Application Form

Opioid Dependence Treatment (ODT) Incentive Grants 2025-26

The Opioid Dependence Treatment (ODT) Incentive Grants 2025–26 aim to increase access to opioid dependence treatment in Western NSW by supporting General Practitioners and Nurse Practitioners to complete the Opioid Treatment Accreditation Course (OTAC). As a targeted initiative, the program seeks to expand the number of accredited prescribers in the region and reduce pressures on hospital outpatient services by improving access to community‑based ODT.

Applications are open to eligible practitioners until 9 am - 16 April 2026.

Applicants must read the Grant Guidelines before applying. Submission of an online application does not guarantee funding, and WNSW PHN may request amendments to proposed activities before approval.

Funding of up to $4,000 per applicant is available, depending on travel requirements and training needs.

APPLICATION DETAILS

Name of Nurse Practitioner or General Practitioner: *

Australian Health Practitioner Regulation Agency - AHPRA Number (if applicable):

Applicant's position title: *

Do you have an ABN? *

Yes No

ABN: *

What is your professional role? *

General Practitioner (GP)Nurse Practitioner (NP)Other

If Other, please specify *

Provide a brief description of your current professional role, including your key duties and areas of clinical practice (one paragraph maximum). *

APPLICATION CONTACT DETAILS

Street address *Street address line 2

City *

State *

Postcode *

Applicants' Email Address *

Applicant's Phone number: *

ELIGIBILITY CRITERIA

1. Are you currently practising within the Western NSW PHN region? *

YesNo

2. Do you hold current AHPRA registration as a General Practitioner or Nurse Practitioner, and have a valid ABN (or access to your employer practice ABN)? *

YesNo

3. Do you hold Professional Indemnity and Public Liability Insurance with a minimum coverage of $10 million for the duration of the proposed activities? *

YesNo

4. Are you able to attend and complete all Incentive activities and deliverables within the prescribed dates and timeframes (including OTAC training, placement, and follow‑up requirements)? *

YesNo

Assessment Criteria

Section 1: Please describe your capacity to complete all required Incentive activities (OTAC training, placement, and follow‑up prescribing requirements) within the required timeframes. (Short paragraph response) *

Section 2: How will you use this training to support improved access to Opioid Dependence Treatment (ODT) in your community? (Short paragraph response) *

Section 3: Briefly explain your understanding of the ODT needs and/or challenges in your area, and how your participation in this program will address them. (Short paragraph response) *

Section 4 : Are you able to commence prescribing ODT for at least two patients within six months of completing accreditation, as required under the program? Do you have any current patients who you could takeover prescribing for? If not, how do you plan to identify or receive suitable patients needing ODT, and/or do you require support with obtaining patients? *

OTHER INFORMATION

From which location (suburb/town) will you be travelling to attend the OTAC training?

Do you require any support from WNSW PHN to organise your placement? If yes, please describe the type of support you may need *

ACTIVITY BUDGET

Please provide a breakdown on how you intend to utilise the funds.

Expense Type *

Description of expenses *

Budgeted Amount (excl GST) *

Total Amount Budgeted $ (excl GST) *

DECLARATION

This section must be completed by the individual practitioner submitting the application.

I declare that:

I confirm the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading, or deceptive misrepresentation, claims or statements. *

I have read, understood, and agree to the Grant Guidelines, should this application be successful. *

I confirm that I will provide receipts for eligible travel and accommodation expenses upon request from WNSW PHN. *

I confirm that, if my application is successful, I am willing to participate in an ODT Community of Practice Group if invited by WNSW PHN.
*

I declare that I am financially able to manage the grant funding within the required timeframe and in accordance with the approved budget.
*

I understand that the evaluation decision is final, and no correspondence will be entered into. *

I understand and accept that information provided in this application will be stored by WNSW PHN in various formats, including hard copy and or electronic. *

I confirm that this application does not duplicate existing funding, service delivery or ongoing operational costs. *

I confirm that if a grant payment is made and I do not attend the required OTAC training, and no alternative arrangements have been approved by WNSW PHN, I will refund the full grant amount to WNSW PHN.
*

I agree to contact WNSW PHN should I become aware of any changes to information contained in this application. *

I understand that this application does not create a legal or binding commitment. *

If the application is successful, I acknowledge that:
- The organisation will be asked to sign a Grant Agreement with the WNSW PHN;
- The organisation will be asked to sign a statement stating they have used the funds in accordance with their application;
- The organisation will provide reports to the WNSW PHN in accordance with their grant agreement; and
- The organisation agrees to maintain adequate insurance for the duration of this grant agreement and provide WNSW PHN with proof when requested. *

I understand if the conditions of the funding are not complied with:
- The WNSW PHN will recover the funds allocated; and
- The WNSW PHN may terminate the grant agreement with the applicant. *

I have read the WNSW PHN General Grant Conditions *

Applicant Signature *

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Name *

Position *

Date: *

Please complete the CAPTCHA challenge below to verify that this submission is being made by a human applicant. *

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