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Providing care to practice communities

How a general practice provides holistic and culturally aware care to their local Aboriginal and Torres Strait Islander community

Please refer to the disclaimer before reading the case studies.


Health and Wellbeing North Ward is a multi-skilled and integrated medical practice offering primary care alongside other allied health providers. As a collective, it focuses on the proactive identification and treatment of risk factors before disease appears, and on patient-centered management of existing conditions.

The practice has a large Aboriginal and Torres Strait Islander community in its area. To provide holistic and culturally aware care, the practice employs a specialist Aboriginal and Torres Strait Islander healthcare worker. Having a dedicated staff member for this community allowed the practice to:

  • Run regular day clinics to address chronic condition management
  • Offer consistent appointments for the local Aboriginal and Torres Strait Islander population and the local school that educates Aboriginal and Torres Strait Islander children from the broader area
  • Provide home visits to those with access and/or language barriers
  • Offer Medicare-rebatable healthcare plans for chronic and mental health conditions through their multidisciplinary set-up.

Patients responded very positively toward the extra care. Patient feedback surveys showed a 95% positive reaction, and practice numbers grew by 38% over two years. The care fostered a sense of loyalty and community among patients, with follow-up appointments kept and measureable improvements in health outcomes.

Adapted from Im​​provement Foundation Australia. Australian Primary Care Collaboratives Program, Case Study: Health and Wellbeing Ward, ‘Multi-skilled, holistic agency adopts “wellness” philosophy. Adelaide: Improvement Foundation, [no date].


The information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Accordingly, The Royal Australian College of General Practitioners Ltd (RACGP) and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the information.