Integrated Team Care



For more information, please download our ITC brochure - Integrated Team Care (ITC)

What is Integrated Team Care?

Integrated Team Care (ITC) is a program that supports you to better manage your Chronic condition.

Am I eligible for ITC?

  • If you identify as Aboriginal and/or Torres Strait Islander.
  • If you have one or more diagnosed Chronic conditions.
  • Your doctor has done a GP Management Plan (GPMP).

What is a GP Management Plan?

A GPMP is completed for people with Chronic health conditions who require team-based care from a GP and other health or care providers. Moorditj Koorts ITC team work with you and your GP to access different services identified in your GPMP.

What are the benefits of ITC?

Personalised support and services that make a real difference to the way you manage your chronic condition.

  • Access to specialist and allied health services.
  • Increase cultural safety of mainstream health care services.
  • Support mainstream services to help Aboriginal people to self identify.
  • Financial Assistance with Specialist consultations, access to medical aids e.g. blood sugar monitors, prescription glasses, CPAP machine etc.

What do you do now?

Get your regular doctor to complete a GPMP & ITC referral form.

  • Your doctor will then send these documents to Moorditj Koort.
  • Moorditj Koort will contact you once we receive this information.

Who is part of the ITC Team?

Our ITC team consists of qualified Aboriginal health workers with local knowledge and networks throughout the community. 

Care Coordinators

  • Attend and advocate on your behalf at medical appointments.
  • Arrange allied health appointments and/or referrals for you.
  • Organize regular GP visits.
  • Work with pharmacies to ensure your medication is up to date.
  • Liaise with GPs around your Care Plan.

Outreach Officers

  • Transport you to and from medical appointments (subject to availability and eligibility).
  • Liaise with health providers.
  • Support you by attending your medical appointments as required.
  • Collect and deliver prescriptions.
  • Help with paperwork at appointments.