Why is team-based hypertension care failing to take hold in Australia? Real-world evidence from primary care

Objective

Australia’s shortage of general practitioners (GPs) has intensified interest in team-based care for hypertension, involving pharmacists and nurses. This study explored primary care providers’ experiences, barriers, and facilitators related to implementing team-based care in Australia.

Design

Qualitative study using semi-structured interviews with primary care providers.

Methods

We conducted 51 interviews with GPs (n=24), nurses (n=12), and pharmacists (n=15), purposively selected from diverse primary care settings. Analysis combined deductive coding, informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research, with inductive thematic analysis to identify emergent themes.

Results

Interviews demonstrated a predominantly GP-centred care model, with nurse and pharmacist involvement largely confined to supporting roles, including blood pressure measurement, prescription refills, patient follow-up and counselling. Their contributions were constrained by barriers at both practice (e.g., limited GP support, fragmented communication across providers) and health system levels (e.g., limited financial incentives and restricted reimbursement pathways). Despite their critical role in care planning, nurses described being “hamstrung” by workload and limited direct funding for hypertension-related services. Pharmacists reported unreimbursed blood pressure checks and restricted funding for medication reviews that constrained the sustainability of their hypertension services. Role ambiguity and the absence of standardised protocols on task sharing further limited collaboration, with nurses and pharmacists describing concerns about overstepping professional boundaries. Attitudes towards team-based care ranged from active disregard (outright rejection) to conditional acceptance and occasional active uptake (strong endorsement).

Conclusion

Despite clear willingness among nurses and pharmacists to alleviate GP burden, team-based care is rarely implemented in routine practice. Addressing system-level barriers (funding models that incentivise team-based care and standardised treatment protocols that clarify shared workflows), alongside provider-level barriers (stronger awareness and training that normalises task sharing), is critical to support genuine team-based hypertension care in Australia.

What is already known on this topic

• Only 32% of Australians with hypertension achieve blood pressure control, and care remains heavily GP-centred amid a projected shortage of over 8000 GPs by 2030 and worsening rural access.

• Global evidence strongly supports team-based care involving nurses and pharmacists as clinically effective and cost-effective, yet its uptake in Australian primary care remains limited.

What this study adds

• Drawing on 51 interviews with GPs, nurses, and pharmacists, we identify barriers to team-based care at the practice-level (workload, role ambiguity, professional hierarchies) and system-level (misaligned financial incentives, fragmented communication).

• Despite their willingness to contribute more, nurses and pharmacists remain systematically undervalued, with their contributions constrained by attitudes, incentives, and authority that continue to reinforce GP-centred care.

How this study might affect research, practice or policy

• Australia’s 70% blood pressure control target by 2030 will remain out of reach without urgent structural reforms to primary care—blended funding models, standardised task-sharing protocols, clearer scopes of practice, and interoperable digital systems are prerequisites for genuine, person-centred, team-based hypertension care.