Chronic Disease Management
We are able to help with chronic disease care and planning. Whether you’re dealing with diabetes, thyroid disease, hypertension, osteoporosis or another condition, our team of doctors provide the very best chronic disease management.
Patients who have complex medical conditions can be seen for a GP Management Plan (GPMP) and/or Team Care Arrangements (TCA) to help coordinate effective care from their doctor and other healthcare providers.
A chronic 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 or stroke. There is no list of eligible conditions.
A GP Management Plan (GPMP) provides a written plan of action that identifies your healthcare needs, outlines the services to be provided by your GP, and lists that actions that you can personally take to help manage your condition.
Your GP may also suggest Team Care Arrangements (TCA) to be provided in conjunction with your Management Plan if you also have complex care needs and require treatment from two or more other health care providers.
It is important to plan regular reviews with your doctor to check that goals are being met and any adjustments required are made at the right time. Our practice nurse can provide support and monitoring between GP visits.