Integrated Team Care (ITC) Program – Transition Webinar – Updates and Next Steps

Hello everyone. I might just wait a little minute. I can see there's a few more people popping in now, so I'll just give it a little minute and wait for a few more people to join. It's only one past, so I feel like that's within the bounds of good timing.

Thank you everyone for joining us today. I know it's quite early in WA, so I appreciate you doing this first thing. Celia, if you have a question, just type it into the chat and one of my team will get back to you.

We are going to have a Q&A at the end, but if you've got some, you know, administrative things, just type in the chat and someone will sort you out.

ITC Team Member:
The chat is turned off, it’s in the Q&A function.

Mel Beacroft:
Oh, it's in the Q&A function. Okay, my apologies Celia, you type in the Q&A function. I'm learning something.

Well, we've got lots of people online and I can see a keen bean in the bottom of my screen there in their car, which is very keen. So, thank you so much for joining. I want to welcome everyone today to the Integrated Team Care (ITC) transition webinar. I know this has been coming for some time, so I appreciate your patience as we put things together. To start, I want to acknowledge that I'm here with my team on Ngunnawal country. I want to recognise Aboriginal and Torres Strait Islander peoples continuing connection to land, sea, waterways and skies. I want to acknowledge the lands on which you are all dialling in from and recognise and pay my respects to all Aboriginal people here on the call today.

So first…I might do some introductions. For anyone who doesn't know me, my name's Mel Beacroft. I work here at the Department of Health, Disability and Ageing and I look after the Integrated Team Care. I want to say a big hello to my boss, Thomas Lester, who will wave to you, who is the Assistant Secretary in First Nations Health Division of the Family Chronic Disease and Preventative Health Branch. I've also got a bunch of my team here today, Leanne, Cass, Casey and Lani and they will be helping me, a bit later on with the Q&A function.

To start us off, I wanted to talk about the purpose of today's meeting. As you know, we recognise that there has been quite a bit of uncertainty about the timeframes for transition of the ITC program and what the future program might look like. We've been working really hard to improve our communications and to be transparent throughout the process. So, we have been trying to send out more regular emails and I know a lot of you reach out to us and ask questions of the team, which is great. Today's session, I'm hoping will provide you with a bit more clarity around the transition process and what we think is hopefully a clearer path forward.

For some housekeeping, you can see that the session is being recorded. The session and a transcription will be made available afterwards, along with a range of resources and fact sheets etc., that you can share with your teams. Transcription means that there'll be a bit of a delay in terms of us putting it up on the website. I can assure you that the team will be madly sorting that out over the course of the next week. Please bear with us while the webinar appears on the website, but for anyone in your team that misses it and they want to see my lovely face, then they'll be able to watch later. We'll let you know by e-mail when it's up and available. That will include the slides as part of the webinar. Obviously, we encourage your participation. We have muted the mics for today just because there's so many participants. There will be a substantial period of time at the end for you to ask questions and we'll do our best to answer them and provide any clarification on anything that's unclear. We've enabled the Q&A function and we encourage you to submit your questions that way.

My team will be monitoring that. So please make if you see a question that you like and you think, yeah, I want to ask that too, please use the upvote buttons rather than the thumbs up. So upvote - because the most popular questions are obviously the ones that you want to hear about. So don't forget upvote questions but we'll get to those at the end.

So… I think we're going to just do a bit of a general update on ITC. So, I'm going to hand over to Leanne.

Leanne Giannini:
Hello everyone. Firstly, we'd like to thank you all for your patience while the team have been continuing to progress work behind the scenes to lay the groundwork for this ITC transition. Mel always likes to refer to us as ducks paddling madly underwater. So that's kind of how it's been.

We'd like to acknowledge those of you who've so willingly engaged with us over the past 12 months or so. It's been hugely beneficial to us to have those insights into the realities of commissioning and delivering services on the ground, and the conversations have helped to inform both the ITC data analytics project and the proposed approach to transition that we'll share with you today.

Since the release of the of the review that Ninti One undertook, we've made a lot of progress on the path forwards. We want to take this opportunity to share that with you and any updates. Just to give you a bit of an overview of what we've been doing over the past 12 months. The team have continued our engagement efforts. We've spoken to many of you both informally and formally. We've compiled a distribution list of 650+ stakeholders. So hopefully all of you are on that and that's why you're here today. That includes PHNS, ACCHOs, all the service providers, peak bodies and other interested parties. We've endeavoured to keep you all updated through our monthly updates and we've consulted directly in what we think is probably over 40 engagements, but probably more. And since March 2024 we've attended more than 10 joint forums with PHN and ITC providers and hosted a PHN Roundtable and we did the webinar at the end of last year that many of you probably attended. We kicked off the ITC Data Analytics project, which I'll provide a bit more info about in a moment, and continued all of the program BAU [business as usual] including the extension of funding for this financial year.

On that data analytics project that I referenced, work is now well underway. We've engaged Ember Advisors who are leading this work and they're collaborating closely with us and our working group members to ensure that the outputs of the project is grounded in sector perspectives and fit for purpose. The aim of this work is to develop a more responsive, equitable and evidence-informed funding distribution model for the program. It will consider the First Nations chronic disease burden, socioeconomic factors, cost pressures and the cost of commissioning and capacity building functions. Secondly, the work will provide us with an estimate of unmet need, which will provide us with a bit of an evidence base to support the department in future funding bids.

We’ve shared in the monthly update…we've established a working group which I referenced. It's co-chaired with NACCHO and that will inform and guide this work. We've already had a lot of valuable input and perspectives from the members, and it's helped to shape the project outputs and it will ensure that those outputs are really grounded in the realities of commissioning and delivering ITC on the ground. So, that group has met twice to date and will continue to meet through to the end of the year.

The Ember Advisors team have delivered us with some preliminary data and findings which has provided some really interesting early insights. We know that there's widespread unmet demand for ITC services, which I'm sure won't come as a surprise to many of you. There are high levels of variability in service delivery models - cost of service delivery, approach to program management and approaches to manage funding to achieve health outcomes for clients accessing the program. This is an outcome of the flexible model for ITC and it's really interesting to see how differently the guidelines have been interpreted across the country and we're hoping that we'll share those outputs with you from the project once it concludes, which will be at the end of the year. We think that data will open some really interesting and productive discussions so that we can gain insights about the differing delivery models and open up a dialogue about how to best meet local needs through this program.

So that's all from me for the updates, and we'll continue to share future updates through our monthly emails. Thank you.

Mel Beacroft:
Thanks, Leanne.

Transition - To help us to find what a successful transition looks like for ITC, we developed a mission statement which has really helped to keep us on track. It's helped us keep one eye on the end goal and enabled us to make sure that everything we've done has this goal in mind. You can see here that we've developed…our mission as we like to think about it is to embed First Nations leadership in the ITC program design and delivery, ensuring communities are empowered to determine how ITC is delivered in PHN regions while maintaining continuity, cultural safety and equity in outcomes for all ITC clients and staff.

What you'll notice about this mission statement is that transition signifies more than just a financial or administrative change. What we're really concerned with for the transition of ITC is a shift in power, placing First Nations leadership and community voices at the centre of decision-making and delivery.

Self-determination means that communities have the authority to decide how services are delivered, whether through First Nations organisations or in partnership with mainstream providers, including PHNs and includes strong First Nations decision making structures. So, I think hopefully you'll agree that it's a pretty bold move and it's more than just an administrative shift. To bring our mission statement to life, we've also had to think about what our pillars of success are, and we want to… because I guess we want to make sure that we work in a way that upholds some key principles. You'll notice that these pillars of success build on some of the principles that were outlined in the Ninti One review. We are again trying to keep these pillars at the centre of everything we do. I won't go through all of them, but we've got clients that…client-centred outcomes and continuity of service. 

We know that we have over 60,000 Aboriginal and Torres Strait Islander people accessing the ITC program and we want to keep them at the heart of all of our decisions. First Nations people with chronic or complex chronic conditions should be able to continue to receive high quality care and experience no disadvantage regardless of where they receive their primary health care. We've got national coverage, workforce sustainability, place based and flexible approaches. The ITC program was designed to support flexible local solutions, which serve particular communities and as Leanne outlined, we know that implementation of the program varies quite widely across the country. This is actually a strength of the program and not something that we're looking to change. We know that different areas require different kinds of programs. So we want to maintain that place based and flexible approach to be informed through a partnership model.

What else have we got? We've got sustainable resourcing and operational efficiency, capacity building for new commissioners, cultural safety and mainstream system reform. This is one of the priority reforms in the national agreement on closing the gap. We want to see some transformation and play our part in terms of transforming the whole health system. It's not just about ACCHO settings. We want ITC clients to access culturally safe, responsive and accessible care, no matter where they choose to receive their primary care. You'll hear me talk a lot today about partnerships and collaborative engagements.

You'll notice…I just wanted to address this straight up I guess, that you'll notice that already I've used the word commissioning several times. I know that that word can be a little bit controversial, particularly for ACCHOs. Today, and when we're talking about the ITC program, when I'm talking about commissioning or commissioners, I'm using it…that word in the sense that that's the current role as it's been defined of PHNs. We know that it can play out in different ways, and we know that ACCHOs already do lots of commissioning-like activities. You'll see further on in the webinar that we want to be really flexible in the future role of First Nations lead organisations. So, I just ask that you hang in there with me and the commissioning idea just for a little while.

Thanks, Casey.

As I say in response to the pillars, we're committed to transitioning ITC to community controlled leadership in a way that accounts for regional needs, sector readiness and ensures that workforce and service continuity are prioritised. We've considered a range of different models and thank you to everyone who's given us ideas or talked about how things might work best in your region. What we're proposing to move forward with is a staged place based and sector led transition model. It's trying to uphold all of those principles in a staged and realistic way. We will continue to see and to use PHN regions for…at least for the short term to support a smooth handover. So essentially, we need to break Australia up into some smaller pieces. At the moment the program's broken up into PHN regions, so we've decided to stick with that at least for the short to medium term. It may…in the future we may decide to change that, but for now, we'll continue on with the regions as they've been defined. 

The process that…in terms of the model…the process will include an expression of interest process. It'll be overseen by a transition advisory group which will enable co-design and shared decision making at each stage of the transition. This is in alignment with many of our pillars, including a structured transition that preserves existing contracts and relationships, causes the least disruption to both clients and the ITC workforce. It strengthens partnerships to develop service models and co-designed approach to engagement and a focus on First Nations clients and service continuity.

Mel Beacroft:

Now we're going to have a bit of a look at what we think some of the ITC regional models are likely to look like, noting that of course we're prioritising flexibility and place-based approaches. Based on conversations that we've had with lots of you and from feedback that we've had from lots of you, we think that these four models, if you like, are probably how the program will transition over time in your region.

And it depends on the organisations in your location. It depends on how primary care works, what players there are, existing relationships or partnerships. There's a whole lot of things that vary across the country so what we didn't want to do is limit you to one particular model.

We wanted to have some flexibility, and that will just depend on how things work in your part of Australia. The core principle really is that First Nations organisations, here we're referring to ACCHOs or ACCOs should work together to determine the model; which one of these might suit your region with the shared goal of ensuring regional coverage for all First Nations people who require ITC.

If we look at these models in some detail and hopefully the pictures help you - it really helped me to understand. Model one is a collaborative First Nations governed roundtable model. It's a regionally based partnership with First Nations-led decision making in the commissioning and program planning process. We know that this model already exists in a few PHN regions across Australia. In this particular model it may be that the PHN continues to manage administration and they would hold the funding. But there's a round table model where everyone comes together, all of the ACCHOs in the region come together to share in decision making and share in power structures by leveraging existing PHN infrastructure like things like contracting, data structures, communications channels, but everyone comes together to make shared decisions.

The value that the PHNs offered to community controlled organisations is things like training, capacity building, shared decision making, but with an independent person holding the funds, but everyone coming together to determine how they'll be distributed.

This model represents a unified partnership-based approach and that may be something that works in your region. If not, you might think about Model 2, which is where we would have an independent ACCHO or an ACCO as a commissioning entity. Here the First Nations organisation would be responsible for commissioning ITC providers across a region. Here when I'm saying commissioning, I'm distinguishing it from service delivery. You can see in the diagram that the ACCO is quite separate from the service providers in exactly the same way that the PHN is separate in the current model. It’d be quite similar to the current model, except we'd replace…you might want to replace the PHN with a First Nations-led organisation to play that same sort of role and then to commission services and distribute funding that way.

The third model is one that we've been listening to you, and we've heard that this is something that you're quite interested in. This is a First Nations-led subcontracting arrangement where a regional ACCHO would deliver services, hold the funds, deliver services, but also subcontract other providers as required to cover gaps in service or create service pathways. A particular ACCHO might not provide service delivery across an entire PHN region, so they might subcontract to some other ACCHOs to provide in their various communities. So, this is…a precedent for this kind of arrangement already exists in the Tackling Indigenous Smoking program. For those of you that are familiar with that, this is kind of in lots of ways, how that might work. A key issue for us to think about for those regions who want to move forward with this subcontracting arrangement is that we'll need to work together to manage potential conflicts of interest in terms of funding decisions. And even though that presents some complexities, we still want to use that as a model if that's something that interests your region.

The fourth model is a PHN commissioning model. Think of this sort of like the current arrangements. This is what we've kind of got now, but we'd make some improvements. We'd apply this model where there's no agreement to one of the other options, or there's no community-controlled organisation that wants to take on the lead in a PHN region.

So communities, your region might decide to continue under the PHN regional commissioning model. If current arrangements are effective, if that's what community wants, however, we’d seek to strengthen First Nations government…governance arrangements. Sorry. While the PHN retains the commissioning role, we wouldn't maintain the status quo; we'd strengthen the governance arrangements by embedding formal partnerships and community driven decision-making mechanisms into the grant agreements. For example, we've heard in a particular PHN region, some Elders sit on procurement panels and influence provider selection, while the PHN takes on the contract and the administration, but engaging community to make decisions.

They're the four models that we think will work for ITC transition and essentially regions can choose which one of those might work for you best.

I guess to re-emphasise that the key principle is that the community controlled sector would come together to determine the model that suits your region, with a shared goal of ensuring that your whole region is covered and that all Aboriginal and Torres Strait Islander people can access ITC. This does mean in some way maintaining some kind of mainstream element to the program. That might mean in terms of a mainstream provider providing service provision. It might mean maintaining mainstream pathways. It might mean out posting ACCHO staff in mainstream settings or some other great alternative that I'm sure that lots of you can come up with or are already doing in your region.

So again, the goal is that all First Nations people will have access to Integrated Team Care programs.

Switch over now. I want to talk a little bit more about this idea of commissioning. Here, when I'm talking about commissioning, I'm really referring to that lead organisation in a particular region.

In model one from the last slide, it's the PHN in partnership with the ACCHOs. In models two and three, it's the ACCHO or ACCO and in model four it's the PHN takes on this role. So being the lead organisation is much more than…about holding the funding or deciding who delivers services. There's a range of other functions that that organisation will need to perform that the PHNs are currently performing in the way the program works. The reason we wanted to focus on this a little bit today is that over the course of our conversations, we’ve…It’s become quite clear that there's some confusion in terms of what transition means in terms of the role of a commissioning body or a lead organisation and a service provider.

We are making quite a distinct delineation there that there are other functions that sit outside of service delivery. In a traditional commissioning role or a lead organisation role and so today for PHNs, that would be things like strategic planning, service design, procuring services, monitoring and evaluation, review and improvement and transition and change management. Under the current model, a commissioning body or a lead organisation doesn't actually provide service delivery or any of those other things which might be, you know, abundantly clear. We have heard what you've said that in terms of a lead organisation...in terms of ACCHOs or ACCOs, it may be the case that the lead organisation will provide service delivery and so that's why we've designed model or option 3 if you like where there's the subcontracting arrangement. 

That's not the traditional model of commissioning or the way that PHNs work, but we understand that there are ACCHOs who are interested in being that lead organisation. As I said, we will have to figure out how to manage conflicts of interest and mitigate some of the risks there in terms of partnership and management of funds and distribution of contracts across a region. But we're committed to making that work and if that's some…if Model 3 with the subcontracting arrangement is something that your region is interested in, then we will work with you to figure out how that might work.

So what do we got next? Timeline. I appreciate that this might be quite small on your screen, but bear with me. We wanted to give you a much clearer understanding of what this…what transition means for you and some of the anticipated milestones in the short to medium term. Note that all of this and we've obviously put our official disclaimer on the top there that some of this is subject to change or subject to government approval and also securing future funding. However, as I've said before, the plan is staged transition, so the first step will be an expression of interest process which will invite interested parties to put their hands up and outline a proposed approach for their region.

Mel Beacroft:

The EOI process will identify what the Ninti Review called “early adopters”, which will be First Nations-led organisations which will be selected to apply for the first grant round to commence transition from 1 July 2027. I want to be clear that this isn't an all or nothing proposition; there will be subsequent opportunities for other interested ACCHOs or ACCOs to nominate their interest to assume a commissioning role in future grant rounds. This will just be the first of, you know, several grant rounds that will happen upfront for early adopters.

We want to ensure that we provide adequate time, information and support to enable conversations and planning to happen within your region because you will have to facilitate some partnerships and we want to allow sufficient time for planning prior to opening an expression of interest. We'll continue to provide targeted information to ensure that interested organisations feel well informed and best placed to submit an EOI application. So that will roll out over the next 12 months. There will be lots of time so if one of your questions is, oh, what will we need to do, what will we need to say? I'm not going to cover that today in precise detail. I imagine that will be subject of a future webinar and certainly a series of future communications.

So you can see, I think the second little diamond, am I going to call it – establishment of a transition steering committee, key enablers for this co-designed model are that we will establish a transition advisory group. We'll also procure an independent probity advisor. The transition group's function will be to work in partnership to help or to develop together the EOI process, establish some selection criteria and also assess EOI applications to identify early adopters. They'll provide oversight of and recommendations about transition and also serve as an Advisory Board and escalation point to address any concerns to support mitigating risks throughout the transition period. So that's a pretty critical enabler of transition.

We're in the process of scoping membership. We hope that we'll be able to resolve that and invite members by the end of the year. Where the plan is to have, you know, a wide membership base in terms of ITC stakeholders, including peak body representatives. At this stage we're considering organisations like NACCHO [National Aboriginal Community Controlled Health Organisation] and the Affiliates, ACCOs [Aboriginal Community Controlled Organisations], PHNs [Primary Health Networks], mainstream health services and also some different areas across the department. We want to ensure that we've got geographical coverage and give lots of representation to First Nations stakeholders.

You can understand that there may be some conflicts of interest in terms of having members that may be currently or wish to in the future receive funding or be a lead organisation. We will get some targeted probity advice to support that process.

The ITC data project that Leanne mentioned earlier will inform the funding distribution and support any future boundary shifts. It will also provide an evidence base if we can bid for additional funding, which of course – as per usual - be subject to government decision. We're also scoping a National Best Practice Unit; we're going to call it. Hopefully we come up with something catchy - a catchy name. It'll be similar to some of our other programs like Australian Family Partnership Program or Tackling Indigenous Smoking that has a separate organisation that would support upskilling in a Community of Practice, an escalation point for queries and concerns, and really provide support and guidance to early adopters and future adopters as the program transitions; so above and beyond what the department and the Community Grants Hub provide.

You'll notice that the EOI process will happen over the next 12 months to allow for co-design. This means that we'll be continuing funding under current arrangements for the next 12 months. My team's working on progressing the paperwork before the end of the year. I wanted to acknowledge now at this point that a 12-month extension might not be received as good news by all of you but I can assure you that transition is underway and it will continue until we've finished - until we've transitioned - and our conversations with all of you and our administrative processes and I guess working in accordance with our mission, have meant that this is one of those things that won't happen overnight, but it is happening.

It's happening now and in the interim we'll provide an additional 12 months funding certainty so that the 60,000 clients currently being provided ITC will have some certainty over their services.

What do we got next Case? Thank you.

This is a longer-term view. The first timeline was really short, over the next 12 to 18 months. This is our timeline over the next four to five years and how we anticipate that transition will roll out as a staged approach. You can see that the full transition of a PHN region may take some time, maybe up to two years and there may be some overlapping funding arrangements again to ensure client service continuity, fidelity to the program and preservation of partnerships and supplier arrangements.

You can see in…we're in pre-capacity building. I've talked already about establishing an ITC steering committee, a probity advisor, the expression of interest - that's all happening. The next stage is 2026-27 where early adopters will be supported to undertake capacity building activities. The intention is for early adopters to collaborate with current ITC grantees during a designated handover period to implement transition plans for clients and staff. And providing an opportunity to pilot, review, test and adjust approaches. Piloting and testing approaches is something that we've heard a lot from you and we're excited that we are able to provide this as an opportunity.

New funding arrangements will commence from about 1st of July 2028 in terms of, fully transitioned program. Future years will focus on evaluating implementation, applying lessons learned and also considering further grant rounds for anyone who didn't pick up transition as an early adopter. As I say, it's not a case of you get to choose to transition now…you may not…your region may not be quite ready. Totally fine. There'll be future opportunities and so that will be built into this process.

So next steps.

We'll be seeking your feedback on the proposed EOI process, the transition approach, and the timeline - everything that's been outlined today. In the next, I don't know, next week or so, you can expect to receive a public survey asking you really how we can best design and implement an inclusive EOI process that enables community controlled organisations to nominate themselves to lead future commissioning arrangements. We really want to get some intel from all of you.

The survey will be released in the next couple of weeks via the ITC distribution list, so if you're not receiving our current emails, please reach out and we'll add you to the list.

The team will continue working on engaging an independent probity advisor and establishing the transition advisory group. We'll have a bunch more communications coming out to you, aimed at providing information and support through lots of different channels, lots of different resources. We're doing our best to improve and make sure that all of this information is publicly available so that you all have the same information and capacity to discuss with your teams, your colleagues and potential partners in your region. Particularly because there's likely to be a reasonably competitive EOI process, we're also trying to maintain consistent messaging, which is why we want to use the distribution list and these public resources as much as possible so that everyone's receiving the same information at the same time. We'll be starting to wind back some of our individual engagements where we can. Of course we're always…our door is definitely open and our mailbox is receiving mail, so we're always glad to hear from you, but in terms of individual meetings for the next little period, the team will be really focused on facilitating the process to make transition happen and to get the EOI process up and running.

What else am I saying? We'll be doing the extension for 2026-27 very soon, so you can again expect to hear from my team. And as Leanne outlined, the ITC data project will be wrapping up by the end of the year and once we have some concrete findings, we will be really pleased to send them out so that everyone can have a look at what we've found out and hopefully where to next.

Remember this webinar will be put public on the website. We will send you the link along with some resources and you can continue to receive our monthly information e-mail updates every month.

That's it for the main talking part. We're going to move into Q&A now. I'm going to get the team, I think, to read out. Hopefully you've all been upvoting your questions. I'll get the team to hit me.

ITC Team Member:

All right, Mel. So the first question…is it expected there would be one model per PHN region? 

Mel Beacroft:

Yes, essentially, yes. It’s…It would be really hard to run two of those models in the PHN region. So yes, it is our expectation that each PHN region would pick one of those models. That may mean…Well, it's likely to mean partnerships with other organisations, whether it be the PHN or other ACCHOs or other First Nations-led organisations in your community. That is our expectation but if you have a creative way in which you could do different things at the same time, then we're certainly open to hear about it.

ITC Team Member:
When the national review was conducted by Ninti One, First Nations specific mental health funding was also included with ITC, will there be a separate update on the First Nations specific mental health funding and whether there are any transitional arrangements for it.

Mel Beacroft:
Great question. Yes….our colleagues in mental health are separately working on transition arrangements for the mental health funding. Please know that we speak with them all the time. They know what's happening and we discuss approaches, but I will make sure that they are aware that you are all interested in hearing from them soon about what might be happening with mental health.

ITC Team Member:
Next question, is there an ETA on the schedule variation…extension for PHNs for 2026-27? 

Mel Beacroft:
I'm going to say…is it too ambitious for me to say end of the year? The team is nodding…by the end of the year. Early Christmas present. Let's think about that.

ITC Team Member:
So there's a question here. Concerned that in a regional PHN with 7 ACCHOs, how we'll reach decision and consensus on a model whilst relationships continue to deteriorate. How will this process be supported by the department?

Mel Beacroft:
I guess these are the kinds of issues and concerns that we'd like to hear about early. And certainly, Catherine, you can put some…you don't have to put any details or even any information about the organisations in your survey response. But these are some of the things that we'd like to hear about early so that we can work with you to figure out a way to come to some agreement in a way that best suits those organisations.

I can't exactly tell you. It will probably depend on the place. It will depend on the relationships. It will depend on, you know, what might work but we will work with you to sort something.

So please, that's something that we want to know about early. The earlier we know, the more time we have to work with your…in your region to find a workable solution for everybody.

ITC Team Member:
So the next question is from Raylene. I wonder why PHN Commissioning is still being considered as part of the process…nothing about the peak organisation NACCHO who has not been identified as an option.

Mel Beacroft:
I'm not sure exactly what you mean, Raylene; I guess we heard in the Ninti Review that a national model was not preferred and certainly in our communications with a whole lot of people…the regional place-based model has been and continues to be a preference and so in terms of PHN commissioning, I guess as I said, I've been using the word commissioning to talk a little bit about, those extra activities that PHNs currently provide. It's not necessarily the PHN commissioning model that we want to preserve. Hence why we've come up with these four different options and again, if someone can come up with a creative fifth option, that would, you know, that's great. We're very open to it. Those options have come up from discussions with all of you in terms of what's happening or what you'd like to see happening in your region. So I guess in answer to Raylene's question, we're working on feedback from the sector and also remember, Raylene, that NACCHO will be involved and in shaping transition through the transition advisory group. That's certainly our intention.

ITC Team Member:
Who is expected to lead the consultation in each PHN region?

Mel Beacroft:
Great question. I guess it depends on relationships. In some places I expect that will… there will be a natural lead. In others, I think what we'd be hoping is that stakeholders would come together, so it may be appropriate for…if there's in particular places for the PHN to reach out to organisations and you know, host a planning, workshop type thing. It may be appropriate for a particular ACCHO to do the same. Or it may be, you know, if there's an ACCO that's in your region, it may be appropriate for them to reach out to everyone. I guess, what we're hoping is that someone, would take the initiative to bring everyone together, and have a conversation or a series of conversations. It depends on the relationships in your region. What we're hoping is that, people will come together, to discuss and to figure out what's on the table as well as what might be off the table, remembering that, it's not our intention to cause conflict or to create riffs, or to put any strain on some existing strained relationship. What we're hoping is that people can come together. If being an early adopter isn't for your region, that's okay too. You might start having some conversations, but these things might not happen for some time, which is totally fine, again, as I said. There's no time limit on when you can transition. If the next well…if that's not something you can do in the next 12 months, totally fine. We can work with you on a solution that you might be able to implement in a couple of years.

ITC Team Member:
Just have a question regarding…will the new program potentially cut ITC funding for some clinics?

Mel Beacroft:
In terms of the transition, is that what you think I mean they meant?

ITC Team Member:

Yes.

Mel Beacroft:

I wouldn't…That's a difficult question to answer. As the as the program transitions and somebody else decides, you know and the not the PHN if that's the case or a collective of organisations determines who will provide service delivery; it is possible that organisations that are current service providers of ITC will not be service providers in the future. I guess that's always on the cards in terms of under the existing arrangements - you know your region, your PHN might go back out to tender and try and re-decide or re-figure out who might be best placed to provide service delivery in your region. So that will be the case in the future. So really difficult to decide. It is certainly not our intention to cut funding to PHN regions. If anything, the ITC data project is about giving us evidence so that we can bid to government for more money so individual regions won't receive less. I can't talk about individual service providers because that depends on a whole range of decisions that aren’t the department’s remit.

ITC Team Member:

A funding question here, Mel, for early adopters trying new innovative models whilst trying to maintain service providers for one to two years this will require additional funding. Is this in scope?

Mel Beacroft:

Yeah, that's one of the difficult things that we've been considering and hence why we need this sort of staged transition. Yes, we're expecting that there will be some, you know, overlap in funding and some dual funding required or additional funding in this example. That's something that we're trying to scope now. We haven't secured additional funding yet, so all of this is subject to government decision. But yes, it is our intention to bid for additional money.

ITC Team Member:
For the expression of interest process, exactly what organisations…what will organisations be expressing interest in being a commissioning organisation, a provider or both?

Mel Beacroft:
For the EOI process, it will be that a First Nations-led organisation will express their interest in being the lead, if you like, under one of those four models. You could potentially be both if you pick that subcontracting model. You may be the lead organisation if you like, receiving the funding and providing service as well as subcontracting to other service providers. Or if you pick Model 2, you might be…if you like an independent ACCO or ACCHO sitting across all of the ACCHOs in your region and working together to provide funding to other organisations. It just depends on what model you're hoping might work in your community.

ITC Team Member:
I think this touches on some questions from before, but it's a question specific to the Northern Queensland context. So NQPHN covers over 15 ATSICHOs [Aboriginal and Torres Strait Islander Community Controlled Health Organisations] from…I'm going to butcher this…Mackay to the Torres Strait. How do you make one model work when there are complete differences in distances, complexities across regional, rural, remote and very remote regions. 

Mel Beacroft:
Yeah, I think that Northern Queensland is one of our big PHN regions that's…we do have a number of huge and quite diverse PHN regions. It is a challenge and something that, you know…it may be the case that…we're not adverse to splitting things necessarily in half, noting that there will only be one funding arrangement per PHN region. So we will have to come up with some solution to suit the entire PHN region. That's just the nature of having to split Australia into lots of little pieces. Unfortunately, some PHN regions are huge but it's the same as if we picked another…What do they call it? Cutting option? I don't know what to describe it. There'd be some bigger regions as well. That's something that we can talk about a bit further, but I can see how that presents some particular challenges in our big PHN regions.

ITC Team Member:
A question here about the transition steering committee or advisory group, has it already been established?

Mel Beacroft:
Absolutely not. We've got some early scratchings, if you like, on a piece of paper, but not a lot more than what I outlined to you before which is we understand what we want the transition advisory group to do, but we haven't yet formalised that in terms of membership or scope or any of those things. So no, it absolutely has not been already established. That's work to come.

ITC Team Member:
A question about the EOI. If there are no ACCHOs or ACCOs in a region, does the PHN still need to submit an EOI? 

Mel Beacroft:
Great question and I think we've talked about this in our team. I'm not sure…Have we come up with an answer for that? I'm not sure yet. The details of the EOI are yet to be resolved, but we will be really clear in communications about what needs to happen in that particular scenario. So the short answer is I don't know yet. We will know and we will tell you.

ITC Team Member:
How will the Transition Advisory Group align with the work and priorities of the established First Nations Health Funding Transition Advisory Group to ensure consistency, cultural integrity and coordinated reform?

Mel Beacroft:
Yeah, that's a great question. So again, our colleagues in the First Nations Health Funding Transition Advisory Group and certainly in the program, we talk to them often. We report through that group and receive updates and provide updates about transition of ITC. It is something that we want to have overall consistency I guess with the entirety of the First Nations Health Funding Transition program. However, we are looking specifically at transition of the Integrated Team Care program. I would expect that there's likely to be some overlap. For example, I know that NACCHO is the Co-Chair of that program advisory group and we will certainly be inviting NACCHO to be part of our transition advisory group. So, there will be some overlap in terms of consistency. We're all moving in the same direction and that is to transition programs to First Nations-led organisations.

ITC Team Member:
I think I have answered the next question already, but just I'll read it out just to make it clear. Does the EOI include service providers or just for the commissioning organisation? 

Mel Beacroft:
So again, it depends on which model you want to choose if you. If you want to choose…if your region wants to choose, I think it was Model 3, which is the subcontracting arrangement, then the lead organisation may also be a service provider and may subcontract other service providers. So in that instance, the EOI would be applied for by that lead organisation who would be a service provider in that particular place. But more broadly, it's about who will take…the EOI will be about who's taking the lead and what the arrangement will be rather than individual service providers.

ITC Team Member:
We have one minute left, Mel. This will be our last question. PHNs - Will there still be a role to play in ensuring mainstream primary health care is culturally appropriate and accessible when being utilised by members of the First Nations community who choose who…either choose not to or cannot access their local ACCHOs?

Mel Beacroft:
I think that's always a role of the PHNs. I'm not sure what's happening with the PHN Review and whether that component will be strengthened just more broadly above and beyond the ITC program. We can…I can certainly find that out. I would say yes to some degree, but in terms of the Integrated Team Care program, I would expect that that would be part of the role that would be taken on by the lead organisation who may or may not be a PHN. And I know that that's a role that ACCHOs and ACCOs are already providing in lots of communities. It sort of depends, but I guess I would say yes, definitely in terms of above and beyond what the ITC program provides.

ITC Team Member:
Apologies, Mel, I got ahead of myself. We have plenty of time for more questions. So I have one here…Is there a plan to provide one-off funding or give grants for all the consultation and planning that's going to be required to submit an EOI?

Mel Beacroft:
Great question. It's not something that we have funding for at the moment, but if that's…I encourage you to submit that feedback in the survey because if that's something that you feel will be required, I'm certainly happy to ask. It's not something that we currently have funding for at the moment. 

So I can't promise you, but I can promise you I'll ask.

ITC Team Member:
There's a question here. Will people who are not known by ACCHOs as being of Aboriginal descent, have to provide confirmation of their Aboriginality? As we believe there are many people currently getting through the cracks, there would certainly be more where funding is to a mainstream service.

Mel Beacroft:
I can't comment on requirements for patients at individual practices or clinics. So I can't comment on that. I'm not sure that I could answer necessarily, to be honest. That's a matter for individual clinics.

ITC Team Member: 
The next question - If a PHN wanted to be an ITC Commissioner under option four, would this only be considered if an ACCO or an ACCHO did not put in an EOI? 

Mel Beacroft:

I'm going to say yes, but our preference is that an ACCO or an ACCHO or a First Nations organisation be the lead. And if a PHN or if a region's wanting the PHN to maintain those administrative functions, we prefer that you see if you can have a think about the roundtable arrangement where people come together and share in decision making. I guess option 4 is almost, I loath to say, a last resort, but it’s in the instance where there isn't a First Nations organisation that's ready to take on the role, then we'll consider option four. But where there is, yes, we'll be giving preference to First Nations organisations in terms of taking the lead.

ITC Team Member:
Question here. I think details still remain to be considered for the EOI, but the question is if you do not want to be a commissioning organisation, do you still need to submit an EOI? 

Mel Beacroft:

No. Although you may want to have some discussions with the organisation that is submitting an EOI if you want to...If you're a service provider, I would certainly encourage there to be discussions and collaboration within individual PHN regions. But no, if you're not aiming to be the lead organisation, then I would expect that no, you won't need to apply for the EOI. Again, we will make the detail and this is why we need quite a bit of lead time - is to firstly figure out the answer to all of these questions and then make sure that we make it really clear to all of you, as well as all interested stakeholders who aren't here today.

ITC Team Member:
There is a question here around the proposed models. Will…they will all require more funding and resources than currently exists. Will this be considered, pushed for in the funding bid? Also, will ACCHOs or ACCOs also be expected to take up the improving cultural safety in mainstream service function that exists in the current ITC funding?

Mel Beacroft:

Yeah, so potentially...In relation to the last bit of the question, very likely in terms of that's part of what we've considered the role of the commissioning entity or the lead organisation. In terms of additional funding to do all of this stuff, yes, it's something that we're really aware of and it is absolutely not our intention to ask First Nations organisations to do more for free. It's something that we're scoping at the moment in terms of how much money we will need to make that happen. So it's yes, it is definitely our intention to ask for more.

ITC Team Member:
I'm going to read this one out. I think it's more a statement, but I think the PHN or closest ACCHO should be considering applying as not all Aboriginal and Torres Strait Islander people attend ACCHOs or there may not be an ACCHO in the area. So, I guess the question more so is will the program preserve pathways for people who aren't accessing ACCHOs?

Mel Beacroft:
The short answer is yes. It is our expectation that regardless of the region and regardless of the lead organisation that we would maintain pathways for First Nations people regardless of where they choose to get their care. So whether they receive primary care from an ACCHO or another primary health care clinic, we would like to see that preserved so that all Aboriginal and Torres Strait Islander people can access ITC. In places where there might not be an ACCHO or an ACCO, that might be places where you consider, the lead organisation continuing to be the PHN, whether that be in a roundtable kind of setup that…where everyone comes together to share decision-making or whether it be a bit more like the current model, but with some more, some strength and governance arrangements that would depend on the particular PHN region. But yes, it's certainly a priority for us is maintaining coverage for all Aboriginal and Torres Strait Islander people.

ITC Team Member:
What considerations will be given to smaller ACCHOs expressing interest in becoming a commissioning organisation within a certain region over larger ACCHOs and organisations, particularly where there are more established ACCHOs and they also submit an expression of interest? Additionally, if multiple ACCHOs from the same region expressed interest, what will be the process for determining which ACCHO is selected? 

Mel Beacroft:

It's a great question, something that we've been thinking about a lot. Part of the answer is a transition advisory group which will help us navigate some of those complex decisions and potentially help us broker a solution, based on partnerships or relationships. I don't think that size, in itself will be part of the decision-making process in terms of size of an organisation. Although capacity or capability certainly will and not necessarily existing capacity or capability, but you know that might be something that you might need some investment in - in order to make that work in a smaller organisation and that's something that we're interested in. I can't give you any specifics, but that's essentially why we want the transition advisory group; is to help us navigate those kinds of complexities.

ITC Team, need to ensure they commission a mainstream service so Aboriginal and Torres Strait Isla Member:
Perfect. The next question is, will the commissioning body, whether they are an ACCHO or ACCOnder people have access to ITC no matter where they choose to go for their primary health care?

Mel Beacroft:
I think I outlined in…when I talked about the models, not necessarily. That would be one way. Another way might be somehow maintaining pathways for Aboriginal and Torres Strait Islander people who use mainstream primary health care clinics. It may be out posting ACCHO staff in another location to maintain those pathways. It just depends. We're not…we're deliberately trying not to be very prescriptive because, as I've said, one of the things…one of the strengths of the ITC program is that it's done quite differently in different regions because different things work. There will need to be some mainstream pathways, but how exactly that will work will be up to particular PHN regions.

ITC Team Member:
We've got a question here around where to next? Will PHNs or the department meet with current service providers to capture thoughts on what the thought is regarding the funding model for the region?

Mel Beacroft:
As I said, yes, if PHNs…if it feels like it's appropriate for PHNs to lead those conversations, great. It may be that PHNs want to pause for a moment and let ACCHOs or ACCOs take the lead in terms of bringing things together. That really depends on the relationships and the complexities in your particular region. I'll leave that to you to navigate and it's certainly something that again in the survey if you want to provide any advice or feedback or if you feel like the department…you need some advice or assistance, you can reach out that way, but it just it really depends on existing relationships. I wouldn't say 100% definitely it's the role of the PHN, it really…in fact it makes a lot of sense for a First Nations organisation to lead that process, but again, it depends on your particular place.

ITC Team Member:
Question about the data project. Will the results of the funding distribution model be finalised prior to the expression of interest? 

Mel Beacroft:

I don't think so. So, no, noting that the data project is providing us with advice and really a sense of what the funding distribution model will look like. We would need to separately, enacting or taking on board recommendations from the data project is a whole separate piece of work, so it's unlikely to be finalised before the EOI, no.

I'm going to say that if there's other questions in terms of smaller questions or anything specifically we will, we can cover those through a…we might put out an email with some additional stuff included. And don't forget there will be resources coming out in the coming week with some more information so that if you haven't madly scribbled down notes or if you're thinking, oh, what did you say about the thing? Stand by. We will be sending you some stuff, some concrete bits of paper so that you can have a look at and talk about amongst your colleagues or with other organisations.

ITC Team Member:
The next question is just about whether or not the webinar will be recorded and distributed. I'm just going to read out the answer for that one. The webinar is being recorded. It'll be made available after the web, like after the actual event, but there might be a small delay because we have to transcribe and include accessibility controls on the actual webinar. Just reading that out for anyone who missed the written answer. 

Mel Beacroft:

Thanks, Cass. Yes, government has really stringent accessibility requirements, which is great, so that the webinar can be accessed by everyone but it does mean we do need to provide a transcription, which does take us a little bit of time, so please be patient.

ITC Team Member:
We have a question here around the third model. Can ACCHOs advise and direct the department that the commissioning level can go to the region rather than a large PHN region?

Mel Beacroft:
In terms of smaller than PHN region?

ITC Team Member:

Yes

Mel Beacroft:

If that's feedback that might work in your particular region, we're very happy to hear about it. We are trying to have some consistency in how we're applying transition across Australia. That's not to say that we wouldn't consider different options, but it's definitely not our preference. But very happy for you to include that in your survey response.

ITC Team Member:
Not a question as such. We have someone asking that that it would be nice to have a national register of all ITC programs in the country. So when people move around, it's an easier referral process. 

Mel Beacroft:

We 100% agree because we have heard from some of you that it is really hard to give a warm referral for your clients when they happen to move. It is definitely on our list of things that we'd like to improve for the program in the future.

ITC Team Member:
Question here around the expression of interest process. Can we please provide contact details the organisations to forward their expression of interest?

Mel Beacroft:

Do you want to take that one, Casey? 

ITC Team Member:

Yeah. As Mel mentioned, part of our next steps will be the release of a public survey. Within that survey, it will get distributed via our distribution list. It doesn't take too long to complete and we will automatically receive the information submitted. Following on from that, expression of interest applications will be submitted by Grant Connect. However, we will give you the dates and the specific times for you to apply for that, but the first step will be completing the survey to provide your feedback on the EOI. 

Mel Beacroft:

And so there's no rush in terms of the expression of interest. There is going to be a long lead time. Everything will run through Grant Connect so that it's publicly available so that you can…no one will miss out. There's not a time crunch and there will be a significant period of time to respond to that EOI process so that regions have lots of time to come together and come to a regional solution.

ITC Team Member:

I’ll just read the last one, which is probably more of a suggestion, but would be good if state-based Affiliates could organise with the department to have yarns with their members, particularly where there needs to be consideration about or around one model. 

Mel Beacroft:

Great suggestion. I love that. That's certainly something that the team's jotted down and we'll see if we can make that happen. Thanks, Renee.

I think we're pretty good. Amazing. Thanks for all the great questions. I know there's been a lot to digest today - lots of information. As I say, please don't panic if you didn't, you know, take snippets of the slides or if you only half wrote down some of the things that I said. There will be in the next week or so, a whole range of stuff coming out to your mailboxes very soon. If you're worried that you're not getting those emails, please get in touch with me and I'll make sure that you're added on to the list. 

The team has a huge and quite extensive list, but I'm sure we've missed a few people. If you've got particular mailboxes or things, we're very happy to add as many as you like, there's kind of…it's a limitless list. But if you got this webinar invite, then chances are you're on the list and you'll get the resources and fact sheets and the survey in the very near future. Stand by for an email letting you know that this webinar is up on the website as well. And then you can watch this all again or at least show to your team if they've not been available today. 

Thanks so much for attending. Really appreciate you and I look forward to touching base with lots of you soon. Thanks.

End of transcript.