BEYOND THE MDT MEET: Realising the Potential of Integrated Neighbourhood Teams (INTs)
The Fuller Stocktake has triggered work on INTs. They are seen as central to more integrated working, at the level of neighbourhood and focussed on complex patients. In my work** supporting primary care systems in developing their INTs, the ‘end point’ assumed is often the bringing professionals together into a Multi-Disciplinary Team (MDT) meet. But does this mean integrated working has been achieved? I don’t think so. To achieve integrated working at the level of neighbourhood we must go beyond the MDT meet.
Common assumptions about MDT working: What are we aiming for?
1) CONVENING TO ADVISE: The most problematic assumption. Bringing various professionals together to advise a lead professional on a complex case does not mean we have an integrated response to the person’s needs. The response to need remains just as fragmented.
2) CONVENING TO COORDINATE: Is this just a problem of coordination? Once people have an MDT meet and agreed actions does this mean we are guaranteed to be effective in meeting needs? Does it solve the fragmentation? I argue that much of the fragmentation remains, as it is driven by avoidably complex structures, fragmented budgets, measures, systems of accountability and narrow remits. Who is ultimately responsible for the actions of the team? Wouldn’t the coordination challenge be far easier if things were less fragmented in the first place?
3) UNITY OF EFFORT*: True integrated MDT working, that delivers the transformation primary care dearly needs, involves more fundamental change. This means systemically simplifying the response to need. Why are we so fragmented? Why are so many professionals involved? Why do we have competing remits and measurement for those involved?
When you study examples of transformational integration the common themes are collective accountability, greater flexibility to DO what matters (not just ASK what matters), the challenging of professional boundaries (leading to a simplified response that is easier to coordinate and achieves greater continuity), re-orientation of specialist support and most importantly a clear understanding of needs in the eyes of person we are trying to help.
In Summary: With INTs, and other integrated working, we will not realise the benefits we hope for if we just aim for the MDT meet or co-location. We need to go further. This means strategic work from ICBs to create the conditions for more integrated work to happen, and for organisations like PCNs to aim further.
We hope these pointers are useful.
What we do to help you
We can WORK WITH YOU directly on any of the things above, either hand-on to provide energy and support you and your organisation towards rapid change or just in a LIGHT TOUCH advisory role > contact@pcnacademy.org.uk
We also run INT Development programmes - see the dedicated page here