General practitioner role in supporting access to the National Disability Insurance Scheme

The general practitioner (GP) can play an essential role in supporting a person to access the National Disability Insurance Scheme (NDIS).

In particular, the GP plays a key role in:

directing the person, family members and others supporting them to information about the NDIS including:
- who is eligible
- how to apply
- what supports are funded
- when a decision can be made by, with, or for an adult with significant cognitive disability; see Guide to NDIS decision making (see also Consent, capacity and decision making for people with developmental disability)
documenting evidence required by individuals seeking NDIS funding, or referring them to an appropriate specialist to provide that evidence; including:
- details of disability requirements
- evidence of disability
providing evidence required for an NDIS plan review—either a routine plan review, or when a review is required due to changes in the person’s circumstances (see Circumstances that require an NDIS plan review).

Figure 1. Circumstances that require an NDIS plan review.

[NB1]

Changes in a person’s function, for example:

a fall resulting in decreased mobility
deterioration of vision requiring access to specialist services for the visually impaired
age-related cognitive changes resulting in the need for higher levels of personal care support
progression of a neurological condition where decreasing function necessitates additional supports
development of, or escalation in, behaviours of concern requiring assessment and intervention.

Changes in personal circumstances or living situation, for example:

illness or incapacity in parents impacting on their ability to provide the care required for a child.

Note:

NDIS = National Disability Insurance Scheme

NB1: An NDIS plan review is intended to inform changes to an NDIS plan, such as type or amount of supports and services funded by the NDIS.

The Royal Australian College of General Practitioners (RACGP) NDIS information for General Practitioners outlines the NDIS access process and how to complete an Access Request form.

The NDIS website provides a list of practical resources for GPs and other health professionals.

Reports provided by medical practitioners to the NDIS must include the following information.

Impact of the disability on a person’s function—to determine a person’s support needs, the NDIS needs to understand how the disability impacts on their daily functioning. Daily functioning includes: communication; mobility; learning; personal care; domestic tasks (eg cooking, shopping); transport; social interaction and social participation; money handling and financial management; self-management, organisation and planning; education; employment.
The permanent (or otherwise) nature of the disability—the NDIS provides funding to support people with permanent and significant disability (except for children under the age of 7 years, where some differences in eligibility apply). If the disability is permanent, this should be explicitly stated.
The person’s prognosis—ie whether the disability is likely to improve, deteriorate or stay the same over time (eg months or years).

If an NDIS application has been rejected, it may be because the disability has not been fully understood, or the significance of the impairment to function may not be clear.

Some other useful links to information about the NDIS are listed in Some useful National Disability Insurance Scheme links.

Figure 2. Some useful National Disability Insurance Scheme links

Advocacy

To assist people to complete their NDIS application or challenge a decision about eligibility, see:

NDIS Quality and Safeguards Commission

Disability advocacy finder.

Complaints and feedback

To assist people to complain about disability services or support, or to provide feedback, see NDIS feedback and complaints.

To complain about quality of service or report abuse, neglect or exploitation, contact the NDIS Quality and Safeguards Commission.

Crisis response

NDIS Support Coordinators can advise on flexible use of funding to meet a person’s needs during a crisis and, if required, apply for urgent review of the person’s NDIS plan for extra funding for necessary supports.

Contact NDIS for urgent plan review. See also NDIS: Change in circumstances.

NDIS also provides information on general health crises that can affect participants (eg coronavirus); see latest advice from NDIS.

Decision reviews (information for participants)

For participants who want to review decisions made by NDIS, see here.

Note: NDIS = National Disability Insurance Scheme