The ever-expanding role of the specialist GP

Over the past few decades, the health needs of New Zealanders have become more complex. People are living longer, often with multiple long-term conditions that require coordinated, continuous and person-centric care. As the health system responds to this growing complexity, the role of the specialist GP has had to evolve with it. 

Today, specialist GPs are not only expert clinicians; they are clinical leaders, educators and champions of multidisciplinary care. 

Becoming a specialist GP in New Zealand takes a minimum of 11 years. Achieving Fellowship of the Royal New Zealand College of General Practitioners (FRNZCGP) signifies in-depth generalist expertise, diagnostic breadth and the ability to manage uncertainty across the full spectrum of primary care.  

More recently, general practice teams have expanded to include roles such as health improvement practitioners, health coaches, health care assistants and nurse practitioners. These roles play vital parts in meeting the physical, mental, social and cultural needs of patients and their whānau. The composition of any given practice team will, and should, vary between urban, rural and hauora Māori settings and be focused on the needs of the individual patient base and the wider community. 

And as teams grow, so too does the leadership responsibility of the specialist GP. 

Looking ahead, leadership, supervision and clinical integration are increasingly prominent components of the role of specialist GPs, with this shift already visible in regulatory settings, and our GP training will adapt to reflect this change in role. The Medical Council of New Zealand makes clear that doctors retain responsibility for supervision, delegation and clinical oversight within team-based models of care.

This makes specialist GPs uniquely positioned to lead multidisciplinary teams. Our generalist training enables us to provide oversight and integrate medical, nursing and allied health input into a single, coherent care plan, which is particularly important for patients with chronic health conditions or complex social needs. 

The College’s 2024 Workforce Survey reinforces the value of multidisciplinary teams, with respondents highlighting improved access, better holistic care and shared workload among the benefits of this more team-based approach to care. However, GPs also reported growing concern about the burden of supervision, medicolegal risk and the lack of infrastructure and funding to support these expanded roles sustainably. 

These concerns were also highlighted earlier in the College’s Your Work Counts project data, which showed that while GPs spend about 55 per cent of their time in patient-facing consultations, current funding models largely remunerate only direct patient care, undervaluing the leadership, teaching and supervisory functions that are now central to safe, high-quality general practice. 

The College has consistently supported regulated health professionals working at the top of their scope. But at the same time, we have been clear that introducing new roles without clearly defined scopes, supervision arrangements and accountability risks fragments care, blurs escalation pathways and undermines patient trust.  

A specialist GP-led multidisciplinary team, when properly supported and where each team member has a clear scope of practice, enables everyone to contribute fully and safely to patient care. Patients establish important continuity of care with their primary care teams, and the specialist GP team leaders oversee the provision of coordinated, high-quality care. 

As primary care continues to evolve, recognising and resourcing the specialist GP as a clinical leader will be essential, not just for the workforce, but for the long-term safety, effectiveness and sustainability of general practice in Aotearoa New Zealand. 

This column was published in NZ Doctor on 16 March 2026.