Information for GPs and health professionals

The role of GP and health professionals

Helping people to understand the NDIS can be really important, particularly for those who have limited community connections and support. Health professionals are instrumental in:

  • referring people to information about who can access the NDIS
  • provide supporting evidence as part of an Access Request Form
  • documenting that the patient has or is likely to have a permanent disability and
  • providing copies of reports or assessments relevant to the diagnosis/condition to describe the extent of the functional impact of the disability

Working together

The NDIS can provide a significant source of support for people with disability. However, the NDIS is not intended to replace other health or other public services, which are the responsibility of state and territory governments. The health system remains responsible for clinical, rehabilitation and medical treatment of conditions – including GPs, surgery and rehabilitation.

Some examples of NDIS supports include disability related aids such as wheelchairs, prosthetics, home modifications, personal care and domestic assistance. For more information about supports that are generally funded by NDIS and those that are generally funded by other services, visit NDIS and other government services.

Accessing the NDIS

If a patient is already receiving disability support services from their state or territory government, they will be contacted by the National Disability Insurance Agency (NDIA) when the scheme becomes available in their area. If they are not currently receiving any disability supports, but wish to join the NDIS, they or their guardian (including carer or nominee) will need to complete an Access Request Form. This form can be obtained by contacting the NDIA on 1800 800 110.

To meet the criteria for accessing the NDIS, a person must:

  • meet residency requirements
  • be aged under 65 at the time they apply to access the Scheme
  • demonstrate they have a permanent disability that affects their everyday life.

How to provide evidence of disability

The evidence you supply to support an NDIS Access Request must relate to your patient’s primary disability which has the greatest impact on their life. In addition, any evidence relating to other disabilities that affect the patient and the impact they have on their functional capacity will be accepted.

It’s important to summarise the impact of the disability on the patient’s day-to-day function in all relevant domains, including: mobility, communication, social interaction, learning, self-care, and their ability to self-manage. You should also include information regarding treatments that have been completed or planned, and the permanency of the impairment.

This evidence will be considered against the legislative access criteria to make the access decision. For further information, visit Providing evidence of your disability.

How to bill when completing an Access Request Form for a patient

In providing evidence to support a person with a disability to make an Access Request, it is reasonable to expect GPs will perform an examination of some description to assess or confirm the patient’s current medical condition. With this examination, the time taken for GPs to assess and provide information to support an Access Request may be claimed under a Medicare item if it is part of the consultation.

Consistent with the operation of the Medicare Benefits Schedule, generally it is at a GP’s discretion to select the Medicare item number that most appropriately reflects the nature of the consultation. However, when a GP provides details about a patient without an associated consultation and without the patient present, a Medicare rebate is not payable under subsection 19(5) of the Health Insurance Act 1973.

NDIS partners

The NDIS has partnerships with Early Childhood Early Intervention (ECEI) and Local Area Coordination partners who employ Local Area Coordinators (LAC). ECEIs employ coordinators who help children and their families access supports and services that are tailored to the child’s needs. They also help children to connect with community health services, playgroups and other local activities. For individuals seven years and older, their main point of contact for the NDIS is an LAC. As with ECEI, LACs help a person to connect to supports, services and local activities. They also help them to understand the NDIS, and how to develop and use their NDIS plans. Find an ECEI or LAC partner in your area.

The role of GP and health professionals when directing patients

Although GPs are not required to make referrals, at times they may need to provide some direction and guidance about the steps required. These common scenarios will help you to understand the extent of your role as different situations present themselves.

This page current as of
12 February 2019