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Chronic Disease Management: Care Plans & Team Care Arrangements

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Chronic Disease Management: Care Plans & Team Care Arrangements

Care Plans

What is a care plan? Here’s everything you need to know...

Care plans (also referred to as GP Management Plans) are available for regular patients with chronic medical conditions that have occurred for 6 months or longer.

It is a document that is written by your practice nurse and regular doctor while in a specific appointment type with you.

There is no out-of-pocket fee for care plans. All item numbers are subsidised by Medicare.

Eligible Chronic health conditions for care plans include:

  • Asthma
  • Diabetes
  • Heart Disease
  • Osteoporosis
  • Arthritis
  • Mental Health
  • Cancer

Team Care Arrangements

Once your care plan has been developed with your GP, you may be eligible for team care arrangements. This is where your GP can co-ordinate for you to see allied health care professionals. In addition to your GP, TCAs require at least two allied health professionals to collaborate in your treatment and health care.

Allied care providers include:

  • Physiotherapists
  • Podiatrist
  • Dietitian
  • Diabetes Nurse
  • Occupational Therapist
  • Exercise Physiologist
  • Audiologist
  • Pharmacist
  • Psychologist

Care Plan & Team Care Arrangement Reviews

Regular reviews of your care plan should occur at least every 3-6 months. This ensures that your goals are still current and allows any changes to be made as required. Care plan reviews are also subsidised by Medicare.

Team Care Referrals

The referral you receive from your GP will state the number of services you have been provided to your allied health care professional(s). If you have not received all 5 visits in your referrL, your GP may issue the remaining number in your review.

Additional Important Information:

  • Your doctor will offer you a copy of your plan.
  • A copy of your plan will be sent to your allied health providers if a TCA is in place.
  • Reviews should be conducted with your nurse & GP every 3 – 6 months.
  • The practice nurses can provide support and monitoring between reviews.
  • A maximum of 5 services are available for each patient per calendar year. Additional services will be at the cost to the patient.

Common Questions

Who can have one?

Anyone with a chronic medical condition that has been present for 6 months or longer.

What is a chronic medical condition?

It is an illness that doesn’t go away but can be managed with various types of treatments. It can be managed by a team to support all your needs.

Is there a cost?

Care Plans & TCAs are bulk billed at McKinley Medical Centre, so there is no charge for these services.

Will allied health providers cost anything under my plan?

Some allied health providers may choose to bulk bill you & others may charge you a fee. However, the rebate will be claimed through Medicare & direct deposited bank into your nominated bank account. Ask your allied health professional at the time of booking.

I have my Plan, what happens next?

  1. Keep a copy of your GPMP / TCA.
  2. Book your appointments with your allied health health providers. Check if there are any fees when booking.
  3. Track how you are responding to the recommendations your healthcare team have given you. Note any goals you would like to discuss at your review appointment.
  4. Book a review with your Practice Nurse & GP every 3-6 months to discuss your treatment & goals. We will endeavour to contact you via SMS to remind you.