Chronic Condition Care
At Friendship Square Medical, we provide ongoing care and support for people living with chronic health conditions.
Chronic conditions are long-term health issues that may need regular monitoring, treatment and support over time. They can affect your day-to-day life, but with good care, planning and follow-up, many chronic conditions can be managed well.
Your GP can help you understand your condition, monitor your health, coordinate care with other health professionals, and support you in making practical changes to improve your wellbeing.
How we can help
Our chronic condition care services include:
Diabetes care
Heart disease and cardiovascular risk management
High blood pressure
High cholesterol
Asthma and COPD
Chronic kidney disease
Osteoporosis
Arthritis and joint pain
Chronic pain
Thyroid conditions
Iron deficiency and anaemia
Weight management and metabolic health
Mental health conditions
Neurological conditions
Cancer follow-up and survivorship care
Medication reviews
Blood test monitoring
Lifestyle and preventive health advice
Referrals to specialists and allied health providers where needed
Care planning and regular review
Ongoing GP care
Living with a chronic condition often involves more than simply treating symptoms. Your GP can help with regular monitoring, medication adjustments, preventive care, lifestyle advice and early identification of complications.
Depending on your condition, this may include blood tests, blood pressure checks, weight monitoring, heart health assessment, lung function testing, foot checks, kidney checks, vaccination advice, medication reviews and referral to other health professionals.
The goal is to help you stay as well as possible, reduce the risk of complications, and make sure your care is coordinated.
Chronic condition management plans
Some patients with chronic conditions may be eligible for a GP Chronic Condition Management Plan.
These plans are designed to support people who need ongoing, coordinated care. They can help document your health conditions, goals, treatment plan, medications, referrals and follow-up needs. From 1 July 2025, GP chronic condition management plan items replaced the previous GP Management Plans and Team Care Arrangements under Medicare.
A plan may also help eligible patients access Medicare-subsidised allied health services, such as physiotherapy, podiatry, dietetics, exercise physiology or diabetes education, where clinically appropriate. The MBS notes that referred allied health services are available for patients with a GP chronic condition management plan, with transition arrangements for older GP Management Plans and Team Care Arrangements until 1 July 2027.
Your GP can discuss whether a chronic condition management plan is suitable for you.
Diabetes, heart health and preventive care
Many chronic conditions are connected. For example, diabetes, high blood pressure, cholesterol, kidney disease and heart disease risk often need to be considered together.
Your GP can help you understand your risk factors, arrange appropriate checks, review medications, support lifestyle changes and coordinate care with specialists or allied health providers where needed.
Regular review is important, even when you are feeling well, because some conditions may not cause symptoms until they are more advanced.
Working with your healthcare team
Good chronic condition care often involves a team. Depending on your needs, this may include your GP, practice nurse, specialist, pharmacist, physiotherapist, podiatrist, dietitian, exercise physiologist, psychologist or other health professional.
Your GP can help coordinate this care, keep track of your overall health picture, and make sure your treatment plan remains practical and up to date.
Book an appointment
To discuss a chronic condition, care plan or regular health review, please book an appointment with one of our GPs.
Chronic condition care often requires a longer appointment, especially for new patients, care planning, medication reviews, multiple health issues or complex symptoms. If you are unsure what appointment type to book, please call our reception team and we can help guide you.
