Introduction

Better integration between health and social care is a longstanding policy objective in England. Recent NHS reforms divided the country into 42 area-based integrated care systems (ICSs), covering populations of around 500,000 to 3 million. ICSs are based on the idea that collaboration between the NHS, social care and others is needed to improve health and reduce health inequalities.

ICSs follow a long line of policy initiatives to encourage more integrated care in England – including integration ‘pilots’, ‘pioneers’, ‘vanguards’, and more. Similar reforms are being developed elsewhere in the UK, and other countries. And new policy initiatives continue to appear. Government published a further white paper on health and social care integration in England in 2021. A new programme of ‘integration frontrunners’ was also announced to help improve discharge for patients leaving hospital.

The rationale for developing more integrated care is clear. More people are living with multiple long-term conditions that require ongoing management and support, such as diabetes or depression. The prevalence of multimorbidity increases with age, but people in more deprived areas are at greater risk of having multiple health conditions and develop them earlier in their lives., Improving health and care for people with complex needs depends on a mix of services and professionals. Yet care is often fragmented and imbalanced towards treating illness in hospitals rather than preventing it further upstream. Over the past 20 years, there has been a major shift in the composition of NHS spend towards hospital care and away from other areas, despite policy goals to strengthen prevention and primary care.

What are multidisciplinary teams?

Integrated care is a broad concept and efforts to achieve it differ depending on the aims and context. A common approach is to develop multidisciplinary teams (MDTs), in which a mix of health and care professionals come together to plan and coordinate services for patients (Box 1). The intended rationale is that professionals care for patients in a more holistic way – they exchange information, make shared decisions and plan interventions to meet patients’ needs, contributing to better quality care.

Community-based MDTs have been a core component of recent efforts to integrate health and social care services in England, often introduced as part of broader programmes to improve the quality and efficiency of local services.,,,,, Greater MDT working is also a central part of the ambition for primary care networks (PCNs) in England, where GPs are expected to work alongside an expanded primary care team., ICSs are likely to pursue similar approaches – and national guidance for the new systems includes developing community-based MDTs., But introducing new models of care is challenging and may not deliver the benefits policymakers expect. If MDTs are to realise their potential, they need to be carefully designed and implemented, drawing on existing evidence and insights.,,

Box 1: Community-based MDTs

MDTs are teams of health and care professionals who plan and coordinate services for their patients. MDTs broadly aim to improve quality of services and identify opportunities to proactively address people’s health and care needs.

The make-up of MDTs varies depending on their aims and focus – and they might involve GPs, district nurses, social workers, mental health staff, staff from the voluntary, community and social enterprise sector, and other health and care professionals. Sometimes MDTs include case managers or care navigators to help coordinate services. Patients and their representatives (such as unpaid carers) may also be considered MDT members.

The functions of MDTs include exchanging information between health professionals, making joint decisions and facilitating access to services depending on patients’ needs. MDTs use a variety of approaches and interventions, such as risk-stratification tools to identify high-risk patients and care planning to help identify relevant services. MDTs operate in a variety of settings including hospitals, care homes and the community – and are not exclusive to health and social care.

In this briefing, we generally focus on community-based MDTs caring for people living at home. These MDTs might include primary care teams, social care staff and other staff from relevant services. Many are based around general practices and typically focus on care for adults with complex health and care needs – for example, with multiple long-term health conditions – or people living with frailty or at high risk of hospitalisation. Individuals may also be identified for support from MDTs due to social risk factors, such as social isolation or poor housing.

The MDTs evaluated by the IAU were structured teams that met regularly to plan the care of the individuals enrolled to their services (Box 2). Our review of the evidence used a broader definition of MDTs, focusing on MDTs involving at least one health care professional. See Appendix for more details.

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