Table 2 Eligibility criteria for Care Plus [20]

A general practice that is part of a PHO can enrol a patient in Care Plus if they are assessed by a doctor or nurse at the general practice as:

• being able to benefit from intensive clinical management in primary health care (at least 2 h of care from 1 or more members of the primary health care team over the following 6 months), and

• having 2 or more chronic health conditions, as long as each condition is one that:

• is a significant disability or has a significant burden of morbidity; and

• creates a significant cost to the health system; and

• has agreed and objective diagnostic criteria; and

• requires continuity of care and where a primary health care team approach has an important role in management; or

• requiring intensive clinical care because they:

• have a terminal illness (defined as someone who has advanced, progressive disease whose death is likely within 12 months); or

• have had 2 acute medical or mental health-related hospital admissions in the past 12 months (excluding surgical admissions); or

• have had 6 first-level service or similar primary health care visits in the past 12 months (including emergency department visits); or

• are on active review for elective services.