Cronic Disease Management

The Chronic Disease Management (CDM) program works to engage with GPs, AHPs, practice nurses and practice staff to enhance chronic disease management and optimise preventative health strategies.

The program offers support, training and assistance with:

  • MBS Primary Care items e.g. health assessments, care plans, asthma and diabetes service incentive payments
  • Best practice guidelines and clinical support systems
  • The use of screening tools e.g. diabetes risk assessment tool (AUSDRISK), cardiovascular risk calculator
  • Coordinating patient care e.g. referral pathways
  • Quality Improvement activities that utilise the Pen CAT data extraction tool e.g. Putting Data into Practice initiative

A chronic medical condition is one that has been present for at least six months or longer, such as:

  • Asthma
  • Cancer
  • Cardiovascular Disease
  • Diabetes
  • Musculoskeletal conditions
  • Stroke

If you have a chronic medical condition, you may be eligible for Medicare benefits if your doctor prepares the following plans for you.

Patients who have had, or are likely to have, a chronic condition for at least six months are eligible for a GP Management Plan (GPMP). Patients who also have complex care needs are also eligible for a Team Care Arrangement (TCA). The GP may be assisted by a practice nurse or other health professional in the preparation of these item numbers.

GP Management Plans are designed for patients who have complex conditions that require ongoing care, and a structured approach.

Your GP will determine if a plan is appropriate for you.

We offer care plans to all eligible patients who suffer from a chronic illness.

Patients are asked to book an appointment with their GP first to determine if they are eligible, and then an appointment will be made with the Practice Nurse who will complete the care plan.

Clinic standard opening hours are:
- Monday - Thursday
- Friday
- Saturday & Sunday
Make an appointment
(03) 5744 1777

LATEST NEWS

We run Skin Clinics on Wednesday and Thursday mornings, bookings are required.

Shingles vaccine – Free to all over 70 - 79.


Flu vaccine – Free to pregnant women and those over the age of 65.
$16 - Flu needle available at the clinic.


Whooping Cough vaccine – Free to pregnant women.
$45 - Available to all others who require it.