GP CHRONIC CONDITION MANAGEMENT PLANS · FOR BEST PRACTICE

Care plans without all the paperwork.

Care plans have never been this simple. Finish GPCCMPs in just a few clicks with Lyrebird and Best Practice.

Try Lyrebird See how it works
Lyrebird · GPCCMP Connected with Best Practice
Best Practice · Patient record Past medical history Medications and allergies Existing patient information
GPCCMP · Generated draft Ready for GP review Patient needs and problems Goals and treatment actions Management and follow-up
Best Practice
Lyrebird Health

Never start a care plan from scratch.

Your patient’s details already filled in. Their goals and treatments drafted from your consultation. See how simple care plans can be with Lyrebird and Best Practice.

Lyrebird · GP CCMPsIllustrative
Alex Morgan ↻ 56 years 02/11 10:15am Consult in progress DictateWrite document
NotepadTranscriptProgress notePatient Summary
Type to edit notes, change format, tone, or add sections
01

Consult as normal

Talk with your patient as you normally would while Lyrebird captures the consultation.

Consult · Alex MorganListening · 04:12
DURING THE CONSULTATION

“Let’s put together a care plan focused on improving your glucose control and managing your knee pain, with support from a diabetes educator and physio.”

02

Create your care plan

With a click, Lyrebird creates a structured GPCCMP using patient information from Best Practice and the goals, treatments and actions discussed during your consultation.

Reviewing an existing plan? For 967 reviews, Lyrebird brings forward the previous care plan from Best Practice and updates it from today’s consultation.

GP CCMP (MBS 965)Ready for review
Clinical historyLoaded from Best Practice
Medical history
Type 2 diabetes, hypertension, osteoarthritis
Current medications
Metformin, perindopril
Allergies
Nil known
Management planDrafted from consult
Patient problems
Type 2 diabetes: HbA1c 7.8%, above target
Knee pain limiting exercise
Goals
Improve glucose control over the next three months
Improve knee pain and mobility
03

Generate referrals

Need to write a referral? Lyrebird can draft those too, using information from your consultation and Best Practice record.

ReferralsDrafted from consult
Diabetes educatorReview diet and glucose monitoring.Referral letter drafted
PhysiotherapistHelp with knee pain and mobility.Referral letter drafted
04

Review & save to BP

Review your completed care plan, make any final changes, then save it directly to Correspondence Out in Best Practice with a click.

Best Practice · Patient recordSaved to BP
ALEX MORGAN
Correspondence Out
GP Chronic Condition Management PlanMBS 965 · 2 November 2026
Referral to diabetes educatorReferral letter · 2 November 2026
Referral to physiotherapistReferral letter · 2 November 2026
GP CCMP and 2 referral lettersSave to BP

Less paperwork. More care planned.

Creating and reviewing care plans shouldn’t feel like a whole separate job. With Lyrebird, it doesn’t have to.

Less to piece together.

Stop digging through records and disconnected systems. Work with your patient’s history right in front of you.

More focus on care.

Spend less time managing paperwork and more time discussing your patient’s goals, treatments and progress.

Less left for later.

Finish your consultation with a care plan ready to review, instead of another document to put together from scratch.

Connected by design.Controlled by you.

We’ve thoughtfully designed our integrations so you can experience the benefits of connected clinical systems, with confidence in how your information is handled and control over clinical decisions.

Purpose-built connections

Lyrebird exchanges information through a secure, purpose-built integration with Best Practice, rather than giving AI unrestricted access to navigate your clinical software.

Access for a defined purpose

Specific information for a specific task. Lyrebird draws only the patient details, history, medications and allergies the care plan needs, and saves the finished plan to Correspondence Out.

Clinical decisions stay with you

You discuss and agree on goals and treatment with your patient, then review, refine and finalise the care plan before saving it to the patient’s record.

Familiar clinical systems.Entirely new possibilities.

Discover a new way of working when the clinical systems you already trust work together through Lyrebird.

Best PracticeHealthShare
CubikoBetterConsult
Services Australia
See all integrations →
EXPERIENCE IT YOURSELF

Your next care plan could be this simple.

Try Lyrebird with Best Practice and experience a simpler way to create and review GPCCMPs.

Get Started
Best Practice · Correspondence Out
Saved to Best Practice
GP Chronic Condition Management PlanMBS 965 · 2 November 2026
Patient detailsFrom Best Practice
Clinical historyFrom Best Practice
Management planReviewed
ReferralsPrepared

Frequently asked questions

Can I use Lyrebird for both new GPCCMPs and reviews?

Yes. Lyrebird supports both MBS item 965 for creating a new GP Chronic Condition Management Plan and item 967 for reviewing an existing plan. Each has a dedicated workflow designed around the relevant care planning requirements.

Does Lyrebird automatically include information from Best Practice?

Yes. Lyrebird draws on information already in your patient’s Best Practice record, including medical history, medications and allergies, when drafting a GPCCMP. This means you don’t need to manually copy those details into the care plan.

Can Lyrebird use information from a previous care plan when creating a review?

Yes. When reviewing an existing GPCCMP using the 967 workflow, Lyrebird can bring forward information from the previous plan and use your current consultation to draft the updated review. You can then check what’s changed, make adjustments and finalise the documentation.

Do I still need to complete the care plan myself?

Lyrebird prepares a structured draft using your consultation and available patient information, so you don’t have to manually complete the plan from scratch. You remain responsible for discussing and agreeing on the care plan with your patient, reviewing the documentation and making any necessary changes before finalising it.

Can I generate referrals as part of the same workflow?

Yes. If your care plan involves other healthcare providers, you can generate related referral letters within the same workflow. Lyrebird uses information from the consultation and patient record to draft the letters, ready for you to review and finalise.

Where does the completed GPCCMP get saved?

Once you’ve reviewed and finalised the care plan or review, you can save it directly to Correspondence Out in the patient’s Best Practice record. There’s no need to download the document or manually copy it across.

Do the GP CCMP drafts meet Medicare requirements?

Lyrebird’s dedicated 965 and 967 workflows are designed to support the relevant Medicare requirements. GPs remain responsible for confirming patient eligibility, meeting the applicable clinical and documentation requirements, and reviewing the final care plan before saving it.

Can a practice nurse start a GPCCMP for the GP to finish?

Yes. A nurse can use Lyrebird to draft a GPCCMP and hand it over to the GP with a note. The GP can then continue the consultation, review the existing draft and finalise the care plan without starting again.