Supporting Self-Care


Funding for Diabetes Care

The Australian Government supports a high-quality and proactive approach to diabetes care through Medicare payments to GPs, nurses, allied health professionals, specialists and and general practices.

There are several item numbers listed on the Medicare Benefits Schedule (MBS) that support the development of diabetes management plans and organising team care. There are also additional incentive payments for GPs who complete an Annual Cycle of Care for their patients with diabetes.

General Practice Management Plans

General Practice Management Plans (GPMP) are documented plans developed together by the GP and the patient. They incorporate the patient’s needs, goals, how these are to be achieved, and reference to any resources used. There is evidence that GPMPs that are reviewed on a regular basis can result in improvement in both process and clinical outcomes.

Team Care Arrangements

Team Care Arrangements (TCA) are expansions of the GPMP that provide details on any allied healthcare worker or team members that implement any part of the GPMP. Diabetes WA has a number of accredited practising dietitians who can provide patients with information, advice and support as part of a TCA.

Annual Cycle of Care

GPs who complete an Annual Cycle of Care for their patients with diabetes may be able to access additional service incentive payments (SIPs) or practice incentive payments (PIPs). An Annual Cycle of Care is a detailed set of patient management steps that can be important in preventing complications associated with diabetes.

An Annual Cycle of Care must include – as a minimum – the following:

  • measurement of weight, height and calculation of BMI (at least twice a year)
  • measurement of HbA1c to assess diabetes control (at least once a year)
  • measurement of blood pressure (at least twice a year)
  • measurement of total cholesterol, triglycerides and HDL cholesterol (at least once a year)
  • test for microalbuminuria (at least once a year)
  • examination of feet (at least twice a year)
  • examination of eyes (at least once every two years)
  • provide education on self-care and managing diabetes (as required)
  • review medications (as required)
  • review diet and encourage good dietary choices (as required)
  • review levels of physical activity and encourage patients to be active (as required)
  • check smoking status and encourage patients to quit (if required).

The above list is considered the minimum level of care that a person with diabetes should receive. Some of the measurements and tests may need to be conducted more frequently than as listed above.


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