Clinicians indicated a number of factors either positively or negatively impacted on the provision of multi-disciplinary and integrated care within the GP Super Clinics. First, clinical and organisational leadership which provided direction and support was considered critical in driving the model of care. In most interviews this was reflected in comments by GP Super Clinic Directors and clinicians. This reflects evidence of the importance of clinical and organisational leadership in most clinical settings.27,28 Many clinicians indicated that the Directors had a clear vision of the model of care which drove a range of strategies to support the model. In GP Super Clinics where this leadership was less evident or where there was uncertainty in the clinical leadership roles, the model of multi-disciplinary care appeared to be one dependent on co-location of disciplines and on a “business as usual approach” rather than a vision of integrated multi-disciplinary teams.
Second, the model of care where multiple disciplines provide care under one roof, was considered critical to the success of the GP Super Clinics. This enabled access to and immediacy of information-sharing among different disciplines which, under other models, were reliant on varying forms of communication between disciplines. Most clinicians were positive about co-location.
I have worked in a private practice before with other [allied health disciplines]. I had little communication with GPs other than through referrals or summaries of interventions. I did not know many of them [GPs] other than at the end of a phone. Here I can catch them in the corridor to discuss a client, as well as having the shared health record. It works brilliantly and I think the clients are getting better care because of these informal corridor conversations.”
Allied health professional – interview
This was further reflected in patient comments in surveys and in interviews.
....This practice offers a range of services all in the one place
Patient - survey
[Moved to this GP Super Clinic] Because of the multi-disciplinary service this clinic gives
Patient - survey
We moved here to be near this clinic. It has a range of service which [spouse] needs and they are all here in one spot. So we don’t have to travel to different spots. And they all know what’s going on with [spouse] as it is all on the record.
Patient - interview
Third, the shared health record was seen by clinicians as a key factor in enabling the sharing of information to support multi-disciplinary care. The record was seen as an efficient and effective tool which resulted in better care for patients. In particular, allied health clinicians commented on the importance of the shared health record in supporting coordination of care, a system which they had not experienced when working in separate locations. The majority of clinicians (88%) in the survey rated IT systems to support multi-disciplinary care as important, with 89% indicating that such IT was in place in their GP Super Clinic. This was reinforced by many patients who indicated that they were happy with the shared health record as it meant that all the clinicians were aware of their clinical information and they did not have to repeat the information when seeing a range of clinicians at the GP Super Clinics.
Fourth, the culture of and team-work within most of the GP Super Clinics were conducive to multi-disciplinary care. Evidence for factors impacting on teamwork in relation to multi-disciplinary care align with elements of the model within the GP Super Clinics, such as co-location and shared electronic health records.29 However, evidence also supports the need for shared planning and protocols. The extent to which these were effectively in place in most GP Super Clinics was not able to be determined accurately. To maintain a positive culture and team-work, more attention to shared planning and protocols may be required.
Fifth, the differences in organisational models including not-for-profit, community owned, private for profit and third party contractual arrangements, did not appear to impact on the provision of multi-disciplinary and integrated care. Rather the flexibility in models provided for under the GP Super Clinics Program allowed resources to be used to suit local needs and contexts. Problems in relation to organisational models occurred where there were third party contractual arrangements requiring reporting at multiple levels and attempts to align sometimes disparate objectives.
Lastly, access to and equity in the Medicare Benefits Schedule (MBS) was raised consistently as a barrier to optimising multi-disciplinary care. In particular, clinicians raised the inconsistency in access for all disciplines and the inequity in remuneration across disciplines for participating in multi-disciplinary teams and in particular for case management. The MBS items 735 to 758 provide rebates for medical practitioners (not including specialists or consultant physicians) to organise and coordinate, or participate in, multi-disciplinary case conferences for patients in the community or patients being discharged into the community from hospital, or people living in residential aged care facilities.30 These items were recognised as supporting some aspects of multi-disciplinary care but the inequity in remuneration was perceived to be a barrier.
GP Super Clinics doctors frequently identified a feeling of guilt in case management as they were able to bill for these services, whereas allied health were unable to bill under the MBS item. In many instances, allied health staff reported willingness to participate in case conferences in the interest of patient care and their professional learning.
27Bisognano M. Leadership’s Role in Execution Healthcare Executive. 2008.
28Mountford J, Webb C. When Clinicians Lead. McKinsey Quarterly. February 2009.
29Jackson-Bowers E. How does teamwork support GPs and Allied Health Professionals to work together? Research Roundup. 2010;14.