Integrated Team Care program
Provides Aboriginal and Torres Strait Islander patients who have one or more chronic condition with a dedicated care coordinator to work closely with them and their care team, as part of ongoing care.
Eligibility criteria
For Aboriginal and Torres Strait Islander people with:
- with one or more chronic conditions
- are of any age, including children with early onset of chronic conditions
- a current GPMP with or without TCA
- are at risk of hospital admission due to their ill health
- have trouble accessing and using the right services for their care
- have trouble managing multiple services and appointments.
Referrals
Referrals can be sent to the preferred provider in your area:
Wollongong
Nowra
- Grand Pacific Health
- South Coast Medical Service Aboriginal Corporation
- Waminda – South Coast Women’s Hetalh and Wellbeing Aboriginal Corporation
A GP Management Plan (GPMP) is required to access ITC. For referrals to a local AMS please ensure the GPMP is not completed at your practice. The AMS will complete the GPMP and enrol your patient into ITC. If the GPMP is completed at your practice the patient will not be able to access ITC via the AMS.
For referrals to GPH, please complete the referral form and send to the Intake Coordinator along with a Aboriginal and Torres Strait Islander Health Assessment (MBS 715) and GPMP. Ensure to include the care coordinator as part of the GPMP/TCA.
Visit HealthPathways for further detailed information.
