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Quality Improvement Initiatives

Below is a list of programs that we are currently recruiting for. As new programs become available, they will be added to this list. This will provide your practice with the opportunity to focus on different areas of quality improvement that suit your interests.

QI Programs available to practices include:


CareMonitor is a shared care management and real time remote monitoring platform with telehealth capability linking healthcare providers with patients.

The value of CareMonitor is that it combines many key aspects in a General Practice's clinical service:

  • Team Based care whether referring to in house or external allied health professionals
  • Built in Teleconsult and Text Messaging
  • Rural and Remote care (cloud based)
  • Monitoring and evaluation of patients (PIP-QI) - remotely
  • A Mobile App to involve the patient
  • Send patients questionnaires and monitor responses
  • Identifies patients at risk and can avoid preventable hospitalisations.
  • Integrates with Best Practice, Medical Director, Genie and Zedmed

Interested in CareMonitor?

If your practice would like to submit an expression of interest about using CareMonitor please complete the form.

This EOI form should only be completed by the person wishing to register their interest in Care Monitor or to receive further information:


Register your EOI now for Winter Strategy 2021

Program Objective: 

To support general practices to improve the management of patients with chronic conditions, at risk of hospitalisation, to stay as well as possible and manage their conditions better and stay at home during the winter months.

Why have a Winter Strategy?

To keep our most vulnerable patients well in the community and reduce their likelihood of being hospitalised over winter.

If you are interested in joining our Winter Strategy Program for 2021 (which will run from February to November) please fill in the below expressions of interest form.

Register your EOI now for Cancer Screening 2021

Did you know?

  • People with breast, cervical and bowel cancers detected through national cancer screening programs have better cancer survival outcomes than those diagnosed who had never been screened (AIHW)
  • 6 out of 10 eligible people are not participating in the National Bowel Cancer Screening Program (CINSW)
  • 40% of eligible women are overdue for a screening mammogram (CINSW)

Cancer Screening rates need to be improved. Patients who are reminded by their GP to attend cancer screening are more likely to screen (CINSW)

Join our Cancer Screening Quality Improvement Initiative which will run in 2021. This program will help practices improve cancer screening rates.

Fill in the below form to express you interest in this initiative.

Register your EOI for next COPD Collaborative Wave

Did you know that COPD has remained the leading cause of potentially preventable hospitalisations since 2015, with 1,344 potentially preventable hospitalisations in the Nepean Blue Mountains region in 2016-17?

The COPD Collaborative aims to reduce the number of hospital admissions in our region and will focus on improving the quality of life and wellbeing of people living with COPD. Complete the expression of interest form for the next COPD Collaborative Wave.

Register your EOI for next LUMOS Wave

In our current Health System, it is difficult to profile how a person interacts with the health system.
As GPs, sometimes you have a limited view of your patients’ journey across the health system and you may feel like you are managing in the dark.
LUMOS is a new partnership initiative between the NBMPHN and NSW Health to assist practices to gain a greater understanding of their patients journey across the health system. LUMOS is a program that securely links encoded data from general practices to other health data in NSW, including hospital, emergency department, mortality and others
LUMOS sheds light on your patients journey through NSW health system and reduces the risk of potentially preventable ED presentations.
LUMOS has the benefits to allow you to gain an unprecedented understanding of your patients and how they are interacting with the health system, bringing the patient journey to light.
Dr Walid Jammal from Hills Family General Practice shared his thoughts on why he become involved with LUMOS

"All GPs and staff in general practices strive to achieve the goal of patient centred, whole person, integrated and coordinated care. Achieving this goal is hindered by systemic issues such as lack of information from the world outside of general practice, thereby hampering your ability to manage and understand the health of your patient population. Integration and linkage of information is one tool designed to overcome this".

If you are interested to learn more about this initiative please contact Catherine Scardilli - Primary Care Quality Improvement Manager on 4708 8173.

Winter Strategy, Cancer Screening and LUMOS EOI Form 

QI initiative you are interested in:*:

Nominated Primary Contact 

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