Diabetes and endocrine presentations out of scope

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

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

Adult patients (aged 16 years or over)

Presenting condition	Out of scope (not routinely provided) criteria
Gestational diabetes	Nil out of scope criteria
Other diabetes mellitus types	Prediabetes, obesity or metabolic syndrome without diabetes
Type 1 diabetes	Private driver's licence holders who require a new or renewed conditional licence Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input Routine podiatry care, including annual diabetes-related neurovascular foot assessment
Type 2 diabetes	Prediabetes care Private driver's licence holders who require a new or renewed conditional licence Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input Routine care or ongoing review for uncomplicated type 2 diabetes, including, but not limited to: Routine podiatry care, including annual diabetes-related neurovascular foot assessment Routine clinical psychology care Routine medical nutrition therapy Routine diabetes education Note: these services can be subsidised by the five (5) allied health services accessible through a General Practitioner Chronic Condition Management Plan (GPCCMP). Get Healthy Service is also available for free health coaching to reach healthy eating and active living goals. Stable, well-controlled type 2 diabetes where HbA1c is at individualised target without undue risk of hypoglycaemia Stable, well-controlled type 2 diabetes where referral is solely for weight loss Severe clinical obesity seeking access to bariatric surgery Note: exception is referral to a specific obesity management service Note: refer to your local HealthPathways for more information on specific services and models of care available within your respective region
Adrenal disorders	Unexplained fatigue without an endocrine disorder
Osteoporosis and metabolic bone disease	Acute fracture requiring orthopaedic intervention Loss of height without further investigation Note: in line with RACGP guidelines, patients with asymptomatic loss of height should be referred for a vertebral x-ray to assess for a vertebral fracture Low fracture risk (low risk on fracture risk calculator; e.g. FRAX or Garvan Fracture Risk Calculator) and no history of minimal trauma fracture Note: consider using the Healthy Bones Australia – Osteoporosis Risk Assessment, Diagnosis and Management flow chart Pathological fracture due to known malignancy (e.g. secondary to metastatic bone disease) Note: referral to treating cancer specialist or emergency department, as appropriate, is indicated Recurrent falls without fracture Note: referral to falls prevention program or appropriate speciality (e.g. neurology, geriatric medicine) Secondary fracture prevention where osteoporosis is suspected Note: consider referral to Osteoporotic Refracture Prevention service, where available Severe bone pain or deformity related to osteoarthritis or inflammatory arthritis
Pituitary disorders	Unexplained fatigue without an endocrine disorder
Thyroid and parathyroid disorders	Asymptomatic, stable thyroid nodule(s) which are classified as benign by ultrasound (ACR TR 1-2) or by combination of low-risk ultrasound (ACR TR 1-4) and biopsy (Bethesda Category II) Mildly elevated parathyroid hormone levels with normal serum calcium levels Unexplained fatigue without an endocrine disorder Uncomplicated primary hypothyroidism, including sub-clinical hypothyroidism in the absence of pregnancy or pregnancy planning

Paediatric patients (aged 0 to 15 years)

Presenting condition	Out of scope (not routinely provided) criteria
Type 1 diabetes	Nil out of scope criteria
Type 2 diabetes	Nil out of scope criteria
Adrenal disorders	Nil out of scope criteria
Calcium and bone disorders	Normocalcaemic hyperparathyroidism or hypoparathyroidism with normal calcium, phosphate and magnesium Simple vitamin D deficiency or vitamin D deficiency without significant bowing of limbs or other nutritional deficiencies Note: referral to a general paediatric outpatient service is indicated
Growth disorders	Height > 1st percentile with normal growth (i.e. growth in line with familial potential or normal growth velocity over 6-12 months) Simple obesity (BMI ≥ 95th percentile for age and sex)
Pituitary disorders	Nil out of scope criteria
Pubertal disorders	Presence of fine downy and non-pigmented short hair (i.e. not considered secondary sexual pubic hair) in the supra pubic area or generalised hypertrichosis without other features of puberty
Thyroid disorders	Positive antibodies in setting of normal thyroid hormone levels Sub-clinical hypothyroidism as indicated by thyroid stimulating hormone (TSH) levels between 5-10 mU/L, normal thyroxine (T4) and no goitre Trisomy 21 with mildly elevated TSH levels (i.e. hyperthyrotropinaemia) and normal free thyroxine (fT4) Note: these patients should already be under the care of a general paediatrician

Current as at: Monday 23 March 2026

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