The Role of a GP in Chronic Disease Management

A team of GP and Allied health professionals preparing a chronic disease management plan in Darwin, Doctor in Darwin

About Chronic Disease

Chronic diseases are health conditions that persist longer than 6 months and sometimes up to years. These diseases cannot be treated with vaccination or cured by just medications, instead, it requires ongoing medical attention and a proper management plan by doctors.

Chronic diseases such as diabetes, cardiovascular and cancer are the leading causes of death and disability in Australia. In fact, 9 in every 10 deaths in Australia is caused due to the 10 commonly identified chronic conditions.

Apart from causing an adverse impact on an individual’s life, chronic diseases also create a huge financial impact on Australia’s health care system.

GPs can help you manage your chronic disease

A chronic disease patients seeking management plans through a GP, Doctor in Darwin

General Practitioners like Territory Medical Group plays a critical role within the Darwin healthcare industry in identifying, diagnosing and treating a wide range of chronic diseases.

With a range of available resources and Medicare’s Chronic Disease Management Plans (formerly called the Enhanced Primary Care or EPC Plan), GPs are at the forefront to help patients manage their diseases across all age groups.

Read below the 4 roles our Darwin doctors play in helping a patient with chronic disease

GPs are your primary healthcare providers

GPs are often your first point of contact with any illness. They are involved in providing primary health care services such as diagnosing chronic diseases and providing preventive healthcare solutions.

They act as your gatekeepers in following up with your on-going treatment and progress and ensure you’re referred to the best specialists if deemed necessary.

GPs brings together a multi-disciplinary team for managing chronic disease

Most patients with chronic diseases require a multidisciplinary team of healthcare providers. That is where a GP will ensure that a patient-centered service is provided to all patients.

Since chronic diseases come with unique symptoms, patients might be requiring customised services.

A GP can tailor all your medical needs according to what’s best suits including playing a vital role in maintaining communication between you, medical specialists and allied health professionals.

GPs can help patients access Medicare support

A GP can help you access Medicare support through a Chronic Disease Management Plan. This plan prepared by a GP provides a structured way to manage chronic diseases in Australia. Often accompanied by other specialists and allied health professionals, a patient can seek medical support from a multi-disciplinary team of care providers.

At our Darwin GP clinic, we provide 5 major types of Chronic Disease Management Plans including plans for managing Diabetes, Heart Diseases and Asthma.

GPs keep a track of your treatment progress

Since your GP is the first point of contact for any chronic condition, they lead your treatment in arranging referrals, tests and biopsies, so all your medical records are accessible to your GP.

With the Australian Government’s cloud-based “My Health Record” initiative, many GPs are now allowed to access your electronic medical records at any given time. They can keep track of your treatment, progress, changes in diagnosis and medication all in one place.

What are the major chronic diseases in Australia?

A patients with chronic disease while consulting a GP in Darwin, Chronic Disease Darwin

The Australian Institute of Health and Welfare identifies 8 major chronic diseases affecting us. They are:

  1. Arthritis
  2. Asthma
  3. Back Pain
  4. Cancer
  5. Cardiovascular diseases
  6. Chronic Obstructive Pulmonary Disease
  7. Diabetes
  8. Mental Health conditions

Know your Chronic Disease Risk Factors

The chronic disease risk factors are well known and only a handful of them are responsible for causing almost all chronic diseases. The risk factors cause the same impact on both men and women and across all age groups, however, your chances of suffering from a chronic disease increase with your age.

Major risk factors like unhealthy diet, excessive use of tobacco and alcohol as well as physical inactivity are major yet modifiable risks along with non-modifiable factors like age and hereditary go hand in hand in causing cancer, diabetes and strokes.


Common Modifiable Risk Factors

  • Unhealthy Diet
  • Excessive smoking and consumption of alcohol
  • No or less physical activities

Common Non-Modifiable Risk Factors

  • Age
  • Genetics

Intermediate Risk Factors

  • Increased blood pressure
  • Increased cholesterol
  • Obesity and Overweight
  • Increased blood glucose levels

Maintain your best health with chronic diseases through Territory Medical Group

Our Darwin Chronic Disease GP has formed a team to help you treat and manage a range of chronic diseases. Lead by Dr. Sara Martin and Dr. Geoff Harper, we will provide all the necessary information about your disease, medications and support through our Chronic Disease Management Plans.

At our Darwin GP Clinic, we provide allied health services to manage any chronic pain conditions along with Acupuncture and head and neck specialists.

Other mental health chronic issues like depression and anxiety can be effectively managed with our Darwin based Psychologist Dr. Kerri Thomas alongside our GPs.

To consult our doctors for any chronic condition, you can book an online appointment or alternatively give us a call at (08) 8948 4333 for further details on our chronic disease management plans.

Did you know that you can book your next appointment via our App?​

It’s easy! Just download it from the App store or Google Play.

Download the Territory Medical app Download the Territory Medical app

Need to renew your script or referral?

You are able to request a repeat prescription or reprint of an existing referral online for General Practitioners at Territory Medical (conditions apply).