General Practitioner
Dr Md Asif Anwar
MBBS, FRACGP, MPHSpeaks English, Bengali- Chronic disease (diabetes, heart, kidney and thyroid)
Dr Sabah Zaki reviewing a patient’s health
Chronic disease management GP in Delacombe, Ballarat.
Living with a long-term condition is easier with a clear plan. Our GPs and practice nurses help you set goals, coordinate your care team and keep track of your health over time.
Prefer to talk? Call (03) 9948 9176
How a care plan works.
Tap a step, or let it play through.
Step 1 of 6
Assess
Your condition and goals
Your GP and nurse review your health, medicines and what matters to you.
What happens
- Health and medicines review
- Tests and measurements
- Your goals
- Who’s in your care team
Step 2 of 6
Plan
A written plan
Your GP prepares a GP chronic condition management plan with goals and actions.
What happens
- Goals and actions
- Allied health referrals
- Medicare rebates for eligible visits
- A copy for you
Step 3 of 6
Team
Coordinated care
Your GP coordinates care with allied health providers and specialists.
What happens
- Allied health referrals
- Specialist communication
- Nurse support
- Pathology onsite
Step 4 of 6
Track
Regular checks
Regular tests and check-ins help keep your condition on track.
Step 5 of 6
Review
Update the plan
Your plan is reviewed regularly and updated as your needs change.
What happens
- Plan reviews
- Progress against goals
- New referrals if needed
- Telehealth for suitable reviews
Step 6 of 6
Live well
Day to day
Self-management, support and lifestyle changes that suit your life.
What happens
- Healthy eating and activity
- Mental health support
- Carer support
- Knowing when to seek help
Conditions we help manage.
Long-term conditions our GPs and nurses support. Choose a service to see what’s involved, how long to book, any costs and which GPs have an interest in it.
Ready to book?
Book online and choose a longer appointment, or call reception to book a care plan.
GPs for chronic disease care.
These GPs have interests in chronic disease management, supported by our practice nurses.
General Practitioner
Dr Devika Kumari Mabula Arachchige
MBBS, FRACGPSpeaks English, Sinhalese- Chronic disease (diabetes, blood pressure)
General Practitioner
Dr Mina Ghorbanpour Landy
MDSpeaks English, Persian- Chronic disease management
General Practitioner
Dr Mukhtar Ali
MBBS (Hons), DCH, FRACGPSpeaks English, Urdu, Arabic- Diabetes
- Chronic disease management
GP Registrar
Dr Khushpinder Kaur
MBBSSpeaks English, Hindi, Punjabi- Chronic disease management
GP Registrar
Dr Harindri Pathiraja
MBBS, AMCSpeaks English, Sinhalese- Chronic disease management
- Diabetes management
General Practitioner
Dr Chanaka (Chan) Amugoda
MBBS, FRACGP, DRANZCOGSpeaks English- Chronic disease (diabetes, blood pressure, cholesterol, asthma)
GP Registrar
Dr Maryam Imran
MBBSSpeaks English, Urdu, Hindi, Punjabi- Chronic disease management
- Diabetes management
GP Registrar
Dr Saly Ahmed
MBBS, Master of Critical Care MedicineSpeaks English, Arabic- Chronic disease management
Getting ready for your care plan.
Bring along:
- 1Your medicines
All medicines, including vitamins and creams.
- 2Recent results
Letters and results from specialists and hospitals.
- 3Your goals
What you’d most like to improve.
- 4Your care team
Names of providers you already see.
Our GPs speak languages including Arabic, Hindi, Persian, Punjabi, Sinhalese, Tamil and Urdu. Interpreters can also be arranged.
Chronic disease questions.
Common questions from our patients. For anything else, our reception team is happy to help.
Book online Health JournalType 2 diabetes and GP chronic condition management plansA written plan for people with a condition lasting six months or more, setting goals and coordinating care. It replaced GP management plans and team care arrangements from 1 July 2025.
Eligible GP services are bulk billed with a valid Medicare card. Allied health providers set their own fees.
Your GP will advise. Plans are reviewed regularly to keep them on track.
Existing plans can continue until 30 June 2027, or you can move to the new plan at your next review.
If you’re registered with MyMedicare, your care plan is provided through your registered practice.
Book a care plan appointment in Delacombe.
Open seven days at Pad 1, Delacombe Town Centre. Bulk billed for eligible patients with a valid Medicare card.
General information only. Your GP will advise what is right for you. In an emergency, call 000.