Your questions answered: GP Health Care Plans
General Practitioner Dr Gary Butler from Illawarra Family Medical Centre answers the most frequently asked questions surrounding GP Health Care Plans.
-
A care plan refers to a General Practitioner Management Plan (GPMP) or a Team Care Arrangement (TCA). Both types of care plans are used by GPs to help people living with chronic diseases, complex medical needs and/or terminal illnesses.
-
People who have at least one chronic medical condition, or complex medical care needs, are eligible for a care plan. A chronic medical condition is defined as an illness or disability that is present for at least six months.
Examples of common conditions that may require care plans include:
Heart disease
History of falls
Asthma
Chronic obstructive pulmonary disease
Diabetes
Cancer
Stroke
Arthritis
Parkinson’s disease
Kidney disease
Mental ill-health
People who are either an in-patient in a public hospital or are already on a care package due to living in a residential aged care facility are not eligible.
-
• Organised, structured and planned approach to your healthcare
• Active participation of patients in their own healthcare
• Ease of coordination between your GP, your specialists, and any allied health providers
• Building rapport between patients and their GP
-
A care plan will be created by your usual doctor (GP). This is the doctor who you have seen most often within the past 12 months, and who will be the doctor you are going to see most in the following 12 months, to manage your health. For the majority of patients, this is their GP.
-
A General Practitioner Management Plan (GPMP) sets out a plan of action to manage your medical condition. The plan is agreed upon by you and your GP, giving you an active role in your healthcare. A GPMP will include:
• Your diagnosed medical condition(s), and any other relevant health information, such as prescribed medications
• The goals of your management plan, as agreed upon by you and your GP
• A list of services and treatment you will need, who will be providing the services, and arrangements for each service
• A list of actions that you can take to actively help manage your condition(s)
• Clear arrangements for reviewing the plan
A Team Care Arrangement (TCA) is generally used for patients with complex medical needs that requires multidisciplinary management. For example, a patient who is recovering from a stroke can require a GP, rehabilitation physician, speech pathologist, physiotherapist, and occupational therapist if their needs are very complex! Due to this, a TCA is more complex than a GPMP to set up for a patient as it requires:
• The patient’s usual medical practitioner (most often their GP)
• At least two other health practitioners that are involved in the patient’s care
• Each practitioner must be providing a different service
• Discussion between the multidisciplinary team members regarding:
• Goals of the treatment and services provided to the patient
• Actions the patient can take to help manage their condition(s)
• Arrangements for review dates
• Clear understanding amongst team members about their role in the patient’s care
Family members and/or informal carers are not regarded as health practitioners.
-
Once a Care Plan has been made by your GP, it should be regularly reviewed and changes made accordingly. Regular reviews, generally every six months, allows you and your medical team to assess whether your goals of treatment are being met.
Your Care Plan may be changed if the goals of treatment change, which can be due to various reason such as an improvement or deterioration of your condition and/or overall health.
-
All aspects of a Care Plan are funded by Medicare through specific “item numbers” that are listed in the Medicare Benefits Scheme (MBS). This means that you are able to claim for all of the following:
• Preparation of a GPMP
• Coordinating the development of a TCA
• Reviewing a GPMP and/or TCA
• Contributing to a multidisciplinary team care plan provided by different provider
• Contributing to a multidisciplinary team care plan provided by residential aged-care facility
In summary, Medicare offers up to five rebated services annually per patient. Additional services are not allowed. If providers accept the Medicare benefit as full payment, there’s no out-of-pocket cost; otherwise, patients pay the difference. Referrals to allied health providers must come from GPs, who require reports from them.