The ‘usual GP’ issue often causes concerns and even a conflict at GP teams across our industry. With this post, I would like to offer some clarification points on the issue.

This issue is considered sensitive because Medicare rule says that Care Plans, Mental Health Plans and Assessments should be performed by the patient’s usual GP.

There are two aspects of the issue that need to be clarified. Firstly, there is a convention between some GPs on the subject of ‘ownership of the patient’. Medicare does not have any rules about that. Generally, doctors agree that patient ‘moved’ from one doctor to another if the patient has seen a new doctor three times for two unrelated issues when the previous doctor was available (e.g. not away on holidays). It means that the patient made his/her choice freely.

Medicare literature states: “A patient’s ‘usual’ GP means the GP, or a GP working in the medical practice, that has provided the majority of care to the patient over the previous 12 months and/or will be providing the majority of care to the patient over the next 12 months.”

So, according to Medicare, the Care Plan ‘belongs’ to the practice, not to the doctor. This rule was made in order to provide timely services when doctors are absent or patients move from one doctor to another within the practice. (My understanding: I had a chance to speak about this to one of the developers of CDM policy from the Department of Health some time ago)

Practice points:

  • A patient may ask any GP at the practice to perform a Care Plan or Care Plan Review or Team Care Arrangement.
  • It is acceptable to perform such service even though that patient attended another GP at the practice regularly.
  • A patient has the right to ask for that service and if eligible, service should be provided.
  • It is not necessary to ‘send’ patient back to a ‘regular GP’ when the patient asked for the service. The request must be recorded in the notes.