Care coordination needed for remote cervical cancer patients: RACGP

The RACGP has welcomed the recognition of GPs as ‘integral’ to the management of patients with cervical cancer but says more needs to be done to support patients in rural and remote areas.
 
In a submission to new clinical guidelines for the management of cervical cancer currently being developed by Cancer Council Australia and the University of Sydney, the college has also flagged gaps it worries may put patients at risk.
 
In the RACGP submission, Professor Mark Morgan, RACGP Expert Committee – Quality Care Chair, said while the college welcomes the guidelines’ recognition of GPs as ‘integral’ to multidisciplinary team care, ‘greater consideration could be given’ to the coordination of care in rural and remote areas.
 
‘Communication with referring GPs is often unclear or delayed, making appointment confirmation time-consuming, and referral services may underestimate the coordination and travel required,’ he wrote.
 
‘As a result, patients may be required to undertake multiple long-distance journeys over short timeframes for consultations, imaging, and treatment, where consolidation of appointments may be possible.’
 
Dr Magdalena Simonis, a GP with a special interest in women’s health, told newsGP that cervical cancer patients in rural and remote areas face ‘very long wait times’, and greater access disparity compared to patients in metropolitan areas.
 
‘And it’s not just making appointments, it’s actually getting there,’ she said.
 
‘In rural and remote parts of Australia, it’s about how women access those services, the time it takes, who can take them, who will bring them back home, who accesses the results?
 
‘A lot don’t have a regular GP, so where is that coordination of care when they don’t have a GP?
 
‘Sometimes they might have fly-in, fly-out doctors who manage that patient cohort, so continuity of care is definitely an ongoing concern.’
 
In the RACGP submission, Professor Morgan also flagged an absence of clarity in who would be responsible for patient recalls and reminders for repeat testing following a cervical cancer diagnosis, and the uploading of results to the National Cancer Screening Register.
 
Dr Simonis says a lack of care coordination for remote and rural people with cervical cancer is ‘exposing them to risk’.
 
This includes GPs not receiving confirmation of whether a referral had been followed through, nor having access to electronic health records that have only been recorded by a hospital, she said.
 
‘Coordination of care is the most neglected aspect of disease management,’ she said.
 
‘We might make the referral, but they’re left out there; we don’t have any confirmation [of an appointment].
 
‘We might receive confirmation from the hospital, certainly if you do it privately, but if you do it through the public system, we don’t necessarily receive the feedback from the hospital after the consultation and treatment.
 
‘We need very consistent communication between the end service and the GP, and we need to have the patient looped into that without the fragmentation, and we need clear follow-up protocols, and where they can access that care.’
 
The RACGP’s cervical cancer submission comes at a time when human papillomavirus (HPV) vaccination rates are falling, putting the goal of eliminating cervical cancer in Australia by 2035 at risk.
 
In 2025 there were an estimated 946 new cases of cervical cancer diagnosed, a slight drop from the 957 cases in 2021.
 
In November 2025 the Federal Government said it was still confident of meeting its cervical cancer elimination target, however, in its 2024–25 Annual Report, the Department of Health, Disability and Ageing reported a decline in HPV vaccination among 15-year-olds.
 
The 2024–25 HPV vaccination rates were 81.50% for females and 78.44% for males, down from the 2023–24 figures of 84.75% and 82.03% respectively, ‘indicating additional effort is required to meet the ≥90% coverage target by 2030’, the report states.
 
Dr Simonis says the Australian health system has ‘a lot of issues’ with vaccine hesitancy.
 
‘And the thing is that we’re seeing more and more of this steering away from general practice, where we actually have that relationship and that oversight, but there’s fragmentation,’ she said.
 
‘So, you don’t know what you’re not doing, because you’re not the only one doing it.’
 
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