Models of multidisciplinary working: international review

Introduction

The Scottish Government (SG) commissioned a review of models of multi-disciplinary team (MDT) working in rural primary care, to provide an international context and comparative information for the Remote and Rural General Practice Working Group, which is helping to deliver the recent Scottish General Practice contract in rural areas.

This review was informed by a scoping review of the academic literature on rural primary care conducted by Healthcare Improvement Scotland (HIS). This concluded that it is not possible to comprehensively summarise the findings as the evidence base for models of rural care was fairly piecemeal, comprising a variety of study types (although mainly case studies), aims, outcomes and geographical areas. The evidence suggests that decision makers should follow general principles of service design, adapting them to needs, as opposed to applying specific models to practice. Much of the evidence described in the HIS report relates to specific socioeconomic and geographic conditions associated with rurality in Australia and America, care must be taken when considering these research findings in the Scottish context.

There has been much progress already achieved over many years at the global level on health workforce through bodies such as the World Health Organisation (WHO), and those specialising in rural health, the World Organization of Family Doctors (WONCA).

For example, the Dublin Declaration on Human Resources for Health: Building the Health Workforce of the Future emphasized the fundamental importance of a competent, enabled and optimally organized and distributed health and social workforce, especially in rural and under-served areas, for the strengthening of health system performance and resilience.

In the Delhi Declaration, "Alma Ata revisited" WONCA recognised that

• primary health care in rural and other areas must be delivered by teams of health workers with a broad range of skills and levels working together in partnership with communities;
• teams of health workers must focus on delivering comprehensive care that responds to the needs of individuals, families and communities, moving away from a narrow medical model and siloed thinking.

And identified the following six key areas as priorities:

1. Equity and access to care

2. Rural proofing of policy

3. Health system development

4. Developing and educating a workforce fit for purpose

5. Realigning the research

6. People and communities

It was agreed that this review would take the form of interviews with key informants who have day to day experience of delivery of rural health, as this might be a more productive approach. It is being produced in parallel with a report on the key descriptors and challenges of remote and rural general practice in Scotland. This review is an attempt to provide pragmatic information about the current status of multi-disciplinary teams in rural areas across different jurisdictions, and hopefully provides learning points for policy makers in Scotland, and beyond.