There are a number of aspects of service delivery requiring development across the GP Super Clinics. The multi-disciplinary model of care, as currently provided is mostly reliant on sequential but discrete service episodes provided by a range of disciplines, integrated through co-location under one roof and by the shared electronic health record rather than a shared, planned approach. Where attempts to apply guidelines for multi-disciplinary care have been made they have been informed by guidelines developed specifically for single-professional practice; in most cases for general practitioners. The model of care was further supported by specific Medicare items such as Team Care Arrangements and Chronic Disease Management items.
Multiple professionals working together in one site is relatively new in the primary care setting in Australia, therefore the development of guidelines for multi-disciplinary team-based care is critical to the achievement of the GP Super Clinics Program Objectives. These could be developed is through consortia between GP Super Clinics, universities, professional colleges and other relevant professional groups. Further, due to the significant personal and practice changes involved, a multi-disciplinary team-based skills assessment and skills development program is required for effective implementation of multi-disciplinary guidelines.
The focus on preventative health care has been on secondary prevention, in managing lifestyle risks in people with chronic conditions. Understandably this aligns with the focus in the GP Super Clinics on chronic illness. The potential for impact, and indeed the expectation of primary prevention occurring in GP Super Clinics is high; however demonstration of this was less than optimal. Where it was occurring it was often reliant on patients being referred by the GP to another discipline for intervention. This is a missed opportunity, with a plethora of research indicating the impact of GPs on reducing risk factors in patients, and at a population level.
The utility of electronic health records beyond use as a record for patient care and as facilitators of multi-disciplinary care was not evident. Their utility as tools in organisational, administrative or quality improvement roles has the potential to enhance the quality and model of care in meeting the needs of local communities.
Community engagement occurred mostly in the early phases of the GP Super Clinics. There were some outstanding examples of community engagement with members of local Aboriginal communities. However there was less demonstration of an ongoing and strategic approach to the community engagement required if the GP Super Clinics are going to continue to meet community needs, and those of specific groups with significant health risks.
Ultimately the GP Super Clinics will be expected to provide models of care which support a range of services in meeting local health care needs requiring shared planning and integration with other local primary and acute health care services. While there was limited evidence of progression to an integrated approach to planning, there is potential for this occurring, especially with the support of other reform initiatives.