Chronic disease management in Kilmore
Living with a long-term condition is easier when someone is watching the whole picture rather than treating each flare-up as it arrives. That is what a chronic condition management plan is for.
Planned care instead of reactive care
Most people with a chronic condition are managing several things at once – medications, blood tests, specialist appointments, and the checks that are supposed to happen at intervals nobody quite remembers.
A chronic condition management plan puts that on paper. What your goals are, what you are taking, which checks are due when, and who else is involved. It turns a scattered set of appointments into a schedule, which is how problems get caught while they are still small.
Where allied health is part of your care, the plan can also give you access to Medicare-subsidised visits to a podiatrist, dietitian, physiotherapist or similar. For a lot of patients that is the difference between being told to see one and actually going.
Who this is for
- Patients with type 2 diabetes, or pre-diabetes
- Anyone with high blood pressure or heart disease
- People with asthma or COPD
- Patients with arthritis or chronic pain
- Anyone managing kidney, thyroid or liver conditions
- Older patients juggling several conditions and medications at once
What is involved
A full review
A longer appointment covering every condition, all your medications, what is working and what is not, and what matters most to you. Bringing everything to one appointment is more useful than raising it in pieces.
A written plan
Your goals, your treatments, the checks you are due and when, and the other professionals involved. You get a copy, so it is not just sitting in a system you cannot see.
Coordinated allied health
Where relevant, your plan connects the other people involved in your care – podiatrist, dietitian, physiotherapist, diabetes educator – and can give access to Medicare-subsidised visits. Your GP will explain how many apply to you.
Scheduled reviews
Every three to six months, so blood tests, blood pressure, feet, eyes and medications get checked when they should. Adjustments happen early rather than at the next crisis.
Book an appointment if
- You have a long-term condition and no written plan
- Your last review was more than six months ago
- You are taking several medications and are not sure they are all still needed
- You have been told to see a podiatrist or dietitian and have not got there
- You are new to the practice and want your conditions properly documented
Before your appointment
Bring every medication you take, including anything from the chemist and any supplements – the boxes are easier than a list. Bring recent results and specialist letters if you have them. Ask reception for a longer appointment and say it is for a care plan, so enough time is set aside.
Related services at All Care
All Care Medical and Dental Centre is at 3 Powlett St, Kilmore VIC 3764, with GP-led medical care and dental services at the same clinic. We welcome new patients from Kilmore, Broadford, Wallan, Wandong, Lancefield, Romsey, Beveridge, Hidden Valley, Heathcote Junction and Pyalong. Book online or call +61 3 9115 2979.
Frequently asked questions
I already had a care plan from another clinic. Does it still count?
Bring it with you. Plans written under the previous arrangements are still recognised, and your GP will tell you whether yours needs updating or replacing. The rules changed in July 2025, so plans written before then work differently to new ones.
How often should my plan be reviewed?
Usually every three to six months, depending on the condition and how stable things are. Your GP will set the interval with you and the clinic can remind you.
Do I need a longer appointment?
Yes. Setting up a plan takes considerably longer than a standard consultation, so tell reception what the appointment is for when you book.
Can I still see my specialist?
Absolutely. The plan is designed to sit alongside specialist care, not replace it, and helps make sure everyone is working from the same information.
Book an appointment at All Care
New patients are welcome. Book online, or call our reception team if you are not sure which appointment you need.