What is a GP management plan, and who should have one?

Chronic conditions are the everyday work of general practice. Around half of Australian adults live with at least one, and managing them well is less about a single appointment than about a plan that everyone involved in your care can follow. That is what a GP management plan is for.

The basics

A GP management plan, often shortened to GPMP, is a written plan prepared by your GP for a chronic or terminal medical condition, meaning one that has lasted or is expected to last six months or more. It records your health problems, the goals you and your GP agree on, the actions each of you will take and the services you need. It is reviewed regularly, usually every three to six months.

A team care arrangement, or TCA, is the companion document used when at least two other health providers are involved in your care, for example a physiotherapist and a dietitian. It coordinates who does what and, importantly, unlocks Medicare rebates for allied health visits.

Conditions that commonly qualify

• Type 1 and type 2 diabetes
• Asthma and chronic obstructive pulmonary disease
• Heart disease, heart failure and high blood pressure
• Osteoarthritis, rheumatoid arthritis and chronic back pain
• Chronic kidney disease
• Stroke recovery and neurological conditions
• Cancer, during and after treatment
• Long-term mental health conditions, alongside a mental health treatment plan

There is no fixed list. If a condition is long-term and would benefit from structured care, your GP can consider a plan.

What happens at the appointment

Book a long appointment. Your GP reviews your history, medicines and recent results, checks the measurements that matter for your condition, and talks through what you want to achieve: fewer flare-ups, better blood sugar, walking without pain, staying independent at home. Together you set realistic goals and agree the steps. If allied health is part of the plan, your GP prepares the team care arrangement and referrals in the same visit.

Using your allied health visits

The five rebated visits can be shared across providers, for example three physiotherapy sessions and two with the dietitian. At Toongabbie Doctors our physiotherapists, dietitian and counsellor consult in the same building, so referrals are quick and your GP receives their reports directly. Allied health services are billed privately with the Medicare rebate applied; ask reception about any gap.

Reviews keep the plan alive

A plan is only useful if it is revisited. Reviews are bulk billed and can often be combined with a routine appointment. Your GP checks progress against the goals, adjusts medicines, updates referrals and renews the allied health entitlement each calendar year.

Management plan or mental health plan?

They are different documents for different purposes. A GP management plan covers physical chronic conditions such as diabetes or arthritis and unlocks allied health rebates for physiotherapy, dietetics, podiatry, exercise physiology and similar. A mental health treatment plan covers psychological conditions and unlocks rebates for psychology sessions. Many patients have both, and your GP can prepare them at separate long appointments.

Which allied health providers are covered

Under a team care arrangement Medicare rebates apply to visits with physiotherapists, dietitians, exercise physiologists, podiatrists, psychologists, occupational therapists, speech pathologists, audiologists, chiropractors, osteopaths, diabetes educators, mental health workers and Aboriginal health workers. The five visits per calendar year are shared across all of them, so your GP will help you decide where they are best used. People with type 2 diabetes may also access group allied health sessions.

Care plans for older adults and carers

If you are caring for an older parent in Toongabbie, a management plan is one of the most useful tools available. It creates a single document that the GP, physiotherapist, pharmacist and any community services can all work from, and it makes a home medicines review or an aged care assessment easier to arrange. Bring the person you care for to a long appointment and, with their consent, you can be involved in setting the goals.

Keeping your plan working

Keep a copy of the plan at home, note your allied health visits so you know how many rebated sessions remain, book the review when reception sends a reminder, and tell your GP if a goal is no longer realistic so it can be adjusted. A plan that is updated regularly is far more useful than one filed away after the first appointment.

Getting started

If you have a long-term condition and no plan, or a plan that has not been reviewed in the last six months, book a long appointment with Dr Hossain or any of our GPs through HotDoc or by calling (02) 7813 6000. Mention that it is for a care plan so reception allows enough time.