Public outpatient services in NSW are generally not provided to patients presenting with these conditions.

On this page

  1. Adult patients (aged 16 years or over)
  2. Paediatric patients (aged 0 to 15 years)

Adult patients (aged 16 years or over)

Presenting conditionOut of scope (not routinely provided)
Abdominal pain
  • Second opinions for conditions already seen by the same specialty.
  • Suspected cholelithiasis or cholecystitis: referral to upper gastrointestinal surgery may be indicated.
Cirrhosis (suspected or known) Nil out of scope criteria.
Concern for colorectal cancer (Rectal bleeding or Positive Faecal Occult Blood Test)
  • Completed colonoscopy with adequate bowel preparation in the last 2 years for the same symptoms: colonoscopy is not required if already performed in the last 2 years and findings were normal (i.e. no polyps) so long as there are no new symptoms or other indication for more frequent colonoscopy.
  • Fissure surgery: referral to colorectal surgery is indicated if medical therapy fails.
  • Haemorrhoid surgery or banding: referral to colorectal surgery is indicated if medical therapy fails.
  • Persistent but unchanged gastrointestinal symptoms previously investigated.
​Gastroenterology screening and surveillance

​Completed colonoscopy with adequate bowel preparation in the last 2 years for the same symptoms
Note: colonoscopy is not required if already performed in the last 2 years and findings were normal (i.e. no polyps) so long as there are no new symptoms or other indications  for more frequent colonoscopy.

Hepatocellular cancer (suspected or known) or liver lesion

Hepatocellular cancer surveillance (when indicated can be conducted in a primary care or specialist setting based on local practice)
Note: Cancer Council guidelines for more information).

Inflammatory bowel disease or irritable bowel syndrome (suspected or known) Nil out of scope criteria.​
Iron deficiency Normochromic, normocytic anaemia with normal iron studies or isolated low serum iron.    Note: Clinical monitoring within primary care for anaemia secondary to gynaecological, haematological or other causes. Consider faecal occult blood test. Refer to outpatient services if anaemia is progressive, faecal occult blood test is positive or if gastrointestinal symptoms emerge.
Liver dysfunction Fatty liver with normal liver function tests and Fibrosis-4 (FIB 4) score below 1.3 (meaning no significant fibrosis evident).
Upper gastrointestinal dysfunction
  • Belching.
  • Halitosis.

Paediatric patients (aged 0 to 15 years)

Presenting conditionOut of scope (not routinely provided)
Abdominal pain
  • Non-tertiary referrals for chronic abdominal pain without concerning features listed in the ‘Emergency’ and ‘Access and prioritisation’ criteria.
  • Second opinions for conditions already seen by the same specialty.
Altered bowel habit
  • Allergic colitis.
  • Non-tertiary referrals for chronic constipation and encopresis.
  • Positive stool multiplex PCR for infection.
  • Self-limiting diarrhoea < 6 weeks.
Coeliac disease Normal coeliac serology (regardless of HLA DQ2 or DQ8 typing).
Failure to thrive in the absence of specific gastrointestinal symptoms and negative coeliac serology Failure to thrive in the absence of specific gastrointestinal symptoms and negative coeliac serology.
Failure to thrive in the context of inadequate energy intake Failure to thrive in the context of inadequate energy intake: arrange for a paediatric dietitian referral for advice on nutrition support to optimise growth.
Gastrointestinal bleeding
  • Non-significant haematochezia (i.e. small, fresh rectal bleeding on wiping) responsive to trial of laxatives.
  • Thriving infant with minor rectal bleeding (i.e. food protein-induced allergic proctocolitis): referrals from paediatricians for allergic proctocolitis remain in-scope.
Helicobacter pylori infection in the absence of dyspeptic symptoms or unexplained iron deficiency anaemia Helicobacter pylori infection in the absence of dyspeptic symptoms or unexplained iron deficiency anaemia.
Inflammatory bowel disease (suspected or known) Bloody diarrhoea in the presence of bacterial infection found on stool multiplex PCR.
Liver dysfunction
  • Hepatitis A with no coagulopathy that is able to have follow-up in the community.
  • Sonographic fatty liver with normal liver function tests and normal liver and spleen size, in a child who has a weight and BMI > 85th centile as per age and sex appropriate centile chart: child would benefit from dietitian or weight management referral in the first instance.
Nutritional and weight concerns
  • Anaemia or iron deficiency secondary to haematological, renal, dietary, physiological or gynaecological cause.
  • Intentional weight loss or body dysmorphia.
  • Isolated low serum ferritin without anaemia, nutritional or weight concerns.
  • Normochromic, normocytic anaemia with normal iron studies.
  • Weight los​​s in the neonatal period: referral should be made to paediatrician.
Parasitic infection with blastocystis hominis and dientamoeba fragilis Parasitic infection with blastocystis hominis and dientamoeba fragili.
Rectal bleeding (small volume) in the setting of formed stools in an otherwise well child Rectal bleeding (small volume) in the setting of formed stools in an otherwise well child: consider 6-week trial of appropriate stool softener. If bleeding persists despite this trial, referral should be made.
Resolved iron deficiency with 3-month trial of adequate iron supplementation Resolved iron deficiency with 3-month trial of adequate iron supplementation (paediatric): consider coeliac screening and holotranscobalamin if unresolved.
Upper gastrointestinal dysfunction
  • < 4 weeks of vomiting.
  • Infantile reflux or colic.

Current as at: Thursday 14 November 2024
Contact page owner: System Purchasing