To assess general practitioners’ (GPs) perceptions about palliative care needs and complexity of patients with common multimorbidity clusters in Portugal, an exploratory cross-sectional study was conducted amongst GPs in Portugal using an anonymous online questionnaire. The instrument included clinical vignettes based on six common multimorbidity clusters, each presented in low- and high-severity versions. For each vignette, participants assessed one-year mortality risk using the Surprise Question, identified palliative care needs, and rated case complexity. Data were analysed using descriptive statistics. Forty GPs (67.5% specialists; 77.5% females) completed the survey (response rate of 13.3%); 45% reported having formal palliative care training. The most commonly observed finding was an elevated perception of palliative care needs associated with cluster severity. For instance, in the high-severity osteoarthritis vignette, 65% of physicians identified a need for palliative care. Notably, this was often independent of a short-term prognosis, as 67.5% of the same physicians would still be surprised by death within a year. Descriptive trends suggest that physicians with palliative care training were more likely to identify these needs, although statistical testing was not performed due to the exploratory nature and sample size of this pilot study. General practitioners’ perception of palliative care needs in multimorbidity is primarily triggered by high disease severity rather than the mere presence of chronic conditions. A nuanced understanding of palliative care beyond end-of-life prognostication exists but appears inconsistent. This exploratory study provides preliminary insights that warrant further investigation with larger samples.