Chronic Conditions Management Plan
Cooridinated care to support long-term health and ongoing medical conditions.
A Chronic Condition Mangement Plan (GPCCMP) is a structured. GP-led care plan designed to support patients living with ongoing or long-term conditions. It helps coordinate your care, set clear health goals, and connect you with the right allied health and specialist services when needed. The aim is to improve long-term health outcomes through planned, coordinated and continuous care.
What conditions can be included ?
A GPCCMP may be suitable if you are living with one or more health conditions including:
- Diabetes
- Heart disease or cardiovascular risk
- Asthma or chronic respiratory conditions
- Chronic kidney disease
- Arthritis and musculoskeletal conditions
- Mental health conditions (such as anxiety or depression)
- Neurological conditions
- Multiple or complex long-term health issues
Your GP will determine whether a GPCCMP is appropriate for your situation.
Why a GPCCMP is important
Living with a chronic condition often requires ongoing carem monitoring, and support.
A GPCCMP helps to:
- Improve coordination of your healthcare
- Support early intervention and prevention of complications
- Provide access to allied health services when needed
- Reduce duplication of tests and appointments
- Support clear long-term health planning
- Ensure your care is consistent and personalised
What type of appointment should I book ?
A long appointment is required to develop a Chronic Condition Management Plan.
This allows enough time for your GP to complete a full assessment of your health, discuss your conditions in detail, and develop a structed care plan tailored to your needs. It also ensures there is time to discuss your goals, answer your questions, and plan any referrals or follow-up care if required. A follow up appointment may be needed to review progress or update your care plan. Our ain is to ensure your care is clear, coordinated, and supportive.
If you are unsure which appointment is right for you, our reception team can help you choose the correct one when you book.
FAQs ?
Is this covered by Medicare ?
Yes. GPCCMP's are Medicare bulk billed. If other concerns outside the chronic conditions limitations are needing to be addressed during these consultations, these may require private billing.
How many appointments are involved in setting up a care plan ?
A care plan is usually completed over one longer practice attendance. The longer GP appointment is sometimes suported with a Nurse attendance.
Can I use my care plan with other providers outside the practice ?
Yes. Your care plan can be shared with other healthcare providers, such as allied health or specialists, to help coordinate your treatment.
Do I need to register with MyMedicare ?
Yes. Medicare funding for GPCCMP's is dependant on KFP being your preferred healthcare provider. Our reception team can help you complete the necessary form if required. You may choose to enroll directly through MyGov prior to your appointment.
