Integrated Team Care (ITC) is a Closing the Gap initiative commissioned by CESPHN to improve health outcomes for Aboriginal and Torres Strait Islander peoples living with chronic health conditions. The program provides culturally safe care coordination, outreach support, and access to supplementary services, helping clients navigate health systems, attend appointments, access allied health and specialist care, and strengthen self-management skills. Through collaboration with Aboriginal health services, GPs, hospitals, and community providers, ITC supports holistic, person-centred care and improved access to timely, coordinated healthcare.
Aboriginal health
658
Number of Clients supported
12873
Occasions of service
5338
Clinical Services
During 2025-26 the ITC program was delivered by Care Coordinators and Outreach Workers based within Sydney Local Health District, South Eastern Sydney Local Health District, and the Sydney Children’s Hospitals Network. The program provided personalised support to Aboriginal and Torres Strait Islander peoples, helping them to better understand and manage their health, access appropriate services, and navigate the healthcare system.
In addition to delivering the ITC program, we supported the establishment of a new general practice service, Gamay Health, operated under the management of the La Perouse Local Aboriginal Land Council. Currently operating one day per week, the service has plans for future expansion and accreditation. Gamay Health plays an important role in supporting community members to access the annual Medicare Benefits Schedule (MBS) Item 715 Aboriginal and Torres Strait Islander Health Assessment, facilitating preventive health screening, the development of General Practitioner (GP) Management Plans, and referrals to the ITC program and other specialist and allied health services where appropriate.
Throughout the year, we also continued to support the delivery of the Deadly Choices program across the CESPHN region. Deadly Choices delivers a range of community-focused, culturally informed, and strengths-based initiatives that empower First Nations peoples to make informed decisions about their health and wellbeing. Through its education program, delivered by a locally based Indigenous Program Coordinator from Cronulla Sharks NRL, in partnership with local high schools, Deadly Choices encourages young people and their families to engage with primary healthcare services and undertake comprehensive health assessments, supporting early intervention and preventive care.