ISML - Closing the Gap

Closing the Gap

Aboriginal and Torres Strait Islander people experience a burden of disease two-and-a-half times that of other Australians. A large part of the burden of disease is due to chronic diseases such as cardiovascular disease, diabetes, cancer, chronic respiratory disease and chronic kidney disease. This can be reduced by earlier identification, and management of risk factors and the disease itself.

Closing the Gap Program

In December 2007, the Council of Australian Governments (COAG) agreed to a partnership between all levels of government to work with Aboriginal and Torres Strait Islander communities to close the gap in Indigenous disadvantage.

Program Aim:

The aim of Closing the Gap - Improving Indigenous Access to Mainstream Primary Care Program - is to contribute to closing the gap in life expectancy by improving access to culturally sensitive primary care services for Indigenous Australians.

Program Objectives:

Increase access to mainstream primary care services by Aboriginal and Torres Strait Islander people;
Improve the capacity of general practice to deliver culturally sensitive primary care services;
Increase the uptake of Indigenous specific Medical Benefits Schedule (MBS) items, including Indigenous health checks and follow up items;
Support mainstream primary care services to encourage Indigenous Australians to self-identify;
Increase awareness and understanding of Closing the Gap measures relevant to mainstream primary care; and
Foster collaboration and support between mainstream primary care and the Indigenous health sectors.

Indigenous Health Incentives

The new PIP Indigenous Health Incentive (IHI), introduced in May 2010, will support general practices and Indigenous health services to provide better health care for Indigenous Australians. This includes best practice management of chronic disease.

To claim this incentive practices will need to be an accredited PIP practice, or be in the process of gaining accreditation, and agree to meet the specific sign-on requirements.

Link to sign-on requirements and payment information

Link to Cultural Awareness Training information

Changes to Medical Benefits Schedule (MBS) Items

From 1 May 2010, there are new Medicare Benefits Schedule (MBS) items that you will need to use to ensure your practice receives outcomes payments. The guidelines refer to these new MBS item numbers. The Aboriginal and Torres Strait Islander Health Check MBS items (704-710) will be combined into one new MBS item number (715). The review items, GP Management Plan (GPMP) MBS item 725 and the Team Care Arrangements (TCA) MBS item 727 will be combined into one new MBS item number 732.

Information about these and other changes are available at http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare_ATSI_mbsha_resource_kit

Aboriginal and Torres Strait Islander Health Checks

The MBS 715 Indigenous Health Check is for Aboriginal and Torres Strait Islander people. The time allowed between health checks is a minimum of 9 months. This allows flexibility during important life stages for children (such as the first few years of life), when more frequent health assessment activities are clinically indicated, and to track health changes occurring with ageing.

The aim of the health checks is to help ensure that Aboriginal and Torres Strait Islander people receive primary health care matched to their needs, by encouraging early detection, diagnosis and intervention for common and treatable conditions that cause considerable morbidity and early mortality.

The following health checks fall under the MBS 715 item number:

Child Health Check (0-14)
The Child Health Check is an annual service for children 0 to 14 years (inclusive).
Adult Health Check (15-54)
The Adult Health Check is an annual service for Aboriginal and Torres Strait Islander people aged between 15 and 54 years (inclusive).
Older Person’s Health Check (55+)
An annual health check is also available for Aboriginal and Torres Strait Islander people who are at least 55 years of age.

Indigenous Follow up Referral Form for Allied Health Services Asfter a MBS 715 Indigenous Health Check

Aboriginal or Torres Strait Islander patients with a health risk factor who have completed a MBS 715 Indigenous health check are eligible for up to 5 subsidised allied health visits and up to 10 free practice nurse or Aboriginal Health Worker visits every 12 months. This includes:

Waist circumference or weight outside desirable ranges
Impaired glucose tolerance
Current smoker
Excess alcohol intake
Elevated blood pressure or cholesterol
Physical inactivity or poor nutrition eg, low fruit and vegetable intake
Family history of type 2 diabetes and coronary heart disease

A referral form is available for use for this purpose, Click here

It is not the same form as used for allied health service referral under a Team Care Arrangement.

If you have any questions about MBS 715 Indigenous Health Checks please contact Practice Support on 4220 7600

PBS listings for Aboriginal and Torres Strait Islander people (Only)

To improve the capacity of the PBS to better meet the needs of Aboriginal and Torres Strait Islander people, the Pharmaceutical Benefits Advisory Committee evaluates and recommends the listings of medications specifically to help with their health needs. This list details all PBS items that are limited for prescription to Aboriginal and Torres Strait Islander people. PBS Information Sheet - Jan 2010

For more information contact This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

IDGP Closing the Gap Program Staff

Indigenous Outreach Worker

The Indigenous Outreach Worker works in a non-clinical role, to encourage and help local Aboriginal and Torres Strait Islander people make better use of available primary health care services.

A focus of the role will be to provide practical assistance to identified Indigenous people to attend general practice appointments and to access other health services as required, including follow up care, specialist services and community pharmacies.

Links will be established with local Indigenous communities to raise awareness of Closing The Gap initiatives and to encourage and support the increased use of mainstream primary care services.

Indigenous Health Project Officer

The Indigenous Health Project Officer works in partnership with local communities and other stakeholders to implement strategies to improve access to mainstream primary health care for Aboriginal and Torres Strait Islander people living in the Illawarra.

The role will provide information and support to general practices regarding Closing The Gap initiatives, including PIP and MBS items, that encourage quality chronic disease management for Indigenous patients.

The role also involves supporting general practices and other mainstream primary health care providers to deliver culturally appropriate health care to Aboriginal and Torres Strait Island people. They will co-ordinate the delivery of cultural awareness/safety training for general practices.

In2Health Aboriginal Medical Reception and Aboriginal Health Worker Traineeships - Generous Subsidies

In2Health Brochure - Medical Receptionist

In2Health AHW Information - Practice

Have you considered an Aboriginal or Torres Strait Islander trainee?

The Graduate School of Medicine and State Training Services and DEEWR have partnered with the Illawarra Shoalhaven Medicare Local to provide Illawarra general practices with an innovative local workforce solution.

Practices now have an exciting opportunity to recruit an Aboriginal administration or Aboriginal Health Worker trainee for a 12 month traineeship. Part time or full time, including mature age, Indigenous trainees have been trained in the first round of the program in April 2011 leading to a certificate III in Business Administration (Medical Reception) or a Certificate IIII Aboriginal Primary Health Care for employment in Illawarra general practices. Wage subsides of up to $10,000 are available!

For more information contact the Indigenous Health Project Officer on (02) 4220 7600

Recording Patient Eligibility for the PBS Co-Payment and IHI PIP

It is a requirement of the IHI PIP that General Practitioners record patient eligibility for the PBS Co-Payment Measure and IHI PIP in patient records. The following is required in patient records:

Offer OR Completion of a Healthcheck MBS item 715
Eligibility criteria such as:
-   Listing the patient's chronic condition/s and/or
-   Listing key health risk factors such as overweight or obesity, high blood pressure or cholesterol
-   Social issues that are likely to impact on a patient's eligibility to take their medications as prescribed such as
    overcrowding, loss of employment, or family crisis
Consent provided by the patient for PBS Co-Payment and IHI PIP

Use shortcuts to create eligibility comments in your practice software! For an example of Medical Director comment shortcuts click here.

Medical Specialists and PBS Co-Payment Measure

Medical specialists are eligible to annotate 'CTG' (Closing the Gap) prescriptions for eligible Aboriginal and Torres Strait Islander patients under the measure when they are:

Providing services at a non-remote (urban or rural) Indigenous Health Service; or
Treating an eligible patient that has been referred by a GP from a PIP Indigenous Health Incentive practice or participating Indigenous Health Service.

When referring eligible patients, GPs have been asked to indicate to the medical specialist that the patient is eligible to receive more affordable PBS medicines under the measure, and instructions on how to annotate PSB scripts.

For example, a GP may use the following words or similar in the referral:
"John Citizen is eligible for extra assistance with the cost of medicines. To ensure he is able to access this, please annotate the top of any prescriptions with the letters 'CTG' and initial or signature"

Please see the following fact sheet for more information, Medical Specialists Fact Sheet PBS Measure - March 2011

A specialist referral tempalatelte is available here.

$5000 and PNIP Funding for Aboriginal Health Workers too

From 1 January, general practices that employ an Aboriginal Health Worker will be entitled to a one off $5000 grant if they opt to become accredited.

Practices must also be registered for the Practice Nurse Incentive Program (PNIP). The PNIP can provide practices with up to $12,500 per annum where an Aboriginal Health Worker works at least 12 hours and 40 minutes a week.

This is in addition to receiving the PNIP to support your practice or enrolled nurses. Incentives are capped at 5 per practice - meaning that a maximum of $125,500 is available each year to support your team of nurse and Aboriginal Health Workers.

For practices to be eligible, their Aboriginal Health Worker must hold a certificate III or above in Aboriginal and Torres Strait Islander Health from a recognised institute such as TAFE or Aboriginal College - Call 1800 222 032 for a list of approved courses.

Additional support is also available for Aboriginal Medical Services and Aboriginal Community Controlled Health Services:

A rural loading of up to 50% based on the Australian Standard Geographic Classification - Remoteness Areas (ASGC-RA)
A loading for Aboriginal Medical Services and Aboriginal Community Controlled Health Services
In urban areas of workforce shortage services can employ an allied health professional such as a Physiotherapist, Dietician and Occupational Therapist, instead of, or in addition to, a practice nurse and / or Aboriginal Health Worker

For more information AGPN has provided a before and after PNIP document, available from, http://www.gpnsw.com.au/data/assets/pdf_file/0017/3950/Pre-and-Post-PNIP.pdf

Find out how much your practice is entitled to.

A PNIP Ready Rekoner is available online at www.medicare.gov.au. Click onto > For Health Professionals > Incentives and Allowances > Practice Nurse Incentive Program.

NEW! Medicare IHI PIP Practice Register for Aboriginal and Torres Strait Islander Communities

Medicare Australia will be seeking permission from practices to be part of an Indigenous Health Incentive (IHI) PIP practice register. An invitation letter will be sent to practices to opt in for the register and include the name, phone number and location of their practice.

The service aim's to help patients access a local IHI PIP registered practice. Patients will also benefit from this service when they are away from their regular practice area.

Medicare will only disclose basic practice contact details to assist patients find a local practice for their care and who is able to provide Closing the gap annotated scripts.

By participating in the register, your practice can contribute to improving access to primary healthcare for Aboriginal and Torres Strait Islander patients in our region.

For more information: Contact Medicare on PH: (02) 6124 6767.

Click on the following links for a copy of the invitation and authority form.