GP Referrals
Programs and Services
We are a team of allied health staff available to work with patients and their GP. Patients can access our allied health services in two ways:
- Self referral: No referral is necessary to consult our staff. Consultation prices are affordable and in line with Medicare Australia’s rebate for eligible services. Rebates are also available from many private health funds.
- GP Referral: Patients with chronic and complex conditions, who are managed by their GP under a GP Management Plan (GPMP) and Team Care Arrangement (TCA), can be referred to our practitioners under the Medicare Plus initiative for up to five free consultations in a calendar year. Those patients who do not qualify for this initiative can still be referred to our team for private consultations.
Our team of clinicians are available to consult your patients at your practice in addition to our CBD location. Please call us to organise a practice visit to assess your service requirements.
Strengths
Allied Health Central has proven success in removing the barriers for patients to access allied health services. Our greatest strength is that our practitioners constitute a true team approach to care, communicating with each other and the GP.
Our Allied Health Professionals focus on multi-dimensional aspects of each patient’s
condition(s), working with the patient and their GP, incorporating evidence based practice to identify and implement management goals and action plans.
Our services under the Enhanced Primary Care (EPC) initiatives are all bulk-billed as are all Department of Veterans’ Affairs referrals. Consultations outside of Medicare are in most instances rebated by private health insurance funds. Self referred appointments are competitively priced.
Frequently Asked Questions
Which patients are eligible for a GP Management Plan (GPMP)?
To be eligible for a GPMP a patient must have a chronic (or terminal) medical condition - one that has been or is likely to be present for 6 months or longer, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions (including dementia), musculoskeletal conditions and stroke. Patients who also have complex care needs are also eligible for Team Care Arrangements (TCA).
Whether a patient meets this criterion is essentially a matter for the GP and, other than the above indicators, the MBS does not comprehensively list all possible medical 'conditions' that either are/are not regarded as chronic medical conditions for the purposes of the EPC or Chronic Disease Management (CDM) items.
Recent questions have asked whether the following are chronic medical conditions for the purposes of the items: alcohol or other substance abuse, smoking, obesity, unspecified chronic pain, hypertension, hypercholesterolemia, or syndrome X, impaired fasting glucose tolerance or impaired glucose tolerance, pregnancy.
The general position on these ‘conditions’ is that they have not been regarded as chronic medical conditions for the purpose of the EPC items to date and this remains the case with the CDM items.
However, in many cases a patient may have complications or co-morbidities, that may be a result of or exacerbated by such conditions or risk factors, that would make them eligible for CDM services.
In some cases these ‘conditions’ would not be commonly regarded as chronic medical conditions of themselves, others may more accurately be regarded as risk factors for development of chronic conditions, some possibly relate more to personal choice/behavioural issues and some (pregnancy without complications) could be regarded as a normal part of life.
It is also recognised, however, that conditions such as the above can occur across a wide spectrum of severity and in a broad range of circumstances, with, for example, some patients with one (or more) of the above conditions being unable to self-manage or comply with care and treatment, being functionally disabled by their condition etc.
A GP must assess whether a patient is eligible for a CDM service, having reference firstly to the MBS eligibility criteria and the above guidance setting stating the general position.
Which patients are eligible for a Team Care Arrangement (TCA)?
This item is for patients with a chronic or terminal medical condition and who require ongoing care from a multidisciplinary team of their GP and at least two other health or care providers. One of the minimum two service providers collaborating with the GP may be another medical practitioner, normally a specialist.
Once a GPMP and TCA have been prepared for a patient and claimed on Medicare, the patient can be referred to the allied health services identified in the TCA.
But what about patients outside the guidelines who I feel would benefit?
Where a patient’s ‘condition’ would not obviously come within the MBS definition, a GP may still consider that, notwithstanding the above, the patient’s condition and circumstances are such that they require the preparation of a GPMP and TCA, for example, because of non-compliance, inability to self-manage, decline in functional abilities and so on.
In these cases, the GP should be satisfied that the GP’s peers would regard the provision of a CDM service as appropriate for that patient, given the patient’s needs and circumstances.
Where a GPMP/TCA is not an option and the patient would benefit from allied health intervention, the GP can always refer to our clinicians in a private framework.
Can a GP do a CDM review and how do they check whether one has already been done?
A review can not be done by “any GP”. The reviewing GP, if not the original GP or one from the same practice, needs to be the patient's new GP.
Where it is unclear whether the patient has a current GPMP, TCA or both, the patient (or their representative) can, whilst at the practice, ring the Medicare Enquiry Line 13 20 11 or 13 21 50 to verify the date of the previous CDM item (if any). The patient (or their representative) will need to quote their Medicare Number and ask whether an item in the range 720 to 731 has previously been paid and if so, when.
It should be noted that the patient's representative must have Power of Attorney and must have previously lodged this with HIC.
Chronic Disease Management Planning Process
