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Primary Care Impact Grants​
Primary Care Impact Grants - Supporting Chronic and Complex Disease Management
Healthy North Coast is offering grants to support better care for chronic diseases, which are long-term conditions with lasting effects on individuals and communities. These diseases are a leading cause of disability and death in Australia, but nearly 40% of their burden could be prevented by addressing modifiable risk factors and improving disease management.
To support these efforts, Healthy North Coast’s Primary Care Impact Grants provide significant funding for local healthcare providers. These grants focus on two critical areas:
- Proactive prevention: Reducing the risk of chronic diseases through early intervention and health promotion.
- Team-based management: Empowering multidisciplinary care teams to deliver comprehensive, patient-centered support.
Multidisciplinary care brings together patients and health professionals from different specialties to address all aspects of a patient’s health. This flexible, collaborative approach adapts to the unique needs of each individual, ensuring high-quality, personalised care.
Healthy North Coast’s Chronic Disease Prevention Grants and Multidisciplinary Team Care Grants are designed to enhance prevention strategies and strengthen care teams, helping to reduce the prevalence and impact of chronic conditions in our community.
Selecting the right grant
Some programs may meet the criteria for both grant opportunities. However, grants will only be awarded from one program per applicant. Please apply for the grant that best aligns with your proposal.
There are two grants open to apply for:
- Chronic Disease Prevention program, read more about the grant.
- Multidisciplinary Team in Chronic disease management, read more about the grant.
During the evaluation process, if we believe your application may be better suited to a different grant program, we will communicate with you directly.
Watch the Information Session Webinar.
Primary Care Impact Grants - Program Details
Chronic and complex disease
While some applicants may meet the requirements of both grant programs, each EOI application is only eligible for one grant award. Please apply for the grant that best aligns with your proposal. During the evaluation process, if we believe your application may be better suited to a different grant program, we will communicate with you directly.
The Chronic Disease Prevention Grants Program is open to primary care providers working in and around the North Coast region of NSW.
- General Practices/Medical Centres
- Allied health providers (such as physiotherapists, occupational therapist, speech pathologists,
exercise physiologist, podiatrist, dietitian, social worker, psychologist) - Nurse led services
The multidisciplinary team care (MDT) grant program addresses healthcare access disparities and chronic disease management by empowering primary care providers to establish or expand MDT initiatives in areas of greatest need.
Disciplines that can be commissioned to form part of the MDT include:
- Allied health professionals (such as physiotherapists, occupational therapist, speech pathologists, exercise physiologist, podiatrist, dietitian, social worker, psychologist)
- Nurses
- Aboriginal health worker/practitioners
- Assistant health workers
- Services that cannot be commissioned as part of the MDT include:
- Dental health workers
For both grants, it is mandatory for eligible general practice applicants that they participate in the Lumos program. Details about the Lumos program are available here. The data gathered and connected via Lumos is invaluable in understanding the effect of interventions in a patient’s health journey. Allied Health Providers and Aboriginal Medical Services are not yet eligible to participate in Lumos and therefore this criteria does not apply.
To learn more about the program, simply fill out the form above with your questions or details, and we will be in contact. We will be hosting an information session in January, where you can meet with our team to ask questions and gain insights about program requirements and funding.Â
Ready to get started?
EOIs will be accepted and evaluated on a rolling basis until the allocated funding is exhausted. The third round of evaluation will take place May 2025.
HNC will undertake an evaluation of EOIs, and if necessary, enter into negotiations with the preferred
Participants. The following evaluation criteria will be applied:
Mandatory Evaluation Criteria
- Completion of all schedules in the
Section B: Participant Return Schedules - Financial capacity;
- Required insurances;
- Conflict of Interest details; and
- Signed Acceptance and Declaration
- Read Standard Terms and Conditions
Primary Care Impact Grants - Region specific information to support your application
What are priority conditions?
Healthy North Coast’s Health Needs Assessment has identified the following chronic conditions as the most prevalent in our region:
- Anxiety
- Osteoarthritis
- Asthma
- Depression
- Osteoporosis
- Chronic Heart Disease
- Type 2 Diabetes
- Chronic Obstructive Pulmonary Disease
- Atrial Fibrillation
- Inflammatory Arthritis
- Stroke
- Renal Failure
- Chronic Kidney Disease
Other high prevalence chronic conditions (such as chronic  pain and cancer) are also eligible for these grant programs, as are interventions targeting multimorbidity or polypharmacy.
What are priority populations?
Priority Populations are groups that are at risk of poorer health outcomes. Healthy North Coast’s identified priority
populations are:
- Aboriginal and Torres Strait Islander peoples
- Culturally and linguistically diverse populations
- People with Disabilities
- LGBTQ+
- People exiting prison
- People experiencing domestic and family violence
- Â People experiencing homelessness
As per the evaluation rubrics, it is not compulsory that your program is targeting a priority population to be eligible, but
programs that are seeking to address known health care inequity are likely to be marked higher.
What are financially disadvantaged communities?
While chronic conditions are prevalent across the whole region, there are areas that for multiple possible reasons have a higher prevalence of chronic conditions. Particular regions of concern are those with lower socioeconomic status, higher proportions of priority populations or higher average ages of the residents.
Our Health Needs Assessment has identified the following LGAs as those whose residents experience high rates of social
and economic disadvantage:
- Kempsey
- Nambucca Valley
- Richmond Valley
- Clarence Valley
- Kyogle
As with Priority Populations, it is not compulsory to run a program in the area of highest possible need, but evaluation
criteria will mark programs higher that are meeting a need in a location with poorer population health outcomes.
Small General Practice List
For the Multidisciplinary Team Grant, the practice where the service is delivered must be a solo/small general practice or an AMS. This is a requirement of the Commonwealth funding. Below is a list of the practices in our region with 4000 or less active patients and is considered solo/small for the purposes of the MDT grant.
- AB Surgery
- Almeda Healthcare
- Ananda Clinics
- Ballina Health Centre
- Ballina West Medical Centre
- Banora Shopping Village Medical Centre
- Bawrunga Medical Clinic Macksville
- Bawrunga Medical Clinic Nambucca Heads
- Bellingen Family Medical Centre
- Bellingen Healing Centre
- Bowra GP Clinic
- Brunswick Heads Medical Centre (BHMC)
- Bulgarr Ngaru Medical Aboriginal Corporation
- Bullinah Aboriginal Health Service
- Cabarita Beach Health Centre
- Cabarita Beach Medical Centre
- Camden Haven Medical Centre
- Casuarina Health & Medical
- Central Pottsville Medical Centre
- Chinese Herbal Medicine of Byron Bay
- Clarence Medical Centre (Clarence Med)
- Clifton Medical Centre
- Coffs Doctors
- Coffs Women’s Health Centre
- Crescent Head Medical Centre
- Doctors at Ballina Fair
- Dorrigo Health & Wellbeing Service
- Dr Castagna Surgery
- Dr Lerm's Surgery
- Dunoon General Practice
- Durri Aboriginal Corporation Medical Service
- East Port Medical Centre
- Evolve Medical Centre
- Five Star Medical Centre
- Galambila Aboriginal Health Service
- Gum Tree Family Medical
- King Street Medical Centre
- Kingscliff Doctors
- Macksville Medical Centre
- Maclean Medical Centre (Macmed)
- McKay Street Surgery Practice
- Mitchell Street General Practice
- Moon Street Medical Practice
- Mount View Medical Centre
- Nambucca Plaza Medical Centre
- Nimbin Medical Centre
- North Coast Medical Centre
- Ocean Drive Family Practice
- OPlus Health Grafton
Plaza Medical Centre - Rekindling the Spirit Health Service
- Restore Medical and Skin Cancer Centre
- Riverside Family Practice
- Riverside General Practice
- Rocks Medico Family Practice
- Seascape Medical Centre
- Sinamed Family Practice
- South Kempsey Medical Centre
- Subbiah Family Practice
- The Bright Side Clinic
- The Clinic East Ballina
- The Family Practice at Yamba
- The Good Shepherd Medical Centre Laurieton
- The Good Shepherd Wauchope
- The Grange Family Medical Centre
- The Health Lodge
- Three Rivers Health
- Tintenbar Medical Centre
- Total Health Pottsville
- Tweed Coast Medical
- Tweed Mall Medical Centre
- Tweed Surgery
- Union Street Family Medical Practice
- Wauchope Family Practice
- Webster Medical Centre
- Werin Aboriginal Corporation
- Wollumbin Street Medical Centre
- Woolgoolga Medical Centre
- Wooli Medical Centre
- Yamba Doctors
- Yamba Medical
- Yamba Private Clinic
- Your Family Practice
Chronic Disease Prevention Program
The Chronic Disease Prevention Grants Program is open to primary care providers working in and around the North Coast region of NSW.
From a total funding of $650,000 (excl. GST), organisations will be able to apply for $20,000 – $50,000 (excl. GST) per grant to support an initiative designed to prevent the future burden of chronic disease and improve health related quality of life in our community.
Initiatives must target primary and/or secondary prevention of chronic diseases that is prevalent in a community, or priority population. There should be good quality evidence in support of the intervention, and a plan to measure the impact in the community through clinical outcomes, PROMs and/or PREMs.
The initiative can be new or an expansion of existing chronic disease prevention program. The grant is intended to help establish or expand, and not to provide ongoing funding after the initial grant award. Outlining your plan to make the
initiative financially sustainable to support the community into the future will be required as part of the evaluation criteria.
It is also required to read the Standard Terms and Conditions prior to submitting your application.
Program examples
A general practice notices a high rate of smokers in their patients and poor accessibility to smoking cessation support in their area.
They identify a practice nurse who is interested and capable of running a smoking cessation program in their practice with the support of resources from NSW Health and Quitline.
An exercise physiology practice wants to start a group cardiovascular disease prevention program as there are no public services in their vicinity.
Multidisciplinary Team Care Program
The Multidisciplinary Team Care grants are designed to facilitate multidisciplinary team (MDT) care in small/solo general practices or Aboriginal Medical Services in areas of need.
This grant is part of the Department of Health and Aged Care’s Strengthening Medicare program based on the recommendations of the Strengthening Medicare Taskforce Report. Encouraging Multi-Disciplinary Care was identified as one of the four priority reform areas and Healthy North Coast is committed to supporting these reforms.
The grants are available for applications from general practices seeking to bring in allied health professionals, or to allied health professionals seeking to connect with general practices. Eligible organisations can apply for one-off grants ranging from $50,000 to $75,000 (excluding GST).
The grant should be used to establish and facilitate a model of care using MDT principles centred in the patient’s location of usual care, their GP clinic. The model of care can be delivered face-to-face or combined with virtual care/telehealth, and in an individual and/or group setting. The model of care should be appropriate for your target condition and population.
The aim of this program is to develop sustainable models of care, utilising MBS items to minimise the cost to patients. This could be through eligible consultation items, allied health services under Medicare or case conferencing item numbers or a combination of the above. A service with a high out of pocket cost to patients may be more financially sustainable, but it is likely to score lower on equity of access.
Services are to be delivered for a minimum period of 12 months. There may be an opportunity at the end of the 12-month period to re-apply for another grant under this program, but it is expected that there will be work underway to making the services self-sustaining. The grant is not designed to fund a service indefinitely. Â
As with the Chronic Disease Prevention Grant, there should be a plan to measure the impact in the community through clinical outcomes, PROMs and/or PREMs. Additionally for this program it is a government requirement of the program that participants complete the EQ-5D-5L outcome measure.
It is also required to read the Standard Terms and Conditions prior to submitting your application.
Program examples
A multidisciplinary allied health practice has identified a high number of referred patients with diabetes travelling to their practice from a small general practice in a rural town two hours west of their clinic.
The allied health team propose a dietician and exercise physiologist from their team travels to this general practice once per month and
sees these patients at their general practice.
A general practitioner and a practice nurse working in a solo GP practice have a high number of older patients with chronic conditions with many struggling to manage their medications.
The nearest pharmacy is one hour drive away and patients have difficulty getting there. The GP reaches out to the pharmacist, and proposes the pharmacist attends their practice once a fortnight to participate in case conferences with the GP and nurse and
do individual medication reviews with patients.
