GPCanShare Cancer Management Service Application Form

The GPCanShare model is a collaboration between CESPHN and the cancer centres of SLHD, SESLHD and St Vincent's Health Network. It involves shared management of a patient with cancer between the specialist services and general practitioner (GP). GPs will be supported by an integrated nurse coordinator to manage their patient in accordance with their cancer centre care plan.

The below cancer centres are involved in the GPCanShare model:
  • The Kinghorn Cancer Centre 
  • Concord Repatriation General Hospital 
  • Royal Prince Alfred Hospital 
  • Sydney Local Health District cancer facilities 
  • St George and Sutherland Hospital 
  • Prince of Wales Hospital
GPs wanting to register for the GPCanShare model are required to complete this form. Registered GPs will be contacted by the relevant integrated nurse coordinator to discuss their needs and relevant patient/s.
CESPHN Privacy Statement
As part of the GPCanShare Program, CESPHN collects GP information (including GP name, gender, languages spoken and general practices address, phone, fax). This information is forwarded to the cancer clinic integrated nurse coordinators to facilitate GP participation in the program. Additional HP information including mobile phone and email address may be forwarded to the Integrated GP Nurse Liaison Nurse to assist with program participation. The National Privacy Principles and Privacy Act prohibit us from releasing this information without your prior consent which is requested in this form.
CESPHN will manage your data in line with our Privacy Policy, which complies with the Privacy Act 1988 (Cth) and the Health Records and Information Privacy Act 2002 (NSW).
If you have any questions about out privacy policy, please contact CESPHN’s Privacy Officer –

GP status

Cancer patient status

Contact information

Organisation information

Additional contact (optional)
We appreciate the demands and availability of GPs so if appropriate please provide details of a practice nurse/manager who is willing to facilitate the link to the integrated nurse coordinator if you are unavailable when contacted.