Say farewell to GPMPs and TCAs

GP management plans and team care arrangements will disappear in November, replaced by a single chronic condition management plan item.

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It’s almost time to say so long, farewell, auf wiedersehen and adieu to both GP management plans and team care arrangements, and guten tag to the mysterious new item replacing them.  

From 1 November the two items will be replaced by new “GP chronic condition management plans”.  

Granular details are still scant, despite the change having been announced as part of last year’s May budget.  

What we know about the changes 

If patients are enrolled in MyMedicare, they’ll have to visit the practice where they are enrolled to get their management plans written up. 

Those who aren’t enrolled in MyMedicare will still be able to present to any practice and get a management plan.  

The same processes will apply to referrals under the Better Access scheme from late 2025.  

Since the scheme kicked off in October 2023, close to 1.5 million patients have registered with MyMedicare. 

There will also be a new set of blended funding payments to support better community care for people with complex chronic disease who frequently attend hospitals administered under the patient enrolment scheme.  

Under the new suite of items, management plan reviews will be remunerated equally to writing a new management plan as part of an effort to encourage reviews.  

What we don’t know 

The major unknown is how the new chronic disease items and the blended funding payments will be remunerated. 

Currently, an item 721 GP management plan costs Medicare $164.35, an item 723 team care arrangement costs it $130.25 and a review of either – done under item 732 – costs $82.10. 

RACGP president Dr Nicole Higgins told The Medical Republic that the federal government has failed to guarantee that the reforms will not result in a net funding decrease.

“These changes are set to start in less than three months, and we still don’t know how they will impact the cost of patient care,” she said.

“The delay is causing GPs and their patients’ unnecessary frustration and stress.

“GPs need to be able to plan ahead for these changes, and time to adjust, particularly in rural and remote areas.”

It’s also unclear how the system will work to prevent a patient shuffling their registration around arbitrarily, given they can reregister with practices an unlimited number of times.  

If a patient really wanted to go to a separate doctor for their chronic care plan, they could just transfer their registration to a new practice temporarily.  

The only hurdle is that it would be mildly inconvenient to do so.  

What’s likely to happen 

Messing around with the value of care plans too much could be a risky business for a government that has made a show of raising the bulk-billing rate. 

Chronic disease and complex care management consultations tend to be bulk billed at a far higher rate than most other primary care services. 

Where the total GP non-referred attendance bulk-billing rate was at 78.8% for the June quarter, the GP chronic disease bulk-billing rate was 99.2%.  

They’re also relatively popular; in the last quarter, GPs did roughly the same number of chronic disease consults as level A consults and after-hours consults respectively.  

On the other hand, chronic care is also expensive. 

In the June quarter, the Medicare benefits spent on GP chronic care items was $327 million – greater than the spend on after-hours care and level A, D and E consults put together.  

The only two groups with larger individual benefit spends were level B and level C consults.  

The peak bodies have been relatively silent on the upcoming changes.  

In a submission to a separate inquiry looking at a refresh of the national strategic framework for chronic conditions in May, the RACGP appeared to hint that it wouldn’t oppose a complete rebuild of chronic disease management.  

“The current MBS rebate system follows a one-size-fits all model, allowing for five visits per calendar year via time-consuming team care arrangements,” it said.  

“Shifting to a referral process like that used for medical non-GP specialists, using informative letters, could be considered as it would streamline access to allied health services.”