Aboriginal and Torres Strait Islander health

One of seven priorities set by the Australian Government is for Primary Health Networks (PHN) to focus on the health of Aboriginal and Torres Strait Islander peoples, through a strengthened primary healthcare model of care and preventive healthcare assessments.

Culturally safe, person, family and community-centred care lie at the heart of good Aboriginal and Torres Strait Islander health care.

Local services for Aboriginal people

Providers can access the following services to support their delivery of culturally appropriate primary health care for Aboriginal people.

  • Dandenong and District Aborigines Co-operative Ltd. (DDACL), including the Bunurong Health Service, is the key local Aboriginal Controlled health organisation.
  • DDACL have a range of specialised services and programs for the Aboriginal community.
  • Ngwala Willumbong is also local Aboriginal Community Controlled Organisation. Ngwala Willumbong delivers alcohol and drug residential rehabilitation and outreach support services.
  • Bunjilwarra is a Koori youth alcohol and drug healing service, located on the Mornington Peninsula, for those people drug-free and ready to address addiction management goals.
  • First Peoples' Health and Wellbeing is an Aboriginal community controlled health service aiming to improve access to affordable primary health care in urban Melbourne. 

Aboriginal Health Liaisons and services exist within the local health networks:

Aboriginal gathering places strengthen communities through sharing cultural heritage, and participation in health, recreation and social activities. They are also a resource for the broader Australian community to learn and connect. Gathering places are established in Hastings, Frankston, Doveton and Mordialloc.


Practice Incentive Payments (PIP)

The PIP Indigenous Health Incentive supports general practices to provide better health care for Aboriginal people, including best practice management for those with, or at risk of chronic disease.

Closing the Gap (CTG)

The CTG PBS Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders living with, or at risk of, chronic disease.

Read more about the CTG PBS co-payment measure.
Click here for CTG education.

Medicare Benefits Scheme (MBS)

Aboriginal Health Council SA provides information and support in the use of the Medicare Benefits Schedule (MBS).

View the Medicare Cheat Sheet.

Integrated Team Care (ITC)

ITC supports Aboriginal and/or Torres Strait Islander people with chronic disease to access specialist, GP and allied health services. 

ITC includes care coordination and supplementary services which has two main components:

  • Care coordination is provided by a qualified healthcare worker to Aboriginal and Torres Strait Islander people with a chronic disease. Patients will be referred by their GP from a general practice participating in the Practice Incentives Program (PIP) Indigenous Health Incentive.

  • Supplementary services refers to a flexible funding pool available to the care coordinator to assist patients to access urgent or essential health services. The funds can be used to improve access to specialist and allied health services that are in accordance with the patient’s care plan.

Who is eligible

  • Aboriginal and/or Torres Strait Islander people who have a chronic disease, have a current GP Management plan (GPMP) and Team Care Arrangements (TCA)
  • Those living in Bayside, Cardinia, Casey, Frankston, Glen Eira, Greater Dandenong, Kingston, Mornington Peninsula, Port Phillip, or Stonnington LGAs.

As a guide, patients most likely to benefit from the service include:

  • Patients who are at greatest risk of experiencing otherwise avoidable (lengthy and/or frequent) hospital admissions;
  • Patients at risk of inappropriate use of services, such as hospital emergency presentations;
  • Patients not using community based services appropriately or at all;
  • Patients who need help to overcome barriers to access services
  • Patients who require more intensive care coordination than is currently able to be provided by General Practice or Aboriginal Health Service staff; 
  • Patients who are unable to manage a mix of multiple community-based services

SEMPHN commissioned Star Health and the Dandenong and District Aborigines Co-operative Limited (DDACL) to develop, implement and administer the ITC program until 30 June 2022.

For more information, This email address is being protected from spambots. You need JavaScript enabled to view it. Caroline, Indigenous Health Project Officer (IHPO) Coordinator.

Click here to view the ITC brochure.
Click here to view the ITC GP Fact Sheet

How to refer:

Ask for an ITC Care Coordinator at

  • Star Health: 9066 1567
  • Bunurong Health Service (DDACL): 03 8902 9700
  • Peninsula Health: Intake Access 1300 665 781

Read more about Commissioning of Aboriginal and Torres Strait Islander health services.

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Contact Information

Need help?

For General Practice support, please call 1300 331 981 (option 2) or email providersupport@semphn.org.au

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