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Integrated care is about ensuring patients or clients get better care by coordinating the different services they receive.

We aim to:

  • assist Aboriginal and Torres Strait Islander peoples to access primary health care as required
  • provide care coordination services to eligible Aboriginal and Torres Strait Islander peoples with chronic disease/s who require multidisciplinary care
  • improve access for Aboriginal and Torres Strait Islander peoples to culturally appropriate mainstream primary care.

Integrated Team Care in the Hume Region is provided by a team consisting of an Indigenous Health Program Officer, Care Coordinator, and two outreach workers who work closely with patients, GPs, specialists, community services, and allied health professionals to improve patient health.


This service is available to all Gateway Health and other medical practice clients who identify as Aboriginal or Torres Strait Islander. We also support medical practices working with Aboriginal and Torres Strait Islander communities.

The service is provided free of charge, drawing on funds provided by the Department of Prime Minister and Cabinet.

Contact us for further information:

Note: To access the Care Coordinator a patient must:

  • be referred by their usual General Practice who is registered for the Indigenous Health Incentive
  • have a current Care Plan, either a GP Management Plan or a Team Care Arrangement outlining health needs
  • have complex eligible health needs which require support and assistance.

Priority is given to patients most in need.

The Integrated Team Care program combines the former Care Coordination and Supplementary Services (CCSS) and Improving Indigenous Access to Mainstream Primary Care (IIAMPC) programs. It recognises and builds on the success of both activities, and strengthens a team-based approach for the provision of coordinated, multidisciplinary care.

Last Update: December 12th, 2022