Closing the Gap - Integrated Team Care


In 2008 the Council of Australian Governments (COAG) agreed to a $1.6 billion National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes to fund a broad package of initiatives addressing the target of closing the life expectancy gap within a generation.

One element of the package has involved engaging GP Networks and from 1 July 2012 Medicare Locals to deliver the Closing the Gap - Improving Indigenous Access to Mainstream Primary Care Program. The aim of this program is to contribute to closing the gap in life expectancy by improving access to culturally sensitive primary care services for Aboriginal Australians.

Primary care services have been identified as generally being a first point of contact for health services in Australia. However, cultural barriers have historically limited access by Aboriginal people. According to 2006 Census figures the area serviced by us is home to approximately 11,500 Aboriginal Australians. Within our region there are several Aboriginal specific health services, however as part of increasing the options for local Aboriginal people and ultimately improving health outcomes CESPHN encourages all mainstream general practices to provide culturally appropriate services.

From 2016-17, the Improving Indigenous Access to Mainstream Primary Care (IIAMPC) activities and the Care Coordination and Supplementary Services (CCSS) have been combined to form the Integrated Team Care (ITC) Activity.

The ITC Activity builds on the formal evaluations of the CCSS and IIAMPC which highlighted the benefit of integrated Indigenous health teams. ITC formalises this team approach so that patients will be supported across the full pathway of care, from encouragement and assistance to accessing health care through to provision of multidisciplinary care. The combined Activity allows greater flexibility to tailor the mix of workforce positions within Indigenous health teams.

ITC provides the opportunity for PHNs to develop flexible approaches to improve Aboriginal and Torres Strait Islander people’s access to high quality, culturally appropriate health care, including care coordination services. It will allow PHNs to develop innovative approaches that best meet local needs through the commissioning process.

The ITC Program is funded by the Department of Health.

Program objectives

(source: Department of Health and Ageing Version 1.1 March 2010)

The aims of the ITC Activity are to:

  • contribute to improving health outcomes for Aboriginal and Torres Strait Islander people with chronic health conditions through better access to coordinated and multidisciplinary care; and
  • contribute to closing the gap in life expectancy by improved access to culturally appropriate mainstream primary care services (including but not limited to general practice, allied health and specialists) for Aboriginal and Torres Strait Islander people.

The objectives are to:

  • achieve better treatment and management of chronic conditions for Aboriginal and Torres Strait Islander people, through better access to the required services and better care coordination and provision of supplementary services;
  • foster collaboration and support between the mainstream primary care and the Aboriginal and Torres Strait Islander health sectors;
  • improve the capacity of mainstream primary care services to deliver culturally appropriate services to Aboriginal and Torres Strait Islander people;
  • increase the uptake of Aboriginal and Torres Strait Islander specific Medicare Benefits Schedule (MBS) items, including Health Assessments for Aboriginal and Torres Strait Islander people and follow up items; support mainstream primary care services to encourage Aboriginal and Torres Strait Islander people to self-identify; and
  • increase awareness and understanding of measures relevant to mainstream primary care.


We have several activities planned to meet the above objectives, which will be tailored to meet local needs.

These involve:

  • promotion of the Program to community organisations through a range of methods.
  • collaborating with Aboriginal health organisations to identify and address barriers to Aboriginal Australians accessing primary care services.
  • promoting general practice as a valid, trustworthy and accessible first point of contact for Aboriginal health needs.
  • assisting general practice to manage specific Aboriginal health needs and issues at the local level.
  • providing support to general practices on methods to encourage Aboriginal Australians to self-identify when accessing primary care services.
  • coordinating education events for general practitioners and practice staff, including cultural awareness training and quality improvement activities.
  • developing and disseminating information resources for Aboriginal Australians.

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