Collaboration in primary care: the need to see the bigger picture

Abstract

The mantras of collaboration, teamwork, interdisciplinary learning, and education have been urged on primary healthcare teams for a very long time. In the UK, Spencer1 suggests that this advocacy goes back to the Dawson Report of 1920,2 but observes: ‘Nevertheless, although the PHCT [primary healthcare team] is widely advocated as the best means for delivering health care in the community, there are problems in realising this ambition.’ 1 Two papers in this issue illustrate the continuing nature of these teamwork problems.3,4 The papers are concerned with the delivery of palliative care services, but the issues they expose are those associated with interdisciplinary teamwork rather than being uniquely related to palliative care. It is accepted that to provide high quality preventive, curative, or rehabilitation care necessitates input from a range of healthcare and other practitioners. To provide such care requires effective communication between all contributors to the care of the individual or community. The basis effective overall communication starts from good communication within a profession. Effective communication then needs to extend to members of other professions and disciplines who form the immediate working team and, subsequently, to members of other teams or organisations. Communication is fundamental to effective teamworking. Focusing on primary care, we know that teamwork can be enhanced by: co-location; facilitated practice-based education; interprofessional learning; shared record systems; shared goals, plans, and activities; and possibly through shared management systems and remuneration.5–10 Fundamental to these approaches to the development of teamwork in primary health care is the idea that education, the organisation of services, and access to resources all need to be utilised to help facilitate and stimulate teamworking. Various approaches to education of practitioners in primary care have been used to develop teamwork. Thomas and colleagues in Liverpool in the 1980s …