Key points

  • Better integration between health and social care services is a longstanding policy objective in England and other countries. Recent reforms to the NHS in England established 42 area-based integrated care systems (ICSs) to lead local efforts to develop more integrated models of care.
  • A common approach is the development of community-based multidisciplinary teams (MDTs), in which a mix of health and care professionals come together to plan and coordinate people’s care. Many MDTs are based around general practices and typically focus on care for adults with complex health and care needs. This briefing brings together evidence from Improvement Analytics Unit (IAU) evaluations of three MDTs and wider evidence to inform current efforts to develop integrated care in England.
  • Despite widespread policy support, evidence on the impact of community-based MDTs is mixed. Our three IAU evaluations found that MDTs did not reduce emergency hospital use – and may even have led to increases – at least in the short term. Our longer term evaluations of the broader programmes in which these teams were implemented found some evidence of reductions in emergency hospital use, but this took between 3 and 6 years. Wider evidence on the impact of community-based MDTs was limited and mixed – though some studies suggest broader integrated care interventions can improve patient satisfaction, perceived quality of care and access.
  • MDTs are not new and are widely thought to be needed to deliver high-quality care for people with chronic conditions. There could be several explanations for lack of clear evidence on impact – including unrealistic assumptions about MDTs and challenges in evaluating impact. The effect of MDTs also depends on many factors, including team resources and skills, staff engagement, IT resources, access to data, population characteristics and the broader context, such as local community services and overall levels of investment.
  • To realise the potential of MDTs, local implementation needs to be carefully planned and supported by ongoing monitoring and evaluation. We make four recommendations:
  1. Develop a clear, evidence-informed ‘logic model’ (or ‘theory of change’) for how service changes are expected to lead to improvements in care. This will help identify the support needed to make MDTs work and set meaningful goals.
  2. Collect data on key aspects of the logic model as part of the implementation of MDTs. This should include resource inputs, activities and outcomes that can be accessed in a timely way.
  3. Monitor inputs, activities and short- and medium-term outputs. This can provide early indications of whether the MDT is working as intended and identify opportunities to learn and course-correct.
  4. Undertake robust evaluation to understand what works, for whom and in which contexts. This should include measures beyond emergency hospital use and reflect outcomes that matter to patients. Robust evaluation requires careful design, reliable data and resources – and input and support from both local and national decision makers.
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