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What is the future of general practice multidisciplinary care?

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The RACGP is inviting feedback on a new draft position statement, in which the college has reaffirmed general practice as the central coordination point for multidisciplinary teams (MDTs) in primary care.
 
The statement outlines a clear vision for team-based models that are patient-centred, grounded in quality and safety, and built around the expertise of GPs and their practice teams.
 
The draft states that general practices remain patients’ first point of contact within the healthcare system and provide whole-person, continuous patient care.
 
‘MDTs that include a GP allow for comprehensive assessment, diagnosis, initiation of treatment and referrals,’ it says.
 
The draft identifies several core principles underpinning MDTs in primary care, including the need for GP inclusion in all teams, a focus on culturally safe and patient-centred care, and that quality and safety underpin the actions of all MDTs.
 
The college also stresses that all team members should be enabled to operate within their agreed scope of practice and collaborate using a shared patient medical record.
 
It also argues that Government funding must support flexible, practice-based care coordination, not only face-to-face services, but also non-clinical activities like governance, team meetings and quality improvement.
 
The RACGP defines an MDT as when at least two healthcare providers from different disciplines ‘work collaboratively with patients to accomplish shared goals within and across settings to achieve coordinated, high-quality care’. They deliver a full range of comprehensive general practice care services and must reflect the broader needs of the community.
 
However, the statement emphasises that a patient and their usual GP or Rural Generalist (RG) are the ‘core members of the general practice MDT’.
 
‘The invaluable expertise and longitudinal care of specialist GPs and RGs significantly enhance the MDT’s ability to effectively address the increasingly complex health needs of the patient population, ultimately leading to improved health outcomes,’ the draft states.
 
The statement does however acknowledge that there are alternative models led by non-GP health professionals due to practical limitations associated with operating in some rural and remote locations.
 
While the college understands these models are necessary in the current environment, it goes on to say that ‘they should not be encouraged’.
 
‘All Australians deserve equitable access to healthcare,’ the draft states.
 
Drawing on evidence from the literature, the statement identifies five principles that are essential to effective team-based care:

• Shared purpose and goals
• Clear roles and responsibility
• Mutual trust
• Effective communication
• The ability to measure process and outcomes of team function

The college highlights the risks of inadequate information sharing, expressing concern over the current limitations of My Health Record as a tool for real-time collaborative care.
 
To support the delivery of safe, coordinated care, the RACGP says robust clinical and cultural governance mechanisms are important to be able to ‘identify, assess and manage potential risks to patient safety, the quality of care and improve patient outcomes’.
 
‘Due to their extensive training, clinical governance expertise and broad scope of practice, GPs are ideally placed to be the clinical lead in MDTs in general practice,’ the draft states.
 
‘Whilst this model is preferred, it is acknowledged there are situations where this may not be possible or practical, such as in rural and remote communities and Aboriginal Community Controlled Health Organisations.’  
 
The statement also references the Unleashing the Potential of our Health Workforce: Scope of Practice Review, which notes that all health professionals can contribute more to healthcare by working at the top of their scope of practice.
 
By keeping GPs at the core of MDTs, the college argues that all health professionals can be better supported to work to their full potential.
 
‘Health professionals working to their top of scope within a general practice team, provides a safer setting, and increases the breadth of expertise and quality of care for patients,’ the draft states.
 
However, it claims that current jurisdictional medicines and poisons regulations, Medicare Benefits Schedule item descriptors and Pharmaceutical Benefits Scheme restrictions ‘unnecessarily curtail GP scope of practice and that of the broader general practice team’.
 
‘Patient access to MDTs in general practice could be significantly improved through policy and regulatory reforms in this area,’ the draft states.
 
For all members of the team to work to their full potential, the position statement addresses the need for workforce reform and funding models, calling for sustainable investment in MDTs.
 
While fee-for-service remains essential, the RACGP suggests leveraging existing funding mechanisms, such as the Workforce Incentive Program and Practice Incentives Program, to better support team coordination, supervision and evaluation.
 
The college emphasises caution against reforms that could result in fragmented, lower-quality care by allowing health professionals to operate beyond their training without adequate oversight. It also warns of the risks of a two-tiered system emerging, where patients in under-served areas receive care from less-qualified providers.
 
‘Completion of online modules or skills workshops are not comparable to years of intensive bedside clinical learning and practical experience in patient assessment, diagnostics and clinical reasoning,’ the draft states.
 
‘If this occurs, it has the potential to reduce equity of access to high-quality healthcare and increase health disparities.’ 
 
The RACGP is encouraging members and stakeholders to provide feedback on the Draft national position statement – General practice multidisciplinary teams, with consultation open until 30 June.
 
The college is also undertaking concurrent targeted consultation with key stakeholder organisations. Once finalised, the statement will help shape the college’s ongoing advocacy.
 
For further information, contact healthreform@racgp.org.au
 
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general practice MDTs multidisciplinary teams position statement primary care RACGP

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