Published: July 2018
Updated: December 2022
Published: July 2018
Multidisciplinary teams (MDTs) are central to achieving the vision of Integrated Care Systems (ICSs) as they are a structured forum in which practitioners from across health and social care can come together around the needs of individuals and communities. MDTs need to have a clear role and purpose, be well led and organised, have sufficient diversity of professions and disciplines, and be supported by an enabling infrastructure. MDTs must be pro-active in how they engage individuals and families in their discussions and decision making. MDTs should also connect with other services and teams in their neighbourhoods and place.
- Multidisciplinary teams (MDTs) can be an effective tool to facilitate collaboration between professionals and hence improve outcomes for people and communities.
- MDTs should proactively consider how to involve individuals and families to ensure that their views and interests are kept at the centre of decision making.
- Successful MDT working requires facilitative leadership, equality between members, encouragement of constructive challenge, and common access to information.
- Teams do not have to be co-located in the same premises to work successfully but opportunities to engage in person, alongside virtual meetings, help to build relationships between members.
- MDTs need a clear purpose and institutional support from their organisations and partnerships to be effective in the long term.
- A structured approach to gathering insights on the working and impact of the teams will support regular reviews and collective reflection on opportunities to improve team practice.
- MDTs should also consider how they can engage with other teams in their locality to support individuals with multiple health and social needs.
MDTs and integrated care
Integrated care requires professionals and practitioners from across different sectors to work together around the needs of people, their families and their communities. Not working together results in a poor experience of care, a wasting of resources, and can lead to individuals suffering harm or being exposed to abuse.
Teams which bring together the relevant professionals and practitioners can be an effective means to encourage better coordination of their work. MDTs have long been deployed within services for individuals with complex needs such as young people who have offended; people diagnosed with cancer; people with severe mental health issues; and people who are at risk of abuse or neglect. In more recent times, they are also being deployed for more diverse populations, such as those within a community at high risk of poor health and social outcomes, people being discharged from hospital, and older people living in residential care homes.
Common elements of MDTs include:
- An identified manager and/or practice leader who facilitates the work of the whole team.
- A single process to access the team with joint meetings to share insights and concerns.
- Shared electronic record of all contacts, assessments and interventions of team members with an individual and their family.
- A key worker system through which care for those with complex support packages is coordinated by a named team member.
- Diversity of professions and disciplines, including those from the Voluntary & Community Sector (VCS).
Individual: Someone who is accessing social or health care services or support due to their own or a family member’s needs.
Team: A group of identified individuals with a shared purpose for which they are mutually accountable, and which requires interaction between team members.
Professional: An individual who has the qualification and experience to undertake the role of a licensed profession.
Practitioner: An individual who has training and experience to undertake other direct care and support roles.
Discipline: A specialist field of practice or study within a profession and/or in academia.
Neighbourhoods: Local areas of often 30,000-50,000 people supported by primary care and their community partners.
Place: A larger geographic area which often includes 250,000-500,000 people such as a borough or county.
System: Usually larger geographies of about one million people which often cover multiple places.
Integrated care: Services working together to ensure people can plan their care to achieve the outcomes important to them.
What is hoped to be achieved by MDTs?
Based on practice and policy guidelines, there are a common set of objectives for what MDTs will achieve across different populations and circumstances:
- MDTs will enable professionals and practitioners from different backgrounds to communicate better each other’s roles, responsibility, and resources.
- MDTs will provide a shared identity and purpose that encourages team members to collaborate with each other.
- MDTs will lead to better communication and trust between team members and more holistic and person-centred practice.
- MDTs will lead to more person-centred care which recognises and addresses social and health inequalities.
- MDTs would help prevent errors in the delivery of care and therefore avoidance of related harm to individuals and their families.
- MDTs will result in resources being used more efficiently through reduced duplication, greater productivity, and more preventative care approaches.
- MDTs will mean professionals and practitioners are less isolated and so improve morale and reduce stress.
What is the evidence on MDTs?
- Better team working in mental health services increases job satisfaction (Huxley et al., 2011).
- Professionals with skills of working with adults being members of child safeguarding MDTs reduces the number of children taken into care and/or placed on child protection plans (Rodger et al., 2020).
- MDTs within cancer care have been shown to significantly increase survival rates for those suffering common types of cancer (Koco et al., 2021).
- National integrated care pilots in England including MDTs led to gradual reductions in the growth of people experiencing unplanned admissions to hospital but this impact took over five years to achieve (Lewis et al., 2021).
- MDTs in mental health in-patient settings which directly involved individuals within meetings did not enable them to influence major decisions. The individuals concerned did appreciate the opportunity to meet the wider care team and share their requests (Haines et al., 2018).
- There is limited research on how community-based MDTs involve individuals in their discussions. Professionals try to be person centred through sharing their insights, but this would be strengthened with more direct discussions with an individual before and after the MDT (Riste et al., 2018).
- MDTs within cancer services can last up to five hours and involve up to 27 professionals. However, on average only three professionals contributed discussions of an individual (Cancer UK, 2016).
MDTs were the most common approach used by Integrated Care and Support Pioneers. This national programme looked for the most ambitious and visionary local areas to drive forward health and social care integration at scale and pace.
An in-depth study of two Pioneer areas observed that added value of MDTs included the sharing of real-time information, professionals learning about the services, processes and decision making of other agencies, developing strategies to support people facing complex situations and risks, and providing peer support.
Issues that MDTs faced included arranging of suitable meeting spaces, accessing input from wider services such as substance misuse and housing, and overcoming challenges related to separate and unconnected electronic record systems. The research found that no one profession dominated discussions but did note that the VCS representatives were less able to engage (Douglas et al., 2022).
Alongside evidence from formal research studies, it is helpful to consider examples of best practice to understand how MDTs are being developed and coordinated within the current health and social care context. The following case examples were identified through SCIE’s direct engagement with local systems and through national health and social care networks.
What enables MDTs to work effectively?
The case studies demonstrate that local areas have been able to use MDTs to overcome many of the on-going challenges to integrated care through adopting innovative and flexible approaches. Building on their experience, and insights from wider research, the following factors can be identified as increasing the effectiveness of MDTs.
Clear purpose: MDTs need a defined role which is supported by team members. Their responsibilities must require interaction across professional and disciplinary boundaries.
Institutional support: MDTs benefit from public endorsement from local leaders of their place and neighbourhoods to provide legitimacy and wider recognition within the system. Practical support with digital infrastructure, shared records and integrated performance systems are also important enablers.
Team leadership: Leaders should generally be facilitative in their approach to encourage different contributions within the team but be ready to be more directional when necessary. An awareness of inter-professional dynamics and a willingness to challenge poor collaborative practice are important competences for team leaders.
Collaborative spaces: MDTs need supportive physical and/or virtual environments and dedicated time for their members to reflect on how the team is operating. These improve communication and strengthen constructive discussion between team members.
Person centred: There is a danger that teams become too inwardly focused on their own functioning. This can lead to people and their families feeling more, not less excluded, from discussions about their care. MDTs therefore need to ensure good communication with individuals about what is being discussed and genuine opportunities for them to contribute to decision-making.
Role diversity: The blend of professions and practitioners must reflect the needs of the population concerned. Processes to engage other specialist practitioners in MDT discussions when relevant will support more holistic working.
Outward-looking: MDTs need to engage with other teams and services in their local neighbourhood and place. This will enable more coordinated care and help the wider system to better understand the role and skills of the MDTs.
Evidence focused: Teams require timely and accurate evidence of their shared impact. Structured opportunities for teams to reflect on this evidence will strengthen their effectiveness.
Integrated care systems will rely on MDTs to encourage better collaboration between professions, disciplines and sectors within neighbourhoods and places. Such collaboration is central to both more coordinated and person-centred care and addressing health and social inequalities. Effective MDTS are dependent on a supportive environment and infrastructure, well-constructed and led teams, and members with the skills and confidence to engage constructively with other professionals.
Whilst some good examples of co-production exist in the development and improvement of MDT working, there is considerable opportunity to strengthen this aspect of how teams are planned and delivered. This will require ICSs to embed the four principles of co-production, ensure that MDTs have the necessary knowledge and support, and develop sufficient local capacity of expert facilitation. Co-production opportunities must also address potential power imbalances between people with lived experience and professionals and ensure that participation reflects local diversity of communities.
Further reading and resources
Analysis of recent developments of integrated care In England: Miller, R., Glasby, J., & Dickinson, H. (2021). Integrated Health and Social Care in England: Ten Years On. International Journal of Integrated Care.
Practical toolkit to support the developments of MDTs: Health Education England (2021) Working differently together: Progressing a one workforce approach.
Guide to how integrated care systems can strengthen co-production: Kings Fund (2021) Understanding integration: how to listen to and learn from people and communities.
Guidance to undertaking an MDT review: NHS England (2022) Multidisciplinary Team Review.
Briefing which outlines strengths-based approaches to leadership including within teams: SCIE (2022) Leadership in strengths-based social care.