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Chronic Condition Management Plans

If you have a chronic or terminal medical condition—such as diabetes, asthma, arthritis, heart disease, cancer, or a mental health condition—you may be eligible for a Chronic Condition Management Plan (CCMP).

These plans are designed to support patients with long-term health needs by providing structured, coordinated care. A CCMP is developed in partnership with your GP and our nursing team, and outlines:

  • Your current health conditions
  • Treatment goals
  • Recommended services and supports
  • Actions you can take to manage your health

Your GP may also suggest a referral to an allied health provider (e.g. podiatrist, physiotherapist, dietitian, psychologist) if your condition would benefit from the involvement of one of these health professionals. This allows access to Medicare-subsidised allied health services—up to five visits per calendar year.

From 1st July, care planning in general practice is changing under the new GP Chronic Condition Management Program (GPCCMP).

If you’re eligible, your GP will work with you to create a Chronic Condition Management Plan (CCMP)—a personalised plan to help manage your long-term health condition. 

This plan will be reviewed regularly (every 3 months) to ensure it stays up to date and continues to meet your needs.

✅ Bulk billed – There’s no out-of-pocket cost for eligible patients.
📋 Eligibility – You must have a condition expected to last 6 months or more.
👥 Continuity of care – Your plan must be prepared and reviewed by your usual GP or someone from the same practice.

If you think you may benefit from a CCMP, please speak with your GP or ask our reception team for more information.

Care Plans are an extra service we provide to our patients to give them the optimum care necessary to manage a chronic disease. Patients that have been diagnosed with a chronic health condition that is likely to be present for 6 months or longer are eligible for a care plan.  The most common conditions that can benefit from a care plan are diabetes, asthma, cancer, heart disease, arthritis and mental health conditions.

A care plan is an agreed plan of action between you and your GP.  It will identify your health care needs, sets out the services to be provided by your GP and lists the actions that you need to take. These plans are provided with the assistance of our nursing team working in conjunction with your GP.

There is no out of pocket charge to our patients for this service – all our Care Plans are bulk-billed to Medicare.

In addition to the care plan, your GP may also put in place a Team Care Arrangement if they feel your condition could benefit from referrals to at least 2 other health professionals who will also provide specific treatment for your condition.  For example, if you are diabetic you may require podiatry on an ongoing basis.

Please speak to your GP if you feel you could benefit from this ongoing care.

For more information on chronic disease care plans ask our reception staff or your GP.