Chronic Disease Management

What is a chronic medical condition?

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, heart disease, diabetes, arthritis and stroke. There is no list of eligible conditions. However, these items are designed for patients who require a structured approach and to enable GPs to plan and coordinate the care of patients with complex conditions requiring ongoing care from a multidisciplinary care team. Your GP will determine whether a plan is appropriate for you.

GP Management Plan

A GP Management Plan (GPMP) can help people with chronic medical conditions by providing an organised approach to care. A GPMP is a plan of action you have agreed with your GP.

This plan:

  • identifies your health and care needs;
  • sets out the services to be provided by your GP; and
  • lists the actions you can take to help manage your condition.

Team Care Arrangements

If you have a chronic medical condition and complex care needs requiring multidisciplinary care, your GP may also develop Team Care Arrangements (TCAs). These will help coordinate more effectively the care you need from your GP and other health or care providers. TCAs require your GP to collaborate with at least two other health or care providers who will give ongoing treatment or services to you. Let your GP or nurse know if there are aspects of your care that you do not want to be discussed with other healthcare providers.

If you have both a GPMP and TCAs prepared for you by your GP, you may be eligible for Medicare rebates for specific individual allied health services that your GP has identified as part of your care. The need for these services must be directly related to your chronic medical (or terminal) condition. If you have type 2 diabetes and your GP has prepared a GPMP, you can also be referred for certain allied health services provided in a group setting.

If a provider accepts the Medicare benefit as full payment for the service, there will be no out-of-pocket cost. If not, you will have to pay the difference between the fee charged and the Medicare rebate.

Regular review of your care plan

Once a plan is in place, it should be regularly reviewed by your GP. This is an important part of the planning cycle, where you and your GP check that your goals are being met and agree on any changes that might be needed. The practice nurse can provide support and monitoring between visits to your GP.

FOR CARE PLAN BOOKINGS, PLEASE CALL THE CLINIC DIRECTLY.

Doctors Offering Chronic Disease Management

Dr Imesha Rajakaruna

Dr Imesha Rajakaruna


English, Singhala


Ipswich


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Dr Dalia Muraleedharan

Dr Dalia Muraleedharan


English, Hindi, Malayalam


Mango Hill


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Dr Rajesh

Dr Rajesh


English, Hindi, Sindhi, Urdu


Smithfield


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Dr Rohini Wickrama

Dr Rohini Wickrama


English, Sinhalese


Windsor


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Dr Tahmina Khatoon

Dr Tahmina Khatoon


Bengali, English


Arundel Parkwood


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Dr Tom Frogbrooke

Dr Tom Frogbrooke


English


Smithfield


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Dr Preeti Gupta

Dr Preeti Gupta


English, Hindi, Punjabi


Corinda


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Dr Ankush Goyal

Dr Ankush Goyal


English, Hindi, Punjabi


Corinda


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Dr Mrunali Nar

Dr Mrunali Nar


English


West End


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Dr Bradley Olsen

Dr Bradley Olsen


English


Mango Hill


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Dr Farzana Rahman

Dr Farzana Rahman


Bengali, English, Hindi, Urdu


Manunda


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Dr Namal Prematillake

Dr Namal Prematillake


English, Sinhalese


West End


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Dr Dean Adit

Dr Dean Adit


English, Malay


Windsor


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Dr Janaka Abeysirigunawardana

Dr Janaka Abeysirigunawardana


English, Russian, Sinhalese


Mango Hill


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Dr Eva Capuano 2

Dr Evangeline Capuano


English, French


Annandale


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Dr Celina Chuo

Dr Celina Chuo


English, Malay


Annerley


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Dr Afshan Bhagat

Dr Afshan Bhagat


English, Gujerati, Urdu


Pullenvale


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Dr Sandy Nandam


English


Windsor


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Dr Cheng Guo


English, Mandarin


Chermside


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Dr Hayley Waddell


English


Annandale


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Dr Ashleigh Lazzarini

Dr Ashleigh Lazzarini


English


Taigum


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Dr Subrata Aditya


Bengali, English


Annerley


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Dr Tripti Hazra


Bengali, English


Annerley


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Dr Madhu Lakshmaiah


English, Hindi, Kannada, Tamil, Telugu


Chermside


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Dr Lisa Bolton


English


Taigum


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Dr Amitosh Mondal

Dr Amitosh Mondal


English


Chermside


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Dr Shahram Sadeghi


English, Farsi Persian, Kurdish, Turkish


Clayfield


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Dr Elizabeth Ayoola


English


Windsor


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Dr Kokila Kodithuwakku


English, Singhala


Deception Bay


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Dr Jennifer Power


English


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Dr Xiaoping (Angie) Jiang


Cantonese, English, Mandarin


Smithfield


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Dr Arash Payervand


English, Farsi Persian


Ipswich


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Dr Megan Rowe


English


Pullenvale


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Dr Raymond Collins


English


Carseldine


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Dr Shaheed Moideen


English, Hindi, Malayalam, Russian


Taigum


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Dr Helen Tumusiime


English


Annerley


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Dr Ion Constantinescu


English, Romanian


Annerley


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Dr Abigail Reid

Dr Abigail Reid


English


Taigum


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Dr Suraiya Akter


Bengali, English


West End


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Dr Sir-Kit Leong


Cantonese, English, Malay


Clayfield


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Doctor Sally Trenorden

Dr Sally Trenorden


English


Clayfield


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Dr Mara Christa

Dr Mara Christa


English, German


Windsor


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Dr Matt Mousavifard


English, Farsi Persian


Taigum


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Dr John Bennett


English


Toowong


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Dr Dilip Dhupelia


English, Gujerati


Toowong


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Dr Stewart McQuade


English


Arundel Parkwood


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Dr Sukhbir Patheja


English


Arundel Parkwood


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Dr Ebby Patel


English, Gujerati, Hindi, Urdu, Zulu


West End, Toowong


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Dr Janan Al Bahadly


Arabic, English


Chermside


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Dr Gurpreet Singh-Sodhi


English, Hindi, Punjabi


Windsor


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Dr Gagandeep Sodhi


English, Hindi, Punjabi


Windsor


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Dr Yvonne Ho


Cantonese, English


Carseldine


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Dr-Helen-Browne

Dr Helen Browne


English


Corinda


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Dr Ben Gordon


English


Corinda


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Dr Frank Occhin

Dr Frank Occhino


English, Italian


Corinda


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Dr Milivoje Tomasevic

Dr Milivoje Tomasevic


Bosnian, Croatian, English, Serbian


Arundel Parkwood


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Dr Dip Chand


English, Fijian, Hindi


Chermside, Carseldine


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