Until that shift occurs, I fear that multidisciplinary care will remain more aspiration than reality.
A colleague recently asked for reflections on what a “true” multidisciplinary model of care would look like in general practice, and what the barriers to realising that were.
He asked – is it rigid MBS/funding models, clinical governance/rules, workforce shortages, or team culture/practice design that is holding us back from realising the vision?
It only took a second and I knew I had to respond. As the President of the Australian Primary Health Care Nurses Association, and a nurse practitioner with decades of experience in general practice, I know because I’ve lived it.
One of the biggest barriers to genuine multidisciplinary general practice is not funding, workforce, or even infrastructure. It is culture – specifically the entrenched professional hegemony that still shapes how healthcare is organised, funded, and valued.
Despite talk about “team-based care”, most general practice systems continue to operate within a hierarchy where medicine sits at the centre and other disciplines are expected to orbit around it.
That hierarchy influences everything: funding models, referral pathways, governance structures, prescribing rights, access to diagnostics, digital systems, and even whose knowledge is considered legitimate.
Nurses, nurse practitioners, pharmacists, allied health professionals, Aboriginal health workers, and others are frequently brought in to “support” care rather than to lead aspects of care within their own scope and expertise.
Their contribution is often framed as supplementary rather than essential. Yet modern health needs – chronic disease, ageing, mental health, prevention, multimorbidity, rural access – are precisely the areas where distributed expertise works best.
You can see it in subtle ways:
- assumptions that the GP must always be the ultimate decision-maker;
- resistance to autonomous prescribing or direct referral pathways;
- funding systems that privilege short episodic medical encounters over longitudinal team-based care;
- clinical governance models that confuse supervision with collaboration.
Related
True multidisciplinary practice requires a shift from hierarchy to partnership.
That does not diminish medicine. It recognises that no single profession can meet contemporary population health needs alone.
The most effective systems internationally use professionals at the top of their scope, with mutual respect, shared records, shared responsibility, and funding that follows patient need rather than professional dominance.
The irony is that the current hegemonic culture creates inefficiency as much as inequity. Highly trained clinicians spend time seeking permission to do work they are already competent to perform, while patients wait longer, fragment across services, or end up in hospital because primary care capacity is artificially constrained.
Culture is harder to reform than policy because it is often invisible to those who benefit from it. Hegemony survives by appearing “normal”. That is why structural reform alone is insufficient.
If we’re going to embrace the potential of scope of practice reform, we need to change professional cultures – without that we’re trapped in the challenges of the past.
If we are serious about multidisciplinary general practice, we need to move beyond the idea that collaboration means everyone contributing to a medically led model. Real collaboration means shared leadership, reciprocal respect, and recognising that expertise exists across disciplines – not in a single professional hierarchy.
Until that cultural shift occurs, I fear that multidisciplinary care will remain more aspiration than reality.
Denise Lyons is president of the Australian Primary Care Nurses Association, a generalist nurse practitioner and a clinical editor at Hunter New England and Central Coast PHN.
This article was first published on Ms Lyons’ LinkedIn feed. Read the original article here.
