SGGPCP encourages an interdisciplinary, coordinated approach to chronic disease management and recommends client and carer empowerment through self-management programs.  The broader aims include to slow the rate of disease and to reduce inappropriate demands on the acute health care system.  SGGPCP recognises the impact of chronic disease for clients, their carers and/or families and engages with member agencies to provide the right care in the right place at the right time.  SGGPCP believes enhancing care coordination and building a whole of service system response is critical to chronic disease management.

SGGPCP aims to:

  • Support member agencies to meet the needs of clients with chronic disease through comprehensive assessment and care planning
  • Ensure options for self-management are available to people with chronic disease across the PCP catchment
  • Encourage partnerships between health and community organisations for better-integrated management of chronic disease across the catchment
  • Assist member agencies with workforce development in the area of chronic disease management

Further information on Integrated Chronic Disease Management:

Department of Health Integrated Chronic Disease Management

Wagner Chronic Care Toolkit

Integrated Chronic Disease Management Clearing House

Chronic Illness Alliance