMs capture information via surveys, which ask patients about their healthcare experiences and the outcomes of their care, giving clinicians an insight into the needs and expectations of patients at the point of care.
This feedback also helps to drive improvement across the NSW health system.
Reach out to FWLHD PRMs Project Manager, Kara Leonard via email.
The CP-D program supports a range of professional development services for health professionals in Far West and Western NSW who provide care for people living with type 2 diabetes.
The CP-D program helps local health professionals advance their skills by offering grants that reduce the cost of further study or professional development.
To date, the initiative has funded over 50 bursaries, scholarships, and study leave grants across Western and Far West NSW. Many recipients are completing, or have completed, their Credentialled Diabetes Educator (CDE) qualifications, significantly boosting the local CDE workforce.
Eligible practitioners working in rural primary healthcare settings – across medical, nursing, midwifery, allied health, dental, and Aboriginal and Torres Strait Islander health – can apply for support through the Health Workforce Scholarship Program.
Health professionals outside primary care settings can enquire about suitable opportunities or grants for type 2 diabetes training by contacting westernT2DM@nswrdn.com.au.
CP-D collaborates with key partners to coordinate practical training events for healthcare providers delivering type 2 diabetes care in Western and Far West NSW.
So far, these professional development activities have included upskilling workshops for non-clinical health professionals, CDE exam preparation sessions, and targeted diabetes education for Aboriginal health practitioners. The Type 2 Diabetes ECHO series is another key initiative.
Information about relevant professional development events can be viewed on the Rural Health Training Calendar and searching for ‘diabetes’. You can also choose ‘diabetes’ as a professional interest in your Rural Health Pro profile to make sure you see diabetes related events. You can also email Rural Health Pro for more information about upcoming events.
Type 2 Diabetes ECHO sessions facilitated by Western NSW Primary Health Network (WNSW PHN) support peer virtual learning for health professionals in Western and Far West NSW through didactic presentations and case discussions. The sessions bring together local GPs, GP registrars, nurses, pharmacists, Aboriginal health professionals, and allied health practitioners to build knowledge, confidence, and capacity in Type 2 Diabetes care.
The sessions provide a unique opportunity for clinicians to discuss real patient cases with a multidisciplinary panel of experts and peers, including endocrinologists, GPs, and credentialled diabetes educators.
Delivered monthly, each session follows the Project ECHO® model; a collaborative learning network where clinicians receive specialist advice in real time, boosting both skills and community connections. Participants are encouraged to present cases, with GPs eligible to claim MBS case conferencing items.
An introductory video explaining the Project ECHO® model is available here.
These virtual sessions offer a range of benefits:
Information about upcoming ECHO sessions can be found on our website here and the Rural Health Training Calendar.
Please email cpd@wnswphn.org.au if you would like to participate in an upcoming ECHO session, request a topic or patent case study, or contribute on the panel.
The CP-D team is focused on strengthening the type 2 diabetes care workforce in Western and Far West NSW by addressing current gaps, forecasting future needs, and offering targeted support.
This includes initiatives such as:
The program is exploring supports for these regions’ diabetes educator workforce, mentors of those in-training, and linking newly qualified diabetes educators to roles where they can utilise their skills.
If you would like to raise a workforce need or solution, contribute to governance or evaluation, or other opportunity, please write to westernT2DM@nswrdn.com.au.
CP-D takes a whole-of-system approach on access to care by supporting the provision of coordinated care systems through establishment and use of HealthPathways, INCA and other digital tools.
HealthPathways is a web-based portal for health practitioners that:
The diabetes pages on HealthPathways have been localised for the Far West and Western NSW regions and will continue to be updated.
Health practitioners can login or register to access localised HealthPathways or email HealthPathways for more information.
Lumos offers participating practices tailored six-monthly reports showing how patients interact with the broader health system, such as GP and hospital visits.
By securely linking de-identified general practice data with other health service data, Lumos provides valuable insight into patient journeys through the NSW health system. Learn more about Lumos here.
Alongside practice-level insights, Lumos data also informs CP-D program evaluation and quality improvement efforts.
To inquire about using Lumos, please email our Digital Health Team.
Eligible GP practices and ACCHSs can access the healthdirect Video Call platform at no cost to support healthcare delivery in rural and remote areas.
Powered by the COVIU system and managed by the WNSW PHN digital health team, this platform is secure, encrypted and compliant for many clinical consultations. The system:
To register a healthdirect Video Call account, please email our Digital Health Team.
The FWLHD’s Integrated Care Services has taken to the airwaves with a podcast to showcase the services on offer and introduce their team to the community. This has been a successful tool in promoting our services and engaging with members of our community.
Search ‘Far West of Centre’ on Spotify, Apple Podcasts, Google Podcasts, Castbox, Amazon Music, RadioPublic, iHeartRadio and Overcast today!
The Care Partnership – Diabetes program is a collaboration between the Western NSW Local Health District, the Far West Local Health District, the Western NSW Primary Health Network and Rural Doctors Networ
