Summary

There are two types of plans that can be prepared by a General Practitioner (GP) for Chronic Disease Management (CDM):

• GP Management Plans (GPMP); and
• Team Care Arrangements (TCAs)

Your GP or practice staff must obtain your agreement before providing these plans.

There are two types of plans:

• If you have a chronic (or terminal) medical condition, your GP may suggest a GPMP.
• If you also have complex care needs and require treatment from two or more other health care providers, your GP may suggest TCAs as well.

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.

If you have both a GPMP and TCAs prepared for you by your GP, you may be eligible for Medicare rebates for certain allied health services.

It is up to a GP to determine whether you are eligible for these allied health services which must be directly related to the management of your chronic condition.

The practice nurse can provide support and monitoring between visits to your GP. Your GP will offer you a copy of your plan.

You and your GP should regularly review your plan/s.

Chronic medical conditions

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 discussed with other health care providers.

Review of GPMPs and TCAs

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.

Referrals for allied health services

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 (or terminal) medical 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.

The Closing the Gap (CTG) PBS Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders living with, or at risk of, chronic disease.

The CTG Pharmaceutical Benefits Scheme (PBS) Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders who are living with, or at risk of, chronic disease.

CTG prescriptions attract a lower or nil patient co-payment for PBS medicines.

Patient eligibility

The measure aims to benefit Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease and, in the opinion of the prescriber:

• would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine, and
• are unlikely to adhere to their medicines regimen without assistance through the measure

Eligible patients can be registered at either:

• general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme or
• Indigenous Health Services in urban and rural settings

Prescriber eligibility

The following prescribers are eligible to provide their patients with a Closing the Gap annotated script:

• any medical practitioner working in a practice that is participating in the Indigenous Health Incentive under the Practice Incentives Programme
• any medical practitioner working in an Indigenous Health Service in rural or urban settings
• any medical specialist in any practice location provided the patient is eligible under the Closing the Gap - PBS Co-payment Measure, and has been referred by a medical practitioner working in a practice that is participating in the Indigenous Health Incentive PBS Co-payment Measure under the Practice Incentives Programme

Annotating prescriptions

When a patient is registered for the measure and the prescriber wants to grant the benefits of the measure to the patient, the prescriber will annotate the patient’s prescription to indicate that it is to be dispensed with co-payment relief. Closing the Gap prescriptions will either have an automated annotation or a manual annotation.

Under the measure, general (non-concessional) patients who present a Closing the Gap prescription should be charged the current concessional rate for each PBS item on that prescription.

Concessional patients who present a Closing the Gap prescription do not need to pay a patient co-payment for each PBS item on that prescription. However, mandatory charges - such as any applicable brand premiums - must still be paid by the patient or their agent.

If a patient presents as an eligible CTG patient but does not have an annotated prescription confirming their eligibility, the pharmacy will need to refer the patient back to their prescriber.

Processing annotated prescriptions

Prescribers must annotate the prescription with the letters 'CTG', their initials and signature.

When you receive a manually annotated prescription and are processing that prescription through your dispensing software, you must ensure that the Closing the Gap code is entered correctly into your processing software either manually or automatically.

The correct code to use will depend on your dispensing software. For example, using a correct Closing the Gap code of H, 00B or CTG00B will make sure the manual annotation is valid.

The main goal of Deadly Choices is to encourage Aboriginal and Torres Strait Islander people to access their local health service and complete an annual ‘Health Check.’

• not just to see the Doctor when they are sick - but
• to visit their health service and access support to prevent or better manage their chronic disease and remain healthy.

Focusing on the biggest contributors to chronic disease – smoking or tobacco use, physical activity and nutrition – is critical to closing the gap in Aboriginal and Torres Strait Islander health. With a higher susceptibility to chronic diseases such as diabetes, heart, lung and kidney diseases in Indigenous peoples, it’s even more important for community to reduce the potential for and impacts of chronic diseases.

Getting regular health checks is the first step.

A Health Check – or 715 – covers all aspects of health – from measuring blood pressure, and sugar levels to mental and emotional wellbeing. It also helps identify if you need follow ups with our other health providers for example, optometrists, dentists, audiologists or podiatrists (to name just a few).

Having a regular health check means a clinic can build a picture and measure changes in a clients health – helping to prevent chronic disease from become reality, and reducing the impact of chronic disease– by providing ongoing health management and support.

To encourage mob to participate, IUIH, and licensees, provide clients with a free Deadly Choices shirt. These shirts change yearly, with a small variety offered to attract different audiences.