Aboriginal people with a chronic disease can be referred to the IHSS by their GP for assistance with specialist appointments, transport, accommodation, and medical aids.

The Indigenous Health Support Service (IHSS)

The Indigenous Health Support Service commences on 1 November 2016.

What is the IHSS?

The IHSS has been contracted to implement the Commonwealth’s Integrated Team Care (ITC) program by Western NSW PHN. The ITC program aims to improve outcomes for Aboriginal people through better access to coordinated and multidisciplinary care, and improve access to culturally appropriate mainstream primary care services.

Who is eligible to be assisted by the IHSS?

Aboriginal or Torres Strait Islander people, including children, in the Western NSW PHN region who have a diagnosed chronic condition, are enrolled for chronic disease management in a general practice or AMS, have a GP management plan in place and are referred by their GP. GPs are encouraged to provide an eligible patient with a Medicare care plan such as, but not limited to, a ATSI health check (MBS item 715), GPMP (MBS item 721) and/or Team Care Arrangements (MBS item 723).

How will the IHSS work?

Operating as a brokerage service, the IHSS will introduce its service to all of the General Practices in western NSW who care for Aboriginal people. A central 1800# (1800 940 757) and a direct email contact for care coordinators (CC) will be communicated to all mainstream general practices and AMSs. Any practice with an Aboriginal client eligible for the service can make contact with the relevant CC. The CC will discuss the needs of the client with the referring practice and the client, and put plans in place to address these needs (e.g. assist in completion of necessary paperwork, arranging payment of specialist gap fees, arranging travel and accommodation logistics around a specialist appointment, organising local transport). Depending on the circumstances, follow-up arrangements may or may not involve the local AMS, if there is one. The support provided would be communicated back to the referring GP. The IHSS will make the payments required either on receipt of an invoice from the specialist service or up front where that was required e.g. accommodation and transport.

An example may help:

Client X attends GP Dr Y for diabetes care. The client is not compliant with his medication, has not seen an endocrinologist for 2 years or had any complication screening done. While Dr Y has given the client referrals, he has not attended the appointments.

-> Dr Y will make contact with the local CC via 1800 940 757. He will follow-up by sending the GP management plan and indicating those aspects of the plan that are most urgent. In the described case this might include referrals to an endocrinologist, podiatrist, ophthalmologist/optometrist and pharmacist for HMR. The CC will identify some referral options both within or outside the AMS, recognising different patient preferences, and then make contact with the closest AMS and arrange for someone to make contact with the client and go and see him and explain what is required and what supports are available. Appointments will be made, transport arranged, gap payments made if required. Feedback will be provided to the GP for the client’s medical record. Any costs incurred by the AMS will be reimbursed by the brokerage service.

Are medical aids available?

  • The IHSS can also fund the cost of medical aids such as
  • Dose administration aids
  • Assistive breathing equipment (e.g. asthma spacers, nebulisers, CPAP machines and accessories for CPAP machines)
  • Blood sugar/glucose monitoring equipment
  • Medical footware prescribed and fitted by a podiatrist
  • Spectacles

Where these are not available through any other program in a clinically acceptable timeframe and where the need is documented in the client’s care plan.

Will this mean the IHSS will become the client’s primary care provider?

NO. The IHSS is a brokerage service, not a parallel clinical service. The IHSS will liaise between the client’s primary care provider (e.g. general practice or AMS), the client and the service they need and provide information back to the client’s primary care provider. The IHSS will facilitate the client receiving the care that is deemed necessary by their GP according to their care plan.

Will the IHSS pay for all the services that the GP refers a client to?

A flexible funding pool (Supplementary Services) is available to IHSS CCs to expedite patient access to urgent and essential allied health or specialist services, certain medical aids and transport to services. The IHSS will be following the Commonwealth’s guidelines regarding ITC and care coordination and supplementary services available at:

Accessible IAHP Programme Guidelines (opens in new tab) 

More information regarding patient eligibility, travel, medical aids, other services, gap payments and care plans is available at:

ITC Frequently Asked Questions (opens in new tab)

Marrabinya IHSS More Information (opens in new tab)

Marrabinya IHSS Referral Form (opens in new tab)

What are the arrangements for patient care from 1st November, to ensure continuity?

IHSS will work with eligible patients and their GPs to ensure continuity of care for any existing patient arrangements and appointments that have been made by Marathon Health or ODGP in the time period beyond 1 November.

Will the IHSS be recruiting for the new roles?

IHSS will shortly begin the recruitment process for the IHSS staff. IHSS will be working with current providers Marathon Health and ODGP to develop a transition plan for patients, and service continuity from 1 November. This will include plans for patients who need arrangements made in September and October, for services after 1 November.


How to make contact with the IHSS:
Email inquiries to: indigenoushealthsupportservice@maarima.com.au
Phone: 1800 940 757
Fax: 08 8082 9889